Friday, July 16, 2021

HIMSS presentation on FHIR CarePlan

 My next speaking engagement is at HIMSS. This will be from the perspective of my employer By Light, as we have been the developer of the current Patient Portal at the VHA - My HealtheVet, and are the implementers of the original Blue Button. I work with the team on the transition to FHIR.

I am not physically going, as I am still very concerned about COVID-19, specifically Delta and whatever comes next. I trust that HIMSS is doing everything they can to provide a good experience, but the Virus does not care about the good works of HIMSS. Further the COVID-19 Vaccine Certificate they are recommending is thru CLEAR : CLEAR Health Pass Validation, and I don't trust CLEAR with my personal data. There are two other alternatives, but they are equally unclear. I am not disappointed, this is likely the only solution that is ready at scale today.  There are standards really close, although I am worried about all solutions.  It is also the likely solution you would have needed to use to fly to Vegas -- In AUGUST!!!

The details on my speaking engagement at virtual HIMSS are that it is about the opportunity that is coming (not yet here) enabled by FHIR and the CarePlan resource in FHIR. I am very excited about the opportunities of Care Plans. They will initially be used as workflow processes within a hospital encounter, but they have so much more to offer.

I think that Care Plans will really be valuable when

  1. The CarePlan actively engages the Patient. Giving the Patient tasks to accomplish. Enabling the Patient to have apps that know what the Patient should be doing, and recording what they do.
  2. The CarePlan enables care participants from outside the hospital system. Where the Patient can choose which physical therapy to use. When the Patient can choose which laboratory to use. All coordinated by a CarePlan
  3. The library CarePlan patterns (Plan Definitions) becomes a formally managed knowledge. The "best" pattern is picked using Clinical Decision Support and customized for the specifics of that Patient. With feedback loops that make the library better based on experiences of the Patients.
  4. Where the system gets mature enough that a Patient can declare their own Goals and intelligent systems aid them picking out a good Plan Definition from the Library, customizing it for their needs, helping them find a Care Team, and leading them to meeting that Goal.

The state of art is... unfortunately far from this. But I can feel it is just over the horizon. The main thing that will prevent this is "the businesses that are healthcare today". The patient will want and strive for this. The Clinicians (doctors, nurses, etc) will strive for this. I would even think that Payers may strive for this. Those that care about improving health will strive for this.


  1. John - I would add to your list of people who would strive for this the non-healthcare sector community based organizations that provide supports and services that ameliorate SDOH driven needs.

    Not to add to the scope but we really need to be thinking about that too, IMHO.

  2. That’s pretty interesting. I think there is a gap when it comes to how sequencing will relate to the vaccines as a travel rule.

  3. Great call out on the potential of Care Plans. BTW - is there an existing library of care plans in public domain that can serve as reference templates for common chronic conditions like managing diabetes, hypertension, etc.?

    I'm assuming people probably don't want to "prescribe" care plans due to liability, etc. -- but part of me thinks that care plans shouldn't really differ much (in baseline content/structure) for well-known common conditions, and if there was a library of FHIR care plan resources to represent best practices for caring for such conditions, that would provide a great reference template to incorporate into FHIR based apps. Could be a great open source project as well.