my care guide ios appbucket.hl7.org/events/fhir/roundtable/2017/presentations/... · 2018. 10....

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.

mailto:[email protected]


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.

http://cds-hooks.org/

http://carekit.org/

http://carekit.org/

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

312/6/17

https://veteransaffairsuxguide.com/

https://veteransaffairsuxguide.com/practice-areas/user-personas/veteran-persona-meghan-post-911-female/

4VHA Human Factors Engineering (HFE) Veteran Personas

12/6/17

https://veteransaffairsuxguide.com/practice-areas/user-personas/

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


https://github.com/smart-on-fhir/Swift-SMART

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)

6

Care Plans app tab



clinFHIR Resource Graph for Meghan

712/6/17

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

8

Today app tab



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

912/6/17

http://cds-hooks.org/

http://hl7.org/fhir/plandefinition.html

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

10

My Guide app tab


https://github.com/DBCG/cqf-ruler

https://www.racgp.org.au/your-practice/guidelines/redbook/

https://oridashiquickhooksstu3.azurewebsites.net/cds/cds-services

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

11

Care Team app tab


My Care Guide app video demo

Updated videos available here: http://clinicalcloud.solutions/my-care-guide/



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



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

1412/6/17

http://wiki.hl7.org/index.php?title=201801_Care_Plan

https://github.com/clinical-cloud/sample-data

my care guide ios appbucket.hl7.org/events/fhir/roundtable/2017/presentations/... · 2018. 10....

Documents