I wonder if the GP 'master care plan' is more like a 'care plan dashboard' rather than an actual care plan? With functions like 'show all overdue / suspended / etc etc'...
- thomas On 20/11/2014 17:25, Heather Leslie wrote: > Hi Karsten, > > I think in practice you will see a variety of care plans depending on the > context. > > The endocrinologist will be using a diabetes care plan for their care of the > patient, and likely not having access to, nor particularly interested in, > what other specialists might be scheduling. > > The cardiologist will be using a cardiology-protocol-based care plan, > probably developed in splendid isolation from the endocrinologist activities. > > The rehab specialist will be using a purpose-built care plan for the > patient's recovery from a knee replacement. > > However it will be critical that the GP or coordinating primary care provider > develop/need a single global care plan, (which can be separated out for the > different purposes, if needed) that provides an overview of all activities > that the patient requires - what is due, overdue, planned etc. This will > ensure that the blood glucose and renal function tests required by both the > endocrinologist and cardiologist iare coordinated, if clinically appropriate > and tests/appts not repeated unnecessarily. They will have access to a > 'master' plan that will detail all reviews/goals/test/appointments for each > 'specialty' plan and have the ability to coordinate the components to suit > the best interests of the patient as a whole - a care plan for the patient, > not just one per problem. > > The patient or the parent/caregiver will also benefit with being able to > schedule appointments/tests etc. > > And we will need to be able to break down that master care plan to see which > components belong with each problem, or are shared between problems, and for > context-based sharing with other health care providers. >
