Care management: Coordinate care plans and care teams

Concisely communicate the right information, at the right time, to the right people, to provide coordinated care to the patient. Easily create, personalize, and enable new care plans for patients, and also manage care team members.

Key capabilities for Care management include:

  • Care team: View and collaborate with care teams to provide the best care for the patient. For more information, see Use unified patient view.
  • Care plan: Create and assign care plans and automate adherence to improve care coordination for your patients.
  • Clinical timeline: See a concise, sequential, and interactive view of patient's clinical occurrences. For more information, see Use unified patient view.
  • Virtual clinic: Provide your care team members the ability to perform virtual appointments with patients.

To help providers create, personalize, and enable new care plans and manage care team members, the Care management app provides capabilities in three categories:

  • Administration for managing organizational data
  • Care management to support delivering care to patients
  • Clinical Data to manage medical information, such as allergies and medical records

Care management creates a model-driven app within Microsoft Power Platform to provide healthcare-specific capabilities as part of Microsoft Cloud for Healthcare. Learn more about how to deploy and configure Care management.

To access Care management, select Care management from your Microsoft Dynamics 365 home page after deployment.

Get started

Care management offers a get started experience that includes guided tours and links to feature documentation and learning paths. This experience helps you onboard new users and highlight new features to existing users. To learn how to enable early access features in Microsoft Cloud for Healthcare, see Enable preview features. Administrators can control whether or not this experience appears to end users.

The Get Started page offers feature tours and links to documentation.

Welcome screen in the get started experience for Care management.

It also shows you optional customizations you can make to Microsoft Cloud for Healthcare, along with additional resources to help with onboarding.

Optional customizations and resources in the get started experience for Care management.

Take a guided tour

The Get Started page offers several guided tours to help you start using Care management. Select the tour you want to take on the Get Started page.

Take a guided tour in Care management.

Your guided tour will begin.

Example guided tour in Care management.

Administration

Select items in the Administration section of the navigation pane to view high-level analytical dashboards, manage patients or practitioners, and manage medical organization accounts.

Health Analytics

The Health Analytics area has views to help you coordinate and manage care plans:

  • Care Plan Activities Dashboard includes actionable charts and data for care managers and coordinators.

    This dashboard includes charts for:

    • Number of active care plan activities by status
    • Past due activities by time range
    • Upcoming activities by time range

    Care Plan Activities Dashboard in Care management.

    All charts have updated controls, including Refresh, View Records, and Expand Chart.

    Updated controls in Care management dashboard charts.

    For more information about enabling early access features in Microsoft Cloud for Healthcare, see Enable preview features.

  • Care Coordinator Dashboard shows active care plan details, appointments, and a personalized timeline.

    Review active care plans with the Care Coordinator dashboard.

  • Care Plan Management lets you filter care plans by date, patient, and care provider, and shows plan activities and patient adherence.

    Review activities and adherence with Care Plan Management.

People: Patients and practitioners

In the People area, you can filter your view to see Active Patients or Active Practitioners, among others.

In Active Patients, select a patient and then select Edit. The Patient form opens and shows basic patient information, and also has links to the patient’s clinical data, the care team, and the healthcare activity timeline. You can customize this form to suit your patient care practices.

On the Patient form, select Related to see activities and categories you can select to display on the form.

People form.

For more information on the patient form, including the clinical timeline and care teams controls, go to Use unified patient view.

Organizations

In the Organizations area, select New to create an account for an organization. Select the arrow to choose the account type. On the Summary tab, enter an account name, and then fill in the information you want for the account. Select Save or Save & Close to save the account.

From the list of views, select the arrow, and then select the type of accounts to view. You can see Active Accounts or All Accounts, among others. Select a listed account and select an action on the command bar. Select Edit to open the account, and then select a tab on the heading bar. You can also select a listed account in the Account Name column to open the account directly.

Locations

In the Locations area, select New to create a new location record for a medical organization. On the General tab, enter a name for the location and fill in the information you want for the location. Select Save or Save & Close to save the location.

From the list of views, select the arrow, and then select the type of locations to view. From the list of location records, select a record and select a command on the command bar. Select Edit to open the location record. From an open location, select the Related tab to select a related activity or category to add as a tab on the form.

Care management

Within the Care management category, create and manage patient care plans, care plan activities, and care plan goals.

For a view of the improved care plan experience, go to Improved care plan experience.

Care plans

Care plans allow care providers to provide distinct actions that both patients and caregivers can perform in order to proactively help a patient achieve health goals. The care plan tool within Microsoft Cloud for Healthcare provides users with the ability to add care plans, and accompanying activities and goals, to a patient's record.

In the Care Plans area, select New to create a care plan. On the Plan details tab, enter a name for the plan and a status, and then fill in the information you want for the care plan. Select Save or Save & Close to save the care plan.

From the list of views, select the arrow, and then select the type of care plans to view. From the list of care plans, select a record and select a command on the command bar. Select Edit to open the care plan.

Care plan.

From within a care plan, you can add activities and the associated goals to the individual care plan. You can also select a care plan template, which allows you to use certain default portions of the care plan and the associated activities and goals.

Care plan goals.

Care plan activities

In the Care Plan Activities area, select New to create a care plan activity. On the General tab, enter a name and care plan goal for the care plan activity, and then select a status. Specify a start and end date for the activity, and then select an activity definition type. Fill in the information you want for the care plan activity. Select Save or Save & Close to save the care plan activity.

From the list of views, select the arrow, and then select a view such as Active Care Plan Activities. Select a listed record and select a command on the command bar. Select Edit to open the care plan activity.

Care plan activities.

Care plan goals

In the Care Plan Goals area, select New to create a care plan goal. On the General tab and Conflicts Tab, enter the required information for the care plan goal. Select Save or Save & Close to save the care plan goal.

From the list of views, select the arrow, and then select a view such as Active Care Plan Goals. Select a listed record and select a command on the command bar. Select Edit to open the care plan goal.

Care Plan Templates

In the Care Plan Templates area, you can create templates that will streamline the creation of a care plan. To create a new care plan template, select New on the command bar. Enter all necessary information and select Save. You can also add associated Care Plan Goal templates and Care Plan Activity templates in the Goals & Activities tab of a care plan.

Care plan template.

You can also import care plan templates directly into Microsoft Cloud for Healthcare. On the command bar, select Import Templates. This opens a dialog that allows you to import a care plan template.

Import templates.

Import care plan template.

Clinical data

Within the Clinical Data category, create and manage patient observations, care plan activities, patient procedures, and appointments.

Observations

In the Observations area, select New to create an observation. On the General tab, enter the owner of the observation and fill in the information you want for the observation. Select Save or Save & Close to save the observation.

From the list of views, select the arrow, and then select a view such as Active Observations or Inactive Observations. Select a listed observation and select a command on the command bar. Select Edit to open the observation.

Encounters

In the Encounters area, select New to create an encounter record. On the General tab, enter a name for the new encounter and fill in the information you want for the encounter. Select Save or Save & Close to save the encounter.

From the list of views, select the arrow, and then select a view such as Active Encounters or Inactive Encounters. Select a listed encounter record and select a command on the command bar. Select Edit to open the encounter record.

Encounters.

Procedures

In the Procedures area, select New to create a procedure record. On the General tab, enter a description for the new procedure and fill in the information you want for the procedure. Select Save or Save & Close to save the procedure.

From the list of views, select the arrow, and then select a view such as Active Procedures, Inactive Procedures, or Patient Details Active Procedures. Select a listed procedure record and select a command on the command bar. Select Edit to open the procedure record.

Appointments

From the Appointments area, select New to create an appointment. On the General tab, enter a subject for the appointment and fill in the information you want for the appointment. Select Save or Save & Close to save the appointment.

From the list of views, select the arrow, and then select a view such as My Open Appointments (EMR). Select a Due value to filter the appointments. Select a listed appointment and select a command on the command bar. Select Edit to open the appointment.

Appointments.

Virtual Clinic

Virtual Clinic allows users to access scheduled and instant visits that have been created within the Patient access portal or through Patient Scheduling within the Patient service center app. Virtual Clinic is a model-driven app that lets users perform the following actions:

  • View dashboards that provide a list of scheduled and instant virtual visits
  • Join virtual visits directly from within a dashboard
  • Access full appointment details in context of virtual visit
  • Access holistic patient view and embedded care management tools during virtual visit

Virtual Clinic timeline.

Virtual Clinic dashboards

The Virtual Clinic app provides two separate dashboards. These dashboards allow users to directly access scheduled or instant visits. Both dashboards use a custom code component created using the Power Apps component framework that provides a view into the virtual visits. These visits have been scheduled in either Patient access or within the scheduling functionality in Patient service center.

Scheduled Virtual Appointments dashboard

The Scheduled Virtual Appointments dashboard lets users view a list of scheduled visits. The dashboard view shows the start time, patient, practitioner, and appointment status. It offers a virtual appointment button that allows the user to join the visit.

Scheduled Virtual Appointments dashboard.

Within the list, the user can select the Join meeting button to enter the visit.

Important

  • The appointment must be in a status of "Booked" for the user to select it to enter the visit.

  • Your system administrator must have enabled patient insight cards for it to appear in Virtual Clinic dashboards. For prerequisites, how to enable the feature, and how to set it up, go to Configure patient insight cards.

Instant Virtual visits dashboard

The Instant Virtual visits dashboard lets users view a refreshed list of patients as they join the queue for a virtual appointment within the Patient access portal. The dashboard view shows the start time, patient, and appointment status. It offers a virtual appointment button that allows the user to join the visit.

Instant Virtual visits dashboard.

Within the list, the user can select the Join meeting button to enter the visit.

Important

  • The appointment must be in a status of "Booked" for the user to select it to enter the visit.

  • Your system administrator must have enabled patient insight cards for it to appear in Virtual Clinic dashboards. For prerequisites, how to enable the feature, and how to set it up, go to Configure patient insight cards.

Virtual appointments

Virtual Clinic uses the Appointment(EMR) entity as a baseline for the creation and allocation of appointments to caregivers. The appointments tab allows users to view a listing of "My Appointments", "Instant Virtual Appointments", and "Scheduled Virtual Appointments". Selecting an appointment will take you to the full appointment view.

Virtual appointment view.

Note

Users can also access virtual appointments by selecting the appointment from within the Instant Virtual visits dashboard or Scheduled Virtual Appointments dashboard.

From within an appointment record, the user can view comprehensive information regarding the appointment and associated patient. The following sections explain each part of the appointment form.

General tab

The General tab outlines information specific to the appointment. The information includes the anticipated start and end times for the appointment, the participant type, and a timeline section for creating notes during a visit. While in the appointment record itself, a user can select Join meeting on the command bar to join the appointment.

General tab join meeting.

Patient Information tab

The Patient Information tab provides a full view of a patient's clinical data. This tab includes a view into a patient's previous and upcoming appointments, allergies, conditions, medications, and procedures. If the user has sufficient rights, the user can add data directly to these sections as needed.

Patient's clinical data.

Virtual Appointment join experience

In Virtual Clinic, there are multiple ways to join a visit based on the preference of the caregiver. The dashboard and appointment records provide buttons that allow for the caregiver to join the appointment; however, the mode in which Microsoft Teams reacts varies based on the type of Teams client that the caregiver is using.

Join on Microsoft Teams desktop client

When joining from the Microsoft Teams desktop client, the Join meeting button will launch a full-sized Teams window. In order to contextually view the patient record while conversing with the patient, just slide the newly launched window to the side of the screen.

Note

For the best experience, use two monitors.

Join Microsoft Teams meeting within browser

Upon selecting the Join meeting button when using Microsoft Teams in a browser, the user might be prompted to select the method by which the user would like to join the meeting experience.

Teams join method.

For the best experience, continue using the browser. This will open a window directly within the browser. Upon selecting this option, Microsoft Teams will prompt the user to join the meeting.

Join meeting in browser.

After joining the meeting, select Teams in the left pane.

Use Teams in meeting.

This approach allows the user to directly converse with the patient while also being within the dashboard or the appointment or patient record.

Viewing patient appointment and care plan while in virtual meeting.

Improved care plan experience

Care plan creation and management are an integral part of care management. To simplify the process, the care plan control experience on the care management solution has been redesigned and simplified for the end user.

Update configuration settings

To view the updated care plan experience, update the configuration settings using the following steps:

  1. Open the Healthcare Administration app.

  2. Select the General tab under Administration settings.

  3. Set the value toggles to On for the Show updated care plans experience on patient record setting.

    A screenshot showing the healthcare administration app configuration settings.

Improved capabilities

Key improvements in capabilities for care management include:

  • Care plans: The improved care plan experience offers a new, simplified and optimized interface for performing all the care plan creation activities.

    To create a new care plan,

    1. Navigate to the patient's Care plans tab.
    2. Select New care plan and enter the details in the new care plan form.
    3. Select Save or Save & Close to save the care plan.

    A screenshot showing a view of the improved care plan creation process.

  • Care plan goals: With the improved experience, care plan goals can be viewed and created within the care plan interface.

    1. Expand the care plan.
    2. Select + New Goal to open a form to enter details for the care plan goal.
    3. Select Save or Save & Close to save the care plan goal.

    A screenshot showing a view of the improved care plan goal creation process.

  • Care plan activities: With the improved experience, care plan activities can be viewed and created within the care plan interface.

    1. Expand any goal under Goals and Activities.
    2. Select + Activity to open a form to enter details for the care plan activities.
    3. Select Save or Save & Close to save the care plan activity.

    A screenshot showing a view of the improved care plan activity creation process.

See also

What is Microsoft Cloud for Healthcare?
Basic navigation in a model-driven app
Use unified patient view
Deploy healthcare solutions
Configure healthcare solutions
Configure Virtual Clinic