Using FHIR Plan Definition
- Sean Muir
Per the specification
The process of applying a PlanDefinition to a particular context typically produces request resources representing the actions that should be performed, typically grouped within a CarePlan and/or RequestGroup to capture relationships between the resulting request resources.
This pattern of “apply” results in the plan definition being a scripting language/procedural methodology
(The specification is not descriptive on multiple “apply” - if you apply the same plan definition twice is the expectation that you create a new care plan or update the existing)
So to implement the following “care management” the “plan definition” apply method will result in a “care plan”
In order to perfect this process we will need to create the target care plan and work backwards
This is probably something to expand upon and note higher in the space
One difference between the FHIR “solution” and the BPM+ “solution” is that the definition and processing aspects are separated while in the BPM+ “solution” the definition and processing are tightly bound.
In other words - the lifecycle and relationship between a plan definition and a resulting care plan are not bound. The relationship is the notion of the apply against a patient at a point in time against the plan definition. The plan definition and care plans continue on different lifecycles and can be updated and modified as needed. One concern is that the resulting “care plan” needs to possible anticipate all changes to the patient status making reducing the benefit of this separation.
The BPM+ solution the definition and processing are tightly bound - when the equivalent of an “apply” is done - there is a “instance” of the process definition created and executed. The approach limits if not eliminates the ability to modify a processes instance “on the fly” so to speak.
As per the above observation - using FHIR plan definition
what is the best practice for the following pathway ?
one plan definition that creates a comprehensive care plan
or three plan definitions that are applied at certain times and conditions
plan def one - has high bp - not on drugs results in order set of lifestyle actions
plan def two - has high bp and lifestyle did not work results in order set of particular drug based on stage and compelling indications
plan def three - has high bp - drugs not effective - “optimize”
Initial draft structure of plan definition
{
"resourceType": "PlanDefinition",
"title": "Hypertension Management",
"goal": [
{
"description": {
"text": "Lifestyle Modifications"
}
},
{
"description": {
"text": "Lose-Weight"
}
},
{
"description": {
"text": "DASH-Diet"
}
},
{
"description": {
"text": "Dietary-sodium-reduction"
}
},
{
"description": {
"text": "Physical-activity"
}
},
{
"description": {
"text": "Moderation-of-alcohol-consumption"
}
},
{
"description": {
"text": "Control-Hypertension"
}
}
],
"action": [
{
"title": "Has Hypertension",
"goalId": [
"Control-Hypertension"
],
"condition": [
{
"kind": "applicability",
"expression": {
"description": "Has Hypertension",
"language": "text"
}
}
],
"action": [
{
"description": "Lifestyle Modifications",
"goalId": [
"Lose-Weight",
"DASH-Diet",
"Dietary-sodium-reduction",
"Physical-activity",
"Moderation-of-alcohol-consumption"
],
"relatedAction": [
{
"actionId": "Has Hypertension",
"relationship": "after"
}
],
"selectionBehavior": "one-or-more",
"action": [
{
"title": "loseweight"
},
{
"title": "dashDiet"
},
{
"title": "sodium"
},
{
"title": "physical"
},
{
"title": "calcohol"
}
]
}
]
},
{
"title": "check bp",
"relatedAction": [
{
"actionId": "Lifestyle Modifications",
"relationship": "after"
}
],
"timingDuration": {
"value": 6,
"unit": "months"
},
"action": [
{
"title": "Compelling Indications Check",
"condition": [
{
"kind": "applicability",
"expression": {
"description": "BP to high",
"language": "text"
}
}
],
"action": [
{
"title": "Check Stage",
"condition": [
{
"kind": "applicability",
"expression": {
"description": "No Compelling",
"language": "text"
}
}
],
"action": [
{
"title": "Administer stage1 Drugs",
"condition": [
{
"kind": "applicability",
"expression": {
"description": "Stage is 1",
"language": "text"
}
}
]
},
{
"title": "Administer stage2 Drugs",
"condition": [
{
"kind": "applicability",
"expression": {
"description": "Stage is 2",
"language": "text"
}
}
]
}
]
},
{
"title": "Administer Compelling Drugs",
"condition": [
{
"kind": "applicability",
"expression": {
"description": "Compelling",
"language": "text"
}
}
]
}
]
}
]
}
]
}