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Announcements
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To hear an overview of the project visit the link here and to download our PowerPoint click MCC eCare Plan Overview 20200624 Final (1).pptx.
Overview
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Initiative ("MCC e-Care Plan Project"), a joint project between the Agency for Healthcare Research and Quality (AHRQ) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). To return to the project landing page, visit ecareplan.ahrq.gov. Project ObjectivesThe MCC e-Care Plan Project aims to: - Promote the interoperable collection, use, and sharing of comprehensive, person-centered health and social data across settings;
- Facilitate coordinated, person-centered care planning approaches that integrate the full care team (including the patient) across settings; and
- Build data capacity to conduct pragmatic Patient Centered Outcomes Research (PCOR).
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Project Purpose
The Development of a SMART on FHIR e-Care Plan application, implementation guide and clinical information models for persons with multiple chronic conditions.
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Project Objectives
- Develop and test a SMART on FHIR e-care plan application
- Create clinical information models (CIM) using existing CKD data elements & standards
- Develop e-care plan application and implementation guide (IG) for point of care data review/entry
- Implement and evaluate the e-care plan application in diverse clinical settings in patients with MCC, including CKD
- Establish an e-care plan repository and development collaborative
- Expand the draft e-care plan application and IG to include cardiovascular disease (CVD), type 2 diabetes, chronic pain, and long COVID
- Expand the CKD data elements and CIMs to consider additional conditions
- Revise e-care plan application and IG to incorporate expanded DESS and pilot test feedback.
- Disseminate all project deliverable through open source channels
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HL7 Patient Care Work Group MeetingsAll upcoming MCC eCare plan HL7 work group meeting dates and information can be found here. To get the information from the June 24, 2020 stakeholder kick-off please follow the link here.
Testing OpportunitiesUpcoming HL7 FHIR IG testing tracks - September 2022 Connectathon
Previous HL7 FHIR IG testing tracks
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Project Deliverable Timeline
| Deliverable | Description | Expected Start | Expected End | Status | Link |
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| MCC Clinical Information Model for CKD | Clinical concept with identified and specified data elements, attributes, vocabularies, and FHIR mappings that will enable standardized transfer of CKD data across health settings | Q4 2019 | Q2 2020 | Complete | | | MCC Clinical Information Model for CVD, T2D, and OUD | Clinical concept with identified and specified data elements, attributes, vocabularies and FHIR mappings that will enable standardized transfer of CVD, T2D, OUD data across health settings | Q2 2021 | Q3 2021 | Complete | | | Data elements for long COVID | Clinical concept with identified and specified data elements, attributes, vocabularies and FHIR mappings that will enable standardized transfer of long COVID data across health settings | Q4 2021 | Q2 2022 |
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| | SMART on FHIR App | An open-source clinician and patient facing SMART on FHIR-based e-care plan application for managing persons with MCC | Q2 2020 | Q3 2021 | Completed (iterations may take place based on pilot feedback) | | | Pilot Lessons Learned | A report that documents the results from testing the SMART on FHIR application including lessons learned and recommended app updates. | Q2 2021 | Q3 2022 | In progress | Link will be posted at a future date | | Implementation Guide | An HL7 implementation guide for MCC starting with CKD value set | Q2 2020 | Q3 |
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Upcoming HL7 FHIR IG testing tracks
- September 2022 Care Planning Track
Previous HL7 FHIR IG testing tracks
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May 2022 Care Planning Track: 2022-05 Care Planning Track
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MCC Project Timeline
2021-2024 Roadmap
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