xShare Project CarePlan
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Care Plan Application overview

The application domain summarises the application-level interactions that can support future European adoption of Care Plans.

Scope of this version:

This version of the guide focuses on the content specification for Care Plans.

It defines the logical model, the implementable HL7 FHIR profile and the mapping between them.

Detailed exchange transitions, workflow orchestration, security patterns, API interactions and deployment architecture are outside the scope of this version, and when included, are provided only for informative purposes. For example, the interaction diagrams below are provided as illustrative examples for patient and health care professional applications.

Application Participants

The application view involves two primary user-facing applications: a patient-facing app and a health care professional app. Both interact with an EHR system that may also support health information exchange or order management capabilities.

Care Plan Application participantsCare Plan Application participants<<mobile>><<clinical>><<backend>>«mobile»Patient App«mobile»Patient App«clinical»HCP App«clinical»HCP App«backend»EHR-S«backend»EHR-SEHR/Order System(FHIR server)

The patient app supports access to the care plan and recording of patient-executed actions. The health care professional app supports patient identification, care plan creation, action recording, monitoring and updates. In both cases, the EHR system is the system of record for the exchanged Care Plan information.

Care Plan Actions Sequence

The following sequences describe possible application interactions around Care Plan access and update. They are not intended to define reference API choreography, or pretend to be exhaustive. For this version of the guide they just provide an example on how the content specification can be used in some application flows.

Patient App Actions Sequence

The patient sequence starts with authentication and identification of the patient and application context. The patient then searches for and retrieves the Care Plan from the EHR system. After viewing the plan, the patient may execute an assigned action and record the result in the patient app. The action record is then sent back to the EHR system so that the plan status, activity record or related outcome information can be updated where appropriate.

Patient AppPatient AppPatientPatient AppEHR-SPatientPatientPatient AppPatient AppEHR-SEHR-SPatient AppPatient AppPatient authentication and identification"Auth and Identification"Authenticates and identifiesValidate session and contextValidate session and contextCare plan search and retrieve"Care plan search and retrieve"Search care planQuery care planCare plan dataDisplay care planExecute and record action"Execute and record action"Execute care plan actionRecord action locallyUpdate care plan action recordRecord executed actionsopt[Update care plan based on executed actions]Update care plan

HCP App Actions Sequence

The health care professional sequence includes authentication, patient identification, care plan creation, action execution and monitoring. The HCP app may retrieve patient health data to support care plan definition or review, publish a new or updated Care Plan, record executed actions, and consult order or activity status when monitoring progress.

HCP AppHCP AppHCP AppHCP AppHealth Care ProfessionalHCP AppEHR-SHealth Care ProfessionalHealth Care ProfessionalHCP AppHCP AppEHR-SEHR-SHCP AppHCP AppHCP AppHCP AppHCP authentication and identification"Auth and Identification"Authenticates and identifiesValidate session and contextValidate session and contextPatient identification search"Patient identification search"Search patientQuery patient identityPatient identityDisplay patient matchCreate care plan"Create care plan"Start care plan creationopt[Consult patient health data]Retrieve patient health dataPatient health dataCreate care planPublish care planExecute and record action"Execute and record action"Execute care plan actionRecord action locallyUpdate care plan action recordRecord executed actionsopt[Update care plan based on executed actions]Update care planAssessment and follow up"Assessment and follow up"Assessment and follow upSearch care planCare plan dataopt[Consult patient health data]Retrieve patient health dataPatient health dataopt[Consult orders status]Query orders statusOrders statusDisplay care planEdit care planPublish care plan update

The diagrams assume that exchanged Care Plan content follows the data model and FHIR profile described in the content and technical sections of this guide.