When diagnosed with one chronic condition, patients are very often plagued with more healthcare issues that go beyond the challenges of their initial concern. Along with additional chronic conditions, which often follow, patients deal with cascading costs, and the need to work with multiple providers and healthcare organizations.
Driving solutions for comprehensive, person-centered care planning can increase safety, efficiency, continuity of care and care coordination for patients — and caregivers can benefit, too.
To address these challenging issues, Dave Carlson MBA, Ph.D., a standards-based solutions architect with BookZurman and founder of Clinical Cloud Solutions, is leading Fast Healthcare Interoperability Resources (HL7® FHIR® standard) for Chronic Care Planning and Management tracks at nationwide health informatics events.
Since 2007, Carlson's work has focused on HEALTH LEVEL SEVEN® (HL7®) data interoperability standards for the healthcare industry, primarily as a subject-matter expert to Veterans Health Administration (VHA) through BookZurman.
In the fall of 2018, Carlson led an expanded track at HL7®’s 19th FHIR® Connectathon in Baltimore, Maryland. This innovative track explored use of FHIR® standards for longitudinal care planning and standardization of clinical practice guidelines for chronic kidney disease (CKD) and similar chronic health conditions, with emphasis on coordination of care across multiple providers and organizations. Out of the past few years of care planning work, Carlson identified the need to lead a multi-organization project around chronic care management coordination.
“This project supports an open community for developing specifications and reference implementations that improve point-of-care planning and management for chronic health conditions. We're working toward solutions to address requirements for team-based care spanning multiple provider organizations and person-centered care planning with engagement by patients,” Carlson shared.
Kathleen Connor and Sean Muir, also subject-matter experts with BookZurman, were involved in the featured Connectathon track. Connor is co-chair of HL7® security and financial management working groups, and a security architect supporting the U.S. Department of Veterans Affairs (VA) Framework project. Muir is a health standards architect supporting the VA development team.
The first time a care planning and management track was featured at HL7, Carlson’s innovative track emphasized dynamic care management scenarios with care plans being created, accessed, and updated by care team members in real time, which were then used by patients and caregivers to review and perform care plan activities. The track monitored data flows between patients, care providers, specialists, home health care providers, telehealth providers, and family caregivers.
By understanding the data flow, Carlson and collaborative partners including Allscripts, Elsevier, InterSystems, Motive Medical Intelligence, Office of the National Coordinator for Health IT (ONC), Phillips Research, Veterans Health Administration (VHA), Perspecta, and others will focus on advancing the maturity of data interoperability standards for care planning and management.
This work includes advancing the definition of computable clinical protocols, and documenting industry best practices for improving care coordination using shared care plans and clinical decision support. These efforts will inform the development of more comprehensive implementation guides and profiles for care management based on FHIR® Release 3.
Carlson continues to share his extensive industry expertise by planning for a care coordination use case at the HIMMS19 Interoperability Showcase™, February 11 – 15, 2019, in Orlando, Florida.
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