Resource type: careplan

Description

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.

Elements

PathShortDefinitionComments
Healthcare plan for patient or groupDescribes 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.
identifierExternal Ids for this planBusiness identifiers assigned to this care plan by the performer or other systems which remain constant as the resource is updated and propagates from server to server.This is a business identifier, not a resource identifier (see [discussion](resource.html#identifiers)). It is best practice for the identifier to only appear on a single resource instance, however business practices may occasionally dictate that multiple resource instances with the same identifier can exist - possibly even with different resource types. For example, multiple Patient and a Person resource instance might share the same social insurance number.
instantiatesCanonicalInstantiates FHIR protocol or definitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.
instantiatesUriInstantiates external protocol or definitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan.This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
basedOnFulfills CarePlanA care plan that is fulfilled in whole or in part by this care plan.
replacesCarePlan replaced by this CarePlanCompleted or terminated care plan whose function is taken by this new care plan.The replacement could be because the initial care plan was immediately rejected (due to an issue) or because the previous care plan was completed, but the need for the action described by the care plan remains ongoing.
partOfPart of referenced CarePlanA larger care plan of which this particular care plan is a component or step.Each care plan is an independent request, such that having a care plan be part of another care plan can cause issues with cascading statuses. As such, this element is still being discussed.
statusdraft | active | suspended | completed | entered-in-error | cancelled | unknownIndicates whether the plan is currently being acted upon, represents future intentions or is now a historical record.The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the care plan. This element is labeled as a modifier because the status contains the code entered-in-error that marks the plan as not currently valid.
intentproposal | plan | order | optionIndicates the level of authority/intentionality associated with the care plan and where the care plan fits into the workflow chain.This element is labeled as a modifier because the intent alters when and how the resource is actually applicable.
categoryType of planIdentifies what "kind" of plan this is to support differentiation between multiple co-existing plans; e.g. "Home health", "psychiatric", "asthma", "disease management", "wellness plan", etc.There may be multiple axes of categorization and one plan may serve multiple purposes. In some cases, this may be redundant with references to CarePlan.concern.
titleHuman-friendly name for the care planHuman-friendly name for the care plan.
descriptionSummary of nature of planA description of the scope and nature of the plan.
subjectWho the care plan is forIdentifies the patient or group whose intended care is described by the plan.
encounterEncounter created as part ofThe Encounter during which this CarePlan was created or to which the creation of this record is tightly associated.This will typically be the encounter the event occurred within, but some activities may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter. CarePlan activities conducted as a result of the care plan may well occur as part of other encounters.
periodTime period plan coversIndicates when the plan did (or is intended to) come into effect and end.Any activities scheduled as part of the plan should be constrained to the specified period regardless of whether the activities are planned within a single encounter/episode or across multiple encounters/episodes (e.g. the longitudinal management of a chronic condition).
createdDate record was first recordedRepresents when this particular CarePlan record was created in the system, which is often a system-generated date.
authorWho is the designated responsible partyWhen populated, the author is responsible for the care plan. The care plan is attributed to the author.The author may also be a contributor. For example, an organization can be an author, but not listed as a contributor.
contributorWho provided the content of the care planIdentifies the individual(s) or organization who provided the contents of the care plan.Collaborative care plans may have multiple contributors.
careTeamWho's involved in plan?Identifies all people and organizations who are expected to be involved in the care envisioned by this plan.
addressesHealth issues this plan addressesIdentifies the conditions/problems/concerns/diagnoses/etc. whose management and/or mitigation are handled by this plan.When the diagnosis is related to an allergy or intolerance, the Condition and AllergyIntolerance resources can both be used. However, to be actionable for decision support, using Condition alone is not sufficient as the allergy or intolerance condition needs to be represented as an AllergyIntolerance.
supportingInfoInformation considered as part of planIdentifies portions of the patient's record that specifically influenced the formation of the plan. These might include comorbidities, recent procedures, limitations, recent assessments, etc.Use "concern" to identify specific conditions addressed by the care plan.
goalDesired outcome of planDescribes the intended objective(s) of carrying out the care plan.Goal can be achieving a particular change or merely maintaining a current state or even slowing a decline.
activityAction to occur as part of planIdentifies 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.
activity.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
activity.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
activity.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
activity.outcomeCodeableConceptResults of the activityIdentifies the outcome at the point when the status of the activity is assessed. For example, the outcome of an education activity could be patient understands (or not).Note that this should not duplicate the activity status (e.g. completed or in progress).
activity.outcomeReferenceAppointment, Encounter, Procedure, etc.Details of the outcome or action resulting from the activity. The reference to an "event" resource, such as Procedure or Encounter or Observation, is the result/outcome of the activity itself. The activity can be conveyed using CarePlan.activity.detail OR using the CarePlan.activity.reference (a reference to a “request” resource).The activity outcome is independent of the outcome of the related goal(s). For example, if the goal is to achieve a target body weight of 150 lbs and an activity is defined to diet, then the activity outcome could be calories consumed whereas the goal outcome is an observation for the actual body weight measured.
activity.progressComments about the activity status/progressNotes about the adherence/status/progress of the activity.This element should NOT be used to describe the activity to be performed - that occurs either within the resource pointed to by activity.detail.reference or in activity.detail.description.
activity.referenceActivity details defined in specific resourceThe details of the proposed activity represented in a specific resource.Standard extension exists ([resource-pertainsToGoal](extension-resource-pertainstogoal.html)) that allows goals to be referenced from any of the referenced resources in CarePlan.activity.reference. The goal should be visible when the resource referenced by CarePlan.activity.reference is viewed independently from the CarePlan. Requests that are pointed to by a CarePlan using this element should *not* point to this CarePlan using the "basedOn" element. i.e. Requests that are part of a CarePlan are not "based on" the CarePlan.
activity.detailIn-line definition of activityA simple summary of a planned activity suitable for a general care plan system (e.g. form driven) that doesn't know about specific resources such as procedure etc.
activity.detail.idUnique id for inter-element referencingUnique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
activity.detail.extensionAdditional content defined by implementationsMay be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
activity.detail.modifierExtensionExtensions that cannot be ignored even if unrecognizedMay be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
activity.detail.kindKind of resourceA description of the kind of resource the in-line definition of a care plan activity is representing. The CarePlan.activity.detail is an in-line definition when a resource is not referenced using CarePlan.activity.reference. For example, a MedicationRequest, a ServiceRequest, or a CommunicationRequest.
activity.detail.instantiatesCanonicalInstantiates FHIR protocol or definitionThe URL pointing to a FHIR-defined protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.
activity.detail.instantiatesUriInstantiates external protocol or definitionThe URL pointing to an externally maintained protocol, guideline, questionnaire or other definition that is adhered to in whole or in part by this CarePlan activity.This might be an HTML page, PDF, etc. or could just be a non-resolvable URI identifier.
activity.detail.codeDetail type of activityDetailed description of the type of planned activity; e.g. what lab test, what procedure, what kind of encounter.Tends to be less relevant for activities involving particular products. Codes should not convey negation - use "prohibited" instead.
activity.detail.reasonCodeWhy activity should be done or why activity was prohibitedProvides the rationale that drove the inclusion of this particular activity as part of the plan or the reason why the activity was prohibited.This could be a diagnosis code. If a full condition record exists or additional detail is needed, use reasonCondition instead.
activity.detail.reasonReferenceWhy activity is neededIndicates another resource, such as the health condition(s), whose existence justifies this request and drove the inclusion of this particular activity as part of the plan.Conditions can be identified at the activity level that are not identified as reasons for the overall plan.
activity.detail.goalGoals this activity relates toInternal reference that identifies the goals that this activity is intended to contribute towards meeting.
activity.detail.statusnot-started | scheduled | in-progress | on-hold | completed | cancelled | stopped | unknown | entered-in-errorIdentifies what progress is being made for the specific activity.Some aspects of status can be inferred based on the resources linked in actionTaken. Note that "status" is only as current as the plan was most recently updated. The unknown code is not to be used to convey other statuses. The unknown code should be used when one of the statuses applies, but the authoring system doesn't know the current state of the activity.
activity.detail.statusReasonReason for current statusProvides reason why the activity isn't yet started, is on hold, was cancelled, etc.Will generally not be present if status is "complete". Be sure to prompt to update this (or at least remove the existing value) if the status is changed.
activity.detail.doNotPerformIf true, activity is prohibiting actionIf true, indicates that the described activity is one that must NOT be engaged in when following the plan. If false, or missing, indicates that the described activity is one that should be engaged in when following the plan.This element is labeled as a modifier because it marks an activity as an activity that is not to be performed.
activity.detail.scheduled[x]When activity is to occurThe period, timing or frequency upon which the described activity is to occur.
activity.detail.locationWhere it should happenIdentifies the facility where the activity will occur; e.g. home, hospital, specific clinic, etc.May reference a specific clinical location or may identify a type of location.
activity.detail.performerWho will be responsible?Identifies who's expected to be involved in the activity.A performer MAY also be a participant in the care plan.
activity.detail.product[x]What is to be administered/suppliedIdentifies the food, drug or other product to be consumed or supplied in the activity.
activity.detail.dailyAmountHow to consume/day?Identifies the quantity expected to be consumed in a given day.
activity.detail.quantityHow much to administer/supply/consumeIdentifies the quantity expected to be supplied, administered or consumed by the subject.
activity.detail.descriptionExtra info describing activity to performThis provides a textual description of constraints on the intended activity occurrence, including relation to other activities. It may also include objectives, pre-conditions and end-conditions. Finally, it may convey specifics about the activity such as body site, method, route, etc.
noteComments about the planGeneral notes about the care plan not covered elsewhere.

Scope and Usage

CarePlan is one of the request resources in the FHIR workflow specification.

Care Plans are used in many areas of healthcare with a variety of scopes. They can be as simple as a general practitioner keeping track of when their patient is next due for a tetanus immunization through to a detailed plan for an oncology patient covering diet, chemotherapy, radiation, lab work and counseling with detailed timing relationships, pre-conditions and goals. They may be used in veterinary care or clinical research to describe the care of a herd or other collection of animals. In public health, they may describe education or immunization campaigns.

This resource takes an intermediate approach to complexity. It captures basic details about who is involved and what actions are intended without dealing in discrete data about dependencies and timing relationships. These can be supported where necessary using the extension mechanism.

The scope of care plans may vary widely. Examples include:

This resource can be used to represent both proposed plans (for example, recommendations from a decision support engine or returned as part of a consult report) as well as active plans. The nature of the plan is communicated by the status. Some systems may need to filter CarePlans to ensure that only appropriate plans are exposed via a given user interface.

Boundaries and Relationships

For simplicity's sake, CarePlan allows the inline definition of activities as part of a plan using the activity.detail element. However, activities can also be defined using references to the various "request" resources. These references could be to resources with a status of "planned" or to an active order. It is possible for planned activities to exist (e.g. appointments) without needing a CarePlan at all. CarePlans are used when there's a need to group activities, goals and/or participants together to provide some degree of context.

CarePlans can be tied to specific Conditions, however they can also be condition-independent and instead focused on a particular type of care (e.g. psychological, nutritional) or the care delivered by a particular practitioner or group of practitioners.

An ImmunizationRecommendation can be interpreted as a narrow type of CarePlan dealing only with immunization events. Where such information could appear in either resource, the immunization-specific resource is preferred.

CarePlans represent a specific plan instance for a particular patient or group. It is not intended to be used to define generic plans or protocols that are independent of a specific individual or group. CarePlan represents a specific intent, not a general definition. Protocols and order sets are supported through PlanDefinition.

Notes

The Provenance resource can be used for detailed review information, such as when the care plan was last reviewed and by whom.

Open Issues

Search Parameters

activity-codeDetail type of activityCarePlan.activity.detail.code
activity-dateSpecified date occurs within period specified by CarePlan.activity.detail.scheduled[x]CarePlan.activity.detail.scheduled
activity-referenceActivity details defined in specific resourceCarePlan.activity.reference
based-onFulfills CarePlanCarePlan.basedOn
care-teamWho's involved in plan?CarePlan.careTeam
categoryType of planCarePlan.category
conditionHealth issues this plan addressesCarePlan.addresses
encounterEncounter created as part ofCarePlan.encounter
goalDesired outcome of planCarePlan.goal
instantiates-canonicalInstantiates FHIR protocol or definitionCarePlan.instantiatesCanonical
instantiates-uriInstantiates external protocol or definitionCarePlan.instantiatesUri
intentproposal | plan | order | optionCarePlan.intent
part-ofPart of referenced CarePlanCarePlan.partOf
performerMatches if the practitioner is listed as a performer in any of the "simple" activities. (For performers of the detailed activities, chain through the activitydetail search parameter.)CarePlan.activity.detail.performer
replacesCarePlan replaced by this CarePlanCarePlan.replaces
statusdraft | active | suspended | completed | entered-in-error | cancelled | unknownCarePlan.status
subjectWho the care plan is forCarePlan.subject

Extension Definitions

These are extension definitions for this resource defined by the spec