my care guide ios appbucket.hl7.org/events/fhir/roundtable/2017/presentations/... · 2018. 10....
TRANSCRIPT
My Care Guide iOS app
Dave Carlson, [email protected]
Clinical Cloud Solutions, LLCDec 6, 2017
http://clinicalcloud.solutions/my-care-guide/
FHIR & flame logo are registered trademarks of Health Level Seven International. Reg. U.S. TM Office.
My Care Guide app components
My Health – Overview of your current medications, allergies, and assessments (FHIR)
My Guide – Suggestions and actionable recommendations from one or more Clinical Decision Support (CDS) services via CDS Hooks
Care Plans – Detailed content from your FHIR care plan(s) including health concerns addressed, goals, and planned activities.
Today – From your care plan(s), current scheduled activities for you to perform. The care activities are integrated with Apple CareKit™ and HealthKit frameworks.
Care Team – List of your care team members and how to contact them. Care teams are represented using the HL7 FHIR standard, and presented via the Apple CareKit™ app views.
212/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
User Centered Design
VHA Human Factors Engineering (HFE) has developed a suite of personas intended to aid in the development of usable and useful HIT that supports seamless care for Veterans.
– https://veteransaffairsuxguide.com
• Meghan’s persona (post 9/11 female Veteran)– Health Issues
• Depression, anxiety & PTSD• TBI with seizures• Headaches• Lower back/extremities pain• Weight management• Pregnancy
– Meghan’s HIT Needs• “Make it easy for me to send my provider information.”• “Help me with my appointments and don’t waste my time.” (time management)• Coordination with neurology and OB/GYN
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4VHA Human Factors Engineering (HFE) Veteran Personas
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HL7 FHIR® for Care Planning
• FHIR v3.0, SMART on FHIR app• Built on the excellent open source
Swift-SMART framework for iOS– OAuth2 & SMART launch framework– Complete FHIR v3.0 model support
• Developing additional iOS Swift frameworks for open source release– CDS Hooks client in Swift for iOS– FHIR care plan view controllers– Mapping between FHIR & Apple CareKit™
• All patient and care plan data are read from a FHIR v3 server
512/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Person Centered Care Planning
• Display one or more care plans from FHIR server(s)– Consolidated within app for
combined view of activities
• Summary– All Conditions & Goals
• Care Plan Detail– Health issues addressed by
selected plan– Goals for this plan– Plan activities (interventions)
• References to FHIR requests• In-line activities• Includes tasks assigned to
Patient (Meghan)
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Care Plans app tab
12/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
clinFHIR Resource Graph for Meghan
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HL7 FHIR® + Apple CareKit™
• FHIR care plan activities are mapped to CareKit™ activities, displayed using CareKit views
• Values entered into CareKit are also shared with Apple HealthKit™, and possibly with other apps
• Assessments entered into CareKit are written back to EHR as new FHIR Observations– Using appropriate LOINC codes
• Observations are then available for evaluation via CDS Hook services, advice shown in app– My Guide app tab
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Today app tab
12/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
CDS Hooks client in iOS Swift
Invoke a CDS Hooks Service that guides the app user toward fulfillment of a Care Plan's goals, or suggests additional activities based on clinical practice guidelines.• Evaluate progress toward care plan goals
– Invoke 'patient-view' hook on all configured CDS services– Query and analyze relevant Observations related to a Goal
target measure (e.g. blood glucose, weight, etc.)– Notify care team members when insufficient progress
• Recommend additions to care plan activities– CDS service uses FHIR PlanDefinition protocols for
preventive care or chronic condition management– Returns CDS Hook ‘suggestion’ cards
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CDS Hooks client in iOS Swift
• CDS ‘patient-view’ hook returns ‘cards’ to app, displayed in My Guide view– Information card (shown here)– Suggestion card– App link card
• Person/patient centered CDS guidance is work-in-progress– Using FHIR PlanDefinition and CQL logic– Suggestion cards for care plan activity updates– Using https://github.com/DBCG/cqf-ruler
• Preventive care practice guidelines– Australian guidelines for preventive activities in
general practice (Red Book), 9th edition– https://oridashiquickhooksstu3.azurewebsites.net/
cds/cds-services
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My Guide app tab
12/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Meghan’s Care Team
• FHIR CareTeam resource(s)
– Query FHIR server references from CarePlan resources
– Consolidated within app for combined view of members from several care plans/teams
• FHIR resources mapped to Apple CareKit care teams
– Displayed using CareKit UI views
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Care Team app tab
12/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
My Care Guide app video demo
Updated videos available here: http://clinicalcloud.solutions/my-care-guide/
1212/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Team Care Guide app for Care Providers
• Care Provider users
– Share care plans among all participants in a Care Team
– Review care plans for all patients they support
• Apple CareKit/HealthKit is applicable only to Patient users
– Eliminate Today tab, used by patients for plan activities
• All other app capabilities are designed using FHIR resources and services
1312/6/17 Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Copyright © 2017 Clinical Cloud Solutions, LLC. All rights reserved.
Join the HL7 Connectathon!
• HL7 FHIR Care Plan connectathon track, Jan 2018 in New Orleans– http://wiki.hl7.org/index.php?title=201801_Care_Plan
• Meghan’s care plan FHIR resources are available for testing
– https://github.com/clinical-cloud/sample-data
• FHIR PlanDefinition, ActivityDefinition & CQL– Care protocols defined using PlanDefinition, create CarePlan for a Patient
– PlanDefinition + CQL = CDS Hook services
• Integrate CDS for care planning via “cds-hooks” service
– Evaluate progress toward care plan goals
– Query and analyze Observations related to Goal target measure
• E.g. blood glucose, weight, etc.
– Suggest new or modified care plan activities
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