"Acceptance reviews capture understanding and agreement to adopt a proposal for health goals, interventional actions or the plan itself. E.g. Upon review of the goals and actions a care manager (e.g. nurse case manager, social worker, physical therapist, pharmacist), PCP, nurse and patient will indicate understanding and acceptance of the Care Plan. Acceptance reviews may be used to indicate a provider’s authorization to perform an intervention and another’s provider acknowledgement." - HL7 Care Plan Domain Analysis Model

This class documents an evaluation of whether the activities that were undertaken have helped the patient meet their health goal. This is in contrast to the Goal Review class, which is an assessment of progress made toward reaching a Goal of the Care Plan. In other words, the Goal Review class asks "did the patient make progress towards their goal?", while this ActivityOutcomeReview class asks "did what we did make a difference?" Note that the efficacy of the Activity towards achieving the Goal is not always knowable, rather one can only know whether the Goal was achieved or not, in which case this review class would simply not be created. However, in cases where the efficacy of the Activity towards achieving the Goal can be characterized, this class could be used to store such information. "An activity outcome review measures the result of individual implemented action (observational or interventional) against goal success criteria. The action outcome review might address only a subset of goal success criteria." - HL7 Care Plan Domain Analysis Model

An impediment which may reduce or block quality of care and/or increase cost, and which may hinder the achievement of the goal(s). "A barrier impacts specific interventions or other plan activities and may necessitate their modification. Barriers are situations outside the health care system which nonetheless reduce or block quality of care and also increase cost. Barrier may also impact on goals achievement if modifications to interventions cannot effectively overcome identified barriers." - HL7 Care Plan Domain Analysis Model.

A single action (treatment, procedure, or activity) designed to achieve an outcome for a diagnosis for which the clinician is accountable. Note that actions include the following categories: Assess/Monitor, Perform, Teach, Manage. "An intervention is a combination of program elements or strategies designed to produce behavior changes or improve health status among individuals or an entire population. interventions may include treatments and procedures, wellness activities, educational programs, new or stronger policies, improvements in the environment, or a health promotion campaign. Interventions that include multiple strategies are typically the most effective in producing desired and lasting change." - DoD/VA iEHR Care and Disease Management model. "Identifies a planned action to occur as part of the plan. For example, a medication to be used, lab tests to perform, self-monitoring, education, etc." - HL7 FHIR, CarePlan.activity Note that FHIR has an Activity and an activity Detail, but since there is a zero to one relationship between activity and detail, we kept the FHIM CareIntervention class as a single class, in keeping with the CarePlan DAM and the FHIM SME review.

This class represents a collection of Care Plan Episodes, each of which is a set of planned actions and goals for a Patient dealing with a given set of issues or concerns over an extended period of time. This Longitudinal Care Plan covers all Care Plans over the life of the Patient, including those that have been terminated because the underlying condition had been resolved. This construct is useful for patients who have long-term problems such as Downs Syndrome or diabetes, which will manifest in different sets of issues to be managed over the course of the patient’s life. Some organizations, including DoD and the VA view the "Care Plan" as a Longitudinal Care Plan – i.e., they consider the Care Plan to be a long-running collection of Care Plan Episodes, whereas other organizations may consider the "Care Plan" to refer to each episode. Organizations in the latter case could consider this class to have one and only one Care Plan Episode associated with it.

This class represents a set of planned actions and goals for a Patient dealing with a given set of issues or concerns. The set of problems being managed may be complex and intertwined, and the Care Plan Episode will likely cover an extended period of time. However, the Care Plan Episode differs from the longitudinal Care Plan in that the longitudinal Care Plan covers all Care Plans over the life of the Patient, including those that have been terminated because the underlying condition had been resolved. The Care Plan Episode is focused on the set of issues that is being managed over a particular period of time or for a particular condition. Note that the HL7 Care Plan DAM includes a confidentiality property that we do not model, as confidentiality is expected to be handled by constructs in the Security and Privacy domain. "The Plan captures the shared attributes for Care Plan, Plan of Care and Treatment Plan." - HL7 Care Plan Domain Analysis Model "Describes the intention of how one or more practitioners intend to deliver care for a particular patient, group or community for a period of time, possibly limited to care for a specific condition or set of conditions." - HL7 FHIR, CarePlan

A care plan guideline is a statement expressed by a professional organization in order to influence how care is delivered. A guideline is a "best practice" and may be driven by historic precidents and outcomes - adapted from the HL7 Care Plan Domain Analysis Model

"The Care Team includes all the people and organizations who plan to participate in the coordination and delivery of care for a patient." - HL7 FHIR, CareTeam

This class documents an interaction between two or more Care Team Members regarding the Care Plan for the patient. This is where the negotiation occurs between providers, or where the care team decides on a course of action during a periodic review. Note also that the care plan steward will likely be involved in such communications as a care team member. "Communication is ongoing during care coordination. Care team communications is what causes the unfolding of the plan as new participants join, propose actions, change goals, record interventions, review outcomes and assess effectiveness of individual actions and of the overall plan." - HL7 Care Plan Domain Analysis Model Note that the DAM has a "pertainsTo" property which "Links the communication to some clinical object which is the target of the communication". This property is of type clinical object, which the FHIM doesn't have at the moment. It could probably be linked to Observation in the future.

A set of Communications among individual Care Team Members as they coordinate their activities for the execution of the Care Plan. The current intent of this class is to provide a record of such communications. It is envisioned that this structure could be used in the future to record negotiations among Care Team Members (especially between members belonging to different organizations) as the Care Plan is formulated. The ability to negotiate between Care Team Members does not exist in an automated fashion today, but would be an important feature in future systems. "A conversation organizes individual communications in a meaningful manner for the benefit and understanding of care plan stakeholders." - HL7 Care Plan Domain Analysis Model

An assessment of progress made toward reaching a Goal of the Care Plan. For example, if the Goal is for the Patient to reduce their weight by 10 pounds by a certain date, an observation would be made on or near that date of the patient’s actual weight, and this weight compared to the goal weight. "Goal reviews reference multiple action outcomes reviews which support overall assessment of a HealthGoal." - HL7 Care Plan Domain Analysis Model

A desired future state, expressed as an Observation. Note that this class is a subtype of Observation, although this observation is for a future state. In other words, this is an Observation in a "Goal" mood (in HL7 V3 speak). The observation date would in this case be the target date of the success criterion, not the date that an actual observation was made. Note also that the value is an Any so it can handle textual goals (like “I want to walk my daughter down the aisle for her wedding”) as well as coded or structured goals such as “HbA1c below 7”. The latter kind of goal could potentially be tested against lab results in an automated fashion. "Defines criteria which must be met to determine goal achievement." - HL7 Care Plan Domain Analysis Model

An objective intended to be realized by the successful execution of the Care Plan. "A health goal specifies a future target or achievement towards which the effort of care planning and execution is directed. Goals represent concrete targets to reduce or eliminate concerns or risks. A Goal may exist in the absence of concerns or risks. For example, a patient may have a goal to improve their fitness level. The plan always has at least one goal." - HL7 Care Plan Domain Analysis Model. "Describes the intended objective(s) for a patient, group or organization care, for example, weight loss, restoring an activity of daily living, obtaining herd immunity via immunization, meeting a process improvement objective, etc." - HL7 FHIR, Goal Note that a goal might be constructed of sub-goals, which might each be associated with a single outcome. For example, a goal to loose 5 pounds per week over 6 weeks might spawn 6 child goals to loose 5 pounds in week 1, week 2, etc. Each child goal would be associated with one actual outcome (i.e., lost 4 pounds in week 1; lost 6 pounds in week 2, etc). Then the "parent" goal outcome could be the total (e.g., lost 28 pounds in 6 weeks).

"Plan reviews are performed at periodic intervals to assess the overall consistency, appropriateness, completeness and effectiveness of the plan. The plan review includes comprehensive review of all the goals." - HL7 Care Plan Domain Analysis Model.

"Successful execution of any plan requires resources. Plan activities indicate resources which must be allocated in preparation for implementation of the activity which uses the resources. The achievement of plan activities requires allocation of human, asset, consumable and service resources." - HL7 Care Plan Domain Analysis Model. Note that the HL7 DAM has three subtypes of Resource Allocation: Asset Allocation, Consumable Allocation, and Service Allocation, whereas the FHIM currently combines these. We may wish to split these subtypes out in the future.