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  1. FHIR Specification Feedback
  2. FHIR-39829

CarePlan.category:AssessPlan - code value="assess-plan" cardinality 1..1 should be downgraded

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    • Icon: Change Request Change Request
    • Resolution: Not Persuasive with Modification
    • Icon: Medium Medium
    • Multiple Chronic Condition Care Plan (FHIR)
    • 1.0.0-ballot [deprecated]
    • Patient Care
    • Multiple Chronic Care Condition Care Plan
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      1. We re-use the US Core Care Plan Resource which requires the slice of ASSSESS-PLAN on category to indicate that the Care Plan Profile in US Core meets the USCDI Data element of Assessment and Plan.
      2. You can have additional slices to further define categories
      3. A survey of vendors stated that despite the required slice, they WILL implment the US Core Profile For their Care Plan implementations as opposed to the base resource AND to meet the USCDI ASSESS-PLAN data element which is our main driver
      4. Of note is that US Core is relaxing the Narrative Text Requirement to MS and will allow generated text on 6.0.0
      5. US Core is also providing guidance  (see US Core Jiras wrt planned changes and guidance on how Care Plans containing discrete fields can be used to meet Assessments and Plans by referencing from Care Plan the many places, modules and fields where assessment and plans exist in EHRs:
        1. FHIR-39902
        2. FHIR-40196
        3. FHIR-39827
      6. The Modification aspect is that we will be adopting the revised US Core 6.0.0 Care Plan resource when published
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      We re-use the US Core Care Plan Resource which requires the slice of ASSSESS-PLAN on category to indicate that the Care Plan Profile in US Core meets the USCDI Data element of Assessment and Plan. You can have additional slices to further define categories A survey of vendors stated that despite the required slice, they WILL implment the US Core Profile For their Care Plan implementations as opposed to the base resource AND to meet the USCDI ASSESS-PLAN data element which is our main driver Of note is that US Core is relaxing the Narrative Text Requirement to MS and will allow generated text on 6.0.0 US Core is also providing guidance  (see US Core Jiras wrt planned changes and guidance on how Care Plans containing discrete fields can be used to meet Assessments and Plans by referencing from Care Plan the many places, modules and fields where assessment and plans exist in EHRs: FHIR-39902 FHIR-40196 FHIR-39827 The Modification aspect is that we will be adopting the revised US Core 6.0.0 Care Plan resource when published
    • Gay Dolin / Karen Bertodatti: 8-0-0
    • Enhancement
    • Compatible, substantive

    Description

      While CarePlan.category:AssessPlan definition is "Type of Plan", the fixed code.value = AssessPlan limits it to Assess-Plan:
      <valueCodeableConcept xmlns="http://hl7.org/fhir">
      <coding>
      <system value="http://hl7.org/fhir/us/core/CodeSystem/careplan-category"/>
      <code value="assess-plan"/>
      </coding>
      </valueCodeableConcept>
      IT is unclear why obligation of this slide is set to mandatory, i.e. cardinality (1..1)

      Assuming that the "assess-plan" value is based on the USCDI data class "Assessment and Plan of Treatment" - which is defined as:
      "Health professional’s conclusions and working assumptions that will guide treatment of the patient." (https://www.healthit.gov/isa/taxonomy/term/581/uscdi-v3)
      This definition narrowly casts Care Plan as artefact representing the "assessment" and the "plan of treatment" components of the care planning (which includes health concerns identification, health goals setting, care | management activities planning, implementation and outcome evaluations)

      While some "care plans" may be narrowly focused (e.g. in episodic care of acute conditions), many more care plans are complex and support full spectrum of care planning and delivery).
      The mandatory slice (cardinality 1..1) appears to compel all implementations to assert that all care plans will be at least of the Assessment and Plan of Treatment type.
      This design decision is highly undesirable.
      Suggestion:
      Relax CarePlan.category:AssessPlan cardinality to 0..1

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            chuscmi Stephen Chu
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            Dates

              Created:
              Updated:
              Resolved: