Assessing Progress Toward the Vision of a Comprehensive, Shared Electronic Care Plan: Scoping Review

Jenna M. Norton, Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States.
Alex Ip, School of Medicine and Health Sciences, George Washington University, Washington, DC, United States.
Nicole Ruggiano, School of Social Work, University of Alabama, Tuscaloosa, AL, United States.
Tolulope Abidogun, Office of Clinical Research Support, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States.
Djibril Souleymane Camara, Public Health Informatics Fellowship Program, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, United States.
Helen Fu, Richard M Fairbanks School of Public Health, Center for Biomedical Informatics, Regenstrief Institute, Indiana University, Indianapolis, IN, United States.
Bat-Zion Hose, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadephia, PA, United States.
Saadia Miran, Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States.
Chun-Ju Hsiao, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, United States.
Jing Wang, College of Nursing, Florida State University, Tallahassee, FL, United States.
Arlene S. Bierman, Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality, Rockville, MD, United States.

Document Type

Journal Article

Publication Date

6-10-2022

Journal

Journal of medical Internet research

Volume

24

Issue

6

DOI

10.2196/36569

Keywords

care coordination; care plan; care planning; chronic condition; chronic disease; digital health; e-care; eHealth; electronic care; electronic care plan; electronic tools; healthcare data; multiple chronic conditions; multiple conditions

Abstract

BACKGROUND: Care plans are central to effective care delivery for people with multiple chronic conditions. But existing care plans-which typically are difficult to share across care settings and care team members-poorly serve people with multiple chronic conditions, who often receive care from numerous clinicians in multiple care settings. Comprehensive, shared electronic care (e-care) plans are dynamic electronic tools that facilitate care coordination and address the totality of health and social needs across care contexts. They have emerged as a potential way to improve care for individuals with multiple chronic conditions. OBJECTIVE: To review the landscape of e-care plans and care plan-related initiatives that could allow the creation of a comprehensive, shared e-care plan and inform a joint initiative by the National Institutes of Health and the Agency for Healthcare Research and Quality to develop e-care planning tools for people with multiple chronic conditions. METHODS: We conducted a scoping review, searching literature from 2015 to June 2020 using Scopus, Clinical Key, and PubMed; we also searched the gray literature. To identify initiatives potentially missing from this search, we interviewed expert informants. Relevant data were then identified and extracted in a structured format for data synthesis and analysis using an expanded typology of care plans adapted to our study context. The extracted data included (1) the perspective of the initiatives; (2) their scope, (3) network, and (4) context; (5) their use of open syntax standards; and (6) their use of open semantic standards. RESULTS: We identified 7 projects for e-care plans and 3 projects for health care data standards. Each project provided critical infrastructure that could be leveraged to promote the vision of a comprehensive, shared e-care plan. All the e-care plan projects supported both broad goals and specific behaviors; 1 project supported a network of professionals across clinical, community, and home-based networks; 4 projects included social determinants of health. Most projects specified an open syntax standard, but only 3 specified open semantic standards. CONCLUSIONS: A comprehensive, shared, interoperable e-care plan has the potential to greatly improve the coordination of care for individuals with multiple chronic conditions across multiple care settings. The need for such a plan is heightened in the wake of the ongoing COVID-19 pandemic. While none of the existing care plan projects meet all the criteria for an optimal e-care plan, they all provide critical infrastructure that can be leveraged as we advance toward the vision of a comprehensive, shared e-care plan. However, critical gaps must be addressed in order to achieve this vision.

Department

School of Medicine and Health Sciences Student Works

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