Experiences in the Development of Electronic Care Plans for the Management of Comorbidities

Recent studies have shown that care plans with comprehensive home interventions can be effective in the management of chronic patients. Evidence also exists about the importance of tailoring these care plans to patients, by integrating comorbidities. In this context, the development, implementation, outcome analysis, and reengineering of care plans adapted to particular patient groups earn relevance. We are concerned with the development and reengineering of electronic care plans dealing with comorbidities. Our hypothesis is that a library of reusable care plan components can facilitate these tasks. To confirm this hypothesis we have carried out an experiment consisting in developing a library of care plan components for the management of patients with COPD or CHF, and next building a care plan for stable COPD&CHF patients by (re)using these components. In this paper we report on this experiment.