This page is part of the Clinical Guidelines (v2.0.0-ballot: STU2 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 1.0.0. For a full list of available versions, see the Directory of published versions
HL7 Patient Care Work Group has developed and continue to improve on Care Plan and Care Coordination standards that can be used in evidence-based care planning and delivery of evidence-based care.
The HL7 standards include Care Plan Domain Analysis Model, Care Coordination Functional Model, and a number of FHIR resources such as Care Plan, Goals, Care Team.
Within the Care Plan standards, there are four cornerstone building blocks that are essential for evidence-based care planning and care delivery:
A goal is a defined outcome or condition to be achieved in the process of patient care. Goals include patient-defined over-arching goals (e.g., alleviation of health concerns, desired/intended positive outcomes from interventions, longevity, function, symptom management, comfort) and health concern-specific or intervention-specific goals to achieve desired outcomes.
Recommendations informs what can or should be done in specific situations to achieve the best health outcomes possible, individually or collectively. It offers a choice among different interventions or measures having an anticipated positive impact on health and implications for the use of resources.
Recommendations assist in informing decisions on whether to undertake specific interventions, clinical tests or public health measures, and on where and when to do so. Recommendations also help in the selection and prioritization across a range of potential interventions.
Order set - a standardized set of evidence-based orders for a certain medical condition. Well-designed standardized order sets assist in communicating best practices by integrating and coordinating care and services across levels of care and through multiple disciplines. Order sets provide evidence-based care and reduce variations and un-intentional oversight by enhancing workflow. They reduce human error and improve patient outcomes through adherence to evidence-based guidelines.