Use Case Repository
AS7_BUC1
Submitted by sfranconi on Tue, 09/10/2024 - 09:56
During 2024, patients Care Plans can be viewed on the Danish health portal Sundhed.dk by patients, relatives, and all health professionals. An evaluation of the sharing is planned. The Care Plans will also be available in the app “Mingle” (English: MyDoctor).
Regarding xShare the plan is to document to Danish use case for Care Plans in the EEHRxF and prepare a first draft for a X-Bundle for Care Plans.
Expressing the Care Plan in the EEHRxF and X-Bundle will be useful to validate how the specifications can be used regional, national and European. The work will also be used as a case to show how future national and cross border projects can be documented – from the initial ideas to full deployment.
The aim is to share the next version of Care Plans on national level in Denmark by using the EEHRxF.
The work will also consider how the xShare Yellow Button can be adopted. A possible first solution is to use the xShare Yellow Button, so the patients can download their own Care Plan and share with health professionals (e.g. specialist for a second opinion, multimorbidity management or social care) and/or informal carers so that family and friends can help them manage their condition.
The implementation cost of the xShare Yellow Button is not financed. The plan is to involve Danish vendors to submit a request for the xShare open call in 2025.
Document Version:
V1.0
Responsible party:
Denmark adoption site - add an email address
Source:
As-Is Situation:
The sharing will be done via the Danish National Infrastructure using a Danish profile HL7 CDA. The Regions' Salary and Tariff Board and the Practitioners' Organization entered into an agreement on implementation in the collective agreement period 2018-2020. With the agreement are allocated funds for technical development, dissemination, and operation of Care Plans.
Care Plans are intended to give patients a better overview of their treatment. Care Plans are maintained by the patient's own doctor and aims to contribute to strengthening the patient's self-care and control of their own illness.
Digital Care Plans have been developed and put into operation for 3 chronic disease areas (COPD, diabetes type 2 and heart failure). The Care Plans are available in all general practice medical systems in Denmark. By February 2024, 30.000 Care Plans are developed or updated every month.
The Care Plan steering board have in 2023 decided that the Care Plans shall be shared with the entire health care sector. The sharing will be done via the Danish National Infrastructure using a Danish profile HL7 CDA.
Currently available products/services and its vendors:
National Care Plan service, integrated to all GP EHR, Sharing via Danish National Infrastructure.
Which health-related standard does your organisation uses and its alignment to the EEHRxF?:
HL7 CDA for sharing Care Plans.
Actors/Users and their Roles:
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Ministry of the Interior and Health of Denmark |
Steering group and funds the project. |
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MedCom |
Project management and for the Care Plan project. Responsible for the Danish profile HL7 CDA (DK CPD). |
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The Danish Organization of General Practitioners |
Safeguards the professional and financial interests of general practitioners. Enters into collective agreements and agreements on behalf of the general practitioners. |
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MEDIQ A/S
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Technical project management of the Care Plan project. Assistant to MedCom in development of HL7 CDA (DK CPD). Assistant to the Danish Health Data Authority for sharing Care Plans from primary care via the national infrastructure. |
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Suppliers of EHR systems |
Implementing Care Plans in EHR systems for general practitioners. In Denmark we have 6 EHR systems used in primary care. |
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The Danish Health Data Authority |
Responsible for the National Infrastructure (XDS Document Sharing) and responsible for the Care Plan sharing project. |
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PLSP
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The General Practitioner Service Platform are responsible for sharing the Care Plans via the national infrastructure.
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Sundhed.dk
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The Danish Health Portal (Sundhe.dk) are responsible for portal where patient and health professional can search and view Care Plans.
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User Perspective:
The health care professionals in Denmark will not achieve benefits for using the EEHRxF and the X-Bundle. Also, they will not benefit from the xShare Yellow Button as access to a patient’s data is permitted by law and does not require consent from the patient.
When a Danish citizen travel in Europe the xShare Yellow Button may be useful, but this must be analysed and compared with the current situation where the patient can look-up his own health-data on his own mobile.
With the button the patients can download their own Care Plan and share the data content in a structured format which can be used for further analyses and learning on how to be healthier.
The Danish vison and expectation to the EEHRxF and the X-Bundles is that it can decrease the time for developing new eHealth services including national deployment. This process will indirect be a great advantage for the users – both health professionals and patients.
System Perspective:
At the moment, this is difficult to estimate as the EEHRxF and xShare Yellow Button is not described with enough details. However, if the EEHRxF and xShare Yellow Button will be accepted and adopted across Europe – the suppliers themselves will implement it.
Now this is difficult to estimate as the EEHRxF and xShare Yellow Button is not described with enough details. It is important to find technical solutions for the “receiver” of data shared with the xShare Yellow Button and in the EEHRxF format. Today’s standards (e.g.: CDA and FHIR) are complex and requires many resources to implement. Most of the standards are also regional or national profiles, which challenges a European implementation and cross border sharing of data.
It is a must that the EEHRxF is built by generic components and supported by applications to be used by the recipient so they can access the data.
Health Information Domain(s) - HIDs:
Care plan
Scenarios for the xShare Yellow Button:
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HIDs |
xShare Yellow Button basic functionality |
Maturity |
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Download |
One-time share |
Linked options |
Start TRL |
End TRL |
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Patient summary |
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Electronic prescription |
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Electronic dispensation |
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Medical image |
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Laboratory results |
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Discharge report |
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Telemonitoring |
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Care plan |
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X |
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1 |
6-7 |
National/regional strategy:
• National eHealth strategy to share more data from GP clinics.
• Strategy for further development/sharing of Care Plans 2023 +5 year.
Strategy towards EHDS:
Regarding EHDS Patient Summary is being implemented in 2024 and 2025 in Denmark.
At the moment no decisions regarding EHDS and Care Plans have been taken. This relation will be discussed during the xShare Project. MEDIQ will facilitate a process with the Danish Health Data Authorities and MedCom.
Business Goals/Benefits and KPIs:
The Yellow Button will allow patients to access their own Care Plans in a structured format (EEHRxF) so they can do own and more detailed analysis. The structured data will make it possible for a patient with diabetes to follow how food, medication, exercise and smoking will affect and control the disease.
Application:
Candidates are Sundhed.dk and Mingle app.
Data Preconditions:
Data for Care Plans is available. We need the EEHRxF and button specification to launch dialog with the vendors.
System Preconditions:
Same as data preconditions.
User Preconditions:
No identified precondition at the moment.
Trigger:
The patient presses the xShare Yellow Button in order to get access to own Care plan in a structured format (EEHRxF).
Challenges/Limitations:
• Resources for the implementation of the xShare Yellow Button and a clear description of the EEHRxF and the Button.
• By sharing: clinician is not allowed to persist patient data.
Involved stakeholders in the BUC definition:
• MedCom.
• Ministry of Health.
• Health Data Authority.
• GP Doctor association.
• Hospitals, municipalities, GP clinics (doctors, nurses, ...).
• Patients and relatives.
Application of pseudonymisation filters:
No
Basic Workflow:
All General Practitioner Clinic (appx. 1.700) have functionality to create and modify Care Plans for patients with COPD, diabetes type 2 and heart failures.
All relevant data for the Care Plans are synchronized to a central Care Plan database at PLSP. In April 2024 more than 300.000 patients have one or more Care Plans, worked out by their General Practitioner.
Care Plans for COPD, diabetes and heart failures was launched as a digital dialog tool between the patient and the doctor. However, in 2023 it was decided to connect the Care Plan database to the national infrastructure with the aim to give access to view content to all health care professionals and the patient’s relatives. To Care Plans are shared via a national XDS services and using a Danish HL7 CDA profile (DK CPD).
The existing sharing is not described in detail in this business use case.
The aim of the business use case is to give the patient and their relatives access to Care Plans in structured format (EEHRxF) via the xShare Yellow Button.
A patient can via button download and print a Care Plan. A new xShare Yellow Button will be developed which will download the Care Plan content to the patients PC or mobile.
This new functionality is planned to run in a pilot with appx. 100 patients. After the pilot the new functionalities will be evaluated.
Alternative Workflows:
N/A
