Here Comes One Billion Clinical Documents

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Oct 24, 2013 (4 years and 2 months ago)

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Get Ready EMRs and HIEs:

Here Comes One Billion Clinical
Documents


Kim Stavrinaki


s


Bob Dolin, MD, FACP, FACMI

Principal, Semantically Yours, LLC

Chair, Health Level Seven


Thursday, March 4, 2010

10:00
-
11:00 a.m.

HIMSS10 Annual Conference & Exhibition

Georgia World Conference Center

Atlanta, GA


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Conflict of Interest Disclosure

Bob Dolin, MD


Has no real or apparent

conflicts of interest to report.


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Meaningful Use?

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Meaningful Use!

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Session Overview


Health Story interoperability strategy


How Health Story leads to meaningful use


What this means for you


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HEALTH STORY
INTEROPERABILITY
STRATEGY

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What is Meaningful Use?

“Meaningful use, in
the long
-
term, is
when EHRs are
used by health
care providers to
improve patient
care, safety and
quality.”


David Blumenthal, MD

National Coordinator for HIT




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Meaningful Use ≈ Data Reuse

patient care

billing/claims
adjudication

research

quality reporting

clinical

decision
support

outcomes
analysis

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Meaningful Use ≈ Data Reuse

“If you can not
measure it,
you can not
improve it.”



Lord Kelvin (1824
-
1907)

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The Health Story Project


Non profit, industry alliance


Founded 2007


Associate Charter
Agreement: HL7


Sponsor HL7 standards for
flow of information between
narrative and EMR
systems


Member organizations
provide direction


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Health Story Members

Founding Members

Participants

All Type | Dictation Services Group | Healthline, Inc.

MD
-
IT | Sten
-
Tel, Inc. | Broward Sheridan Technical Center

Contributors

Aprima Software | Scribe Healthcare Technologies

Promoters

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Health Story: Guiding Principles

7. Use proven technology

6. Base strategy on existing standards

5. Minimize disruption to clinician workflow

4. Provide a glide path for incremental interoperability

3. Enable broad stakeholder engagement

2. Leverage current technology investments

1. Inclusive and open process

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Narrative

Text

HL7 CDA Structured
Documents

Coded Discrete
Data Elements

EHR
Repository

HIM

Applications

Clinical
Applications

SNOMED CT

Disease, DF
-
00000

Metabolic Disease, D6
-
00000

Disorder of glucose metabolism,
D6
-
50100

Diabetes Mellitus, DB
-
61000

Ty pe 1, DB
-
61010

Insulin dependant ty pe IA,
DB
-
61020

Neonatal,
DB75110

Carpenter Sy ndrome,
DB
-
02324

Disorder of carbohy drate
metabolism, D6
-
50000

Health Story: Incremental Interoperability

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HL7 Clinical Document Architecture



Health Story specifications
are based on HL7 CDA


CDA is “just right”


Single standard for entire
EHR is too broad


Multiple standards and/or
messages for each EHR
function may be too difficult to
implement

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Other benefits of CDA:


Normative HL7 standard since 2000


Widely implemented


Provides a gentle on
-
ramp to information
exchange



Provides

mechanism for inserting evidence
-
based medicine directly into the process of
care


Top down strategy lets you implement once
and reuse many times for new scenarios


HL7 Clinical Document Architecture

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CDA is the basis for ...


Consult Note


Continuity of Care Document


Diagnostic Imaging Report


Discharge Summary


Healthcare
-
associated Infections,
Public Health Case Reports


History and Physical


Operative Note


Personal Health Monitoring


Plan
-
2
-
Plan Personal Health
Record


Procedure Note


Quality Reporting Document


Minimum Data Set


Unstructured Documents



… and more …



HITSP/C28 Emergency Care
Summary


HITSP/C32
-

Summary Documents
Using HL7 CCD


HITSP/C38
-

Patient Level Quality
Data Document Using IHE

Medical Summary (XDS
-
MS)


HITSP/C48 Encounter Document
constructs


HITSP/C84 Consult and History &
Physical Note Document


HITSP/C78 Immunization Document


HITSP/C74 PHRM


HITSP/C62 Scanned document



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Today’s Workflow

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Growing Use of Clinician EMR Interaction

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Evolving Dictation/Transcription

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Path to Meaningful Use

“A journey of a
thousand miles
begins with a
single step.”



Lao
-
tzu,
The Way of Lao
-
tzu

Chinese philosopher (604 BX


531 BC)

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Health Story


Meaningful Use

Meaningful
Use

Health

Story Interoperability Strategy




Delivers common

clinical documents

to the point of care




Standardizing document types and sections today makes it easier
to agree on data

elements tomorrow




Incrementally adding key data elements into narrative is attractive
to clinicians




Partial

structuring facilitates natural language processing

Health Story’s path to Meaningful Use



Hit the ground running with basic CDA, to meet the needs of front line clinicians



Incrementally layer discrete data elements into CDA documents

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Incrementalism Works for the Internet

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Why Health Story?


HL7 Implementation
Guide for CDA R2:
Procedure Note


Sample: Endoscopy Report



Judy Logan


Associate Professor


Oregon Health & Science University

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WHAT THIS MEANS

FOR YOU

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Actionable Next Steps


Is your system
capable of producing
an HL7 CDA
document?



Requirements:






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A physician’s practical

need for fast and easy

methods for creating

clinical documentation

The enterprise need for

structured and coded

information capture to
support meaningful use

In Summary

Computer image courtesy of M*Modal

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Q&A

Bob Dolin, MD

bobdolin@gmail.com