© 2014 white paper: hit standards for him practices anna orlova, lisa spellman diana warner, harry...

© 2014

White Paper: HIT Standards for HIM Practices

Anna Orlova, Lisa Spellman Diana Warner, Harry Rhodes

Problem

Currently, it is unclear how information management (HIM) practices in healthcare organizations are supported by capabilities of health information systems (HIS) to carry out these practices.

It is also unclear if current IHE profiles support necessary HIS capabilities for HIM practices.

IHE Universe1. People – Profile Specifiers (vendors, professional

associations, HIS implementers)2. IHE Committees where the Profiles are specified3. IHE efforts are aimed to data/systems interoperability

in the healthcare domains(examples)– ITI– Radiology– Cardiology– Other

4. Health Information Systems (HIS) that implement IHE profiles

HIM Practices Universe1. People – HIM Professionals (coders, record managers, HIS

implementers, HIS users (MDs and other clinicians), data analysts)2. Healthcare Organizations where HIM activities are performed3. HIM Practices are aimed to the Clinical Documentation

Improvement (CDI)(examples)– Data coding– Clinical documentation (records) management (Data Capture,

Data/Record Quality Validation, Record Management (Matching, Maintenance, Compliance, Archiving, Retention, Disposition))

– Data use to inform/support clinical practice– Data analysis– eDiscovery

4. Health Information Systems - HIS - that support HIM practices

HIM and IHE Universes AmalgamationHealth Information Systems should support

HIM practices

HIM practices should inform IHE Profile Specifiers

Health Information Systems built based on the IHE Profiles should support HIM practices

HIM and IHE Universes Amalgamation

Examples of Current IHE Profiles That Support HIM Practices

IHE Universe – ITI XDS Profiles Family

Cross-Enterprise Document Sharing (XDS) Profiles Family enables a number of healthcare delivery organizations belonging to an XDS Affinity Domain (e.g., a community of care) to cooperate in the care of a patient by sharing clinical records in the form of documents as they proceed with their patients’ care delivery activities. This profile is based upon ebXML Registry standards and SOAP. It describes the configuration of an ebXML Registry in sufficient detail to support Cross Enterprise Document Sharing.

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross-Enterprise Document Sharing (XDS) Integration Profile .URL: http://ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol1.pdf

IHE Universe – Information Technology Infrastructure (ITI) Technical Framework

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL: http://ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol1.pdf

IHE Universe – Information Technology Infrastructure (ITI) Technical Framework

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). URL: http://ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_TF_Vol1.pdf

HIM

IHE Universe – ITI XDW ProfileThe Cross-Enterprise Document Workflow (XDW) Integration Profile

enables participants in a multi-organizational environment to manage and track the tasks related to patient-centric workflows as the systems hosting workflow management applications coordinate their activities for the health professionals and patients they support. XDW builds upon the sharing of health documents provided by other IHE profiles such as XDS, adding the means to associate documents conveying clinical facts to a patient-specific workflow. XDW provides a common interoperability infrastructure upon which a wide range of specific workflow definitions may be supported. It is designed to support the complexity of health services delivery with flexibility to adapt as workflows evolve.

Integrating the Healthcare Enterprise (IHE). Information Technology Infrastructure (ITI) Technical Framework (TF). Cross-Enterprise Document Workflow (XDW). T rial Implementation URL: http://ihe.net/uploadedFiles/Documents/ITI/IHE_ITI_Suppl_XDW.pdf

IHE Universe – ITI XDW Profile


IHE Universe – ITI XDW Profile


HIM

IHE Universe – Radiology DomainThe Scheduled Workflow (SWF) Integration Profile establishes the

continuity and integrity of basic departmental imaging data acquired in an environment where examinations are generally being ordered. It specifies a number of transactions that maintain the consistency of patient and ordering information as well as defining the scheduling and imaging acquisition procedure steps. This profile also makes it possible to determine whether images and other evidence objects associated with a particular performed procedure step have been stored (archived) and are available to enable subsequent workflow steps, such as reporting. It may also provide central coordination of the completion of processing and reporting steps as well as notification of appointments to the Order Placer.

Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: http://ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol1.pdf

IHE Universe – Radiology Domain


IHE Scheduled Workflow (SWF) Profile

IHE Universe – Radiology Domain


IHE Scheduled Workflow (SWF) Profile

HIM

IHE Universe – Cardiology Domain

The Evidence Documents Profile defines ways for data recorded in the course of carrying out a procedure step, such as observations, measurements, and results (i.e., evidence documents), to be output by devices, such as acquisition systems and other workstations; to be stored and managed by archival systems; and to be retrieved and presented or used by display and reporting systems. This allows detailed non-image information, such as measurements, CAD results, procedure logs, etc. to be made available as input to the process of generating a clinical Report, either as additional evidence for the reporting physician, or in some cases for selected items in the Evidence Document to be included in the report.

Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: hhttp://ihe.net/uploadedFiles/Documents/Cardiology/IHE_CARD_TF_Vol1.pdf


Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: http://ihe.net/uploadedFiles/Documents/Cardiology/IHE_CARD_TF_Vol1.pdf


Integrating the Healthcare Enterprise (IHE). Radiology Technical Framework (TF). Scheduled Workflow (SWF) Integration Profile. URL: http://ihe.net/uploadedFiles/Documents/Cardiology/IHE_CARD_TF_Vol1.pdf

HIM

HIM Universe

HIM Universe is Ruled by Information Governance

Information Governance (IG) in Healthcare

• Technology advances – devices, telemedicine, mobile, patient generated data

• Data and information growth• Systems* implemented without

Governance and without needed “rules of the road”** for functioning in digital environment

* EHRs, ERPs, other clinical and non-clinical systems**principles, standards, definitions, protocols, guidelines

TransformationUnderway

Source: D. Green. Presentation at Health Data Palooza, June 2014

“Recognized as a healthcare imperative, information governance (IG) establishes the policy-level rules, investment priorities and accountabilities for managing the lifecycle of information.”

Cohasset Associates | AHIMA 2014 “Information Governance in Healthcare – A Call to Adopt Information Governance Practices”. http://www.ahima.org/IGwhitepaper.

For healthcare, like other industries, adopting IG underscores the value of information as an asset essential for advancing the goals and priorities of the organization. In healthcare - information is necessary…

•for safe, quality and effective care of individuals,•for reducing per capita costs of healthcare which requires operational excellence, and•for improving the health of population(s)

Information management and control is an undeniable healthcare imperative.

Information Governance


http://www.ahima.org/IGwhitepaper

Information Governance in Healthcare: First Benchmarking Survey – White Paper

White paper available now:


Cohasset Associates | AHIMA 2014 “Information Governance in Healthcare – A Call to Adopt Information Governance Practices”. http://www.ahima.org/IGwhitepaper.





Information Governance in the US: Examples beyond HIPAA

K. Baldwin-Stried Reich. E-Discovery in Healthcare – A Crucial Role for HIM Professionals in the Information Governance Era. Presentation at ILHIMA Annual Meeting. Tinley Park IL, March 28, 2014

Information Governance: Examples

K. Baldwin-Stried Reich. E-Discovery in Healthcare – A Crucial Role for HIM Professionals in the Information Governance Era. Presentation at ILHIMA Annual Meeting. Tinley Park IL, March 28, 2014

The White Paper Objectives

1. Explain/model the relationship between HIM practices (clinical-HIM workflow, HIM activities checklist) and capabilities of HIS products to support these practices

2. Conduct a gap analysis between HIM practices and existing IHE and other HIT standards for HIS aimed to support HIM practices

3. Create the roadmap for the development of new IHE profiles to support HIM practices

4. Inform IHE development process by defining Profile Specifier checklist alligned with the HIM practices checklist

Efforts To Date

#=8 #=?

2014

AHIMA IG White Paper, 2014AHIMA HIM Principles Taskforce

Report (to be developed)

IG Principle

HIM Principles

Information Governance Principles*:

1.Accountability 2.Transparency3.Integrity4.Protection 5.Compliance 6.Availability7.Retention8.Disposition

*American Record Management Association (ARMA). Generally Accepted Record Management Principles. Information Governance Maturity Model. 2013

Needed Efforts

Needed Efforts- White Paper Scope

Use Cases

#=8 #=?

2014



IG Principle

HIM Principles




Use Cases

#=8 #=?

2014



IG Principle

HIM Principles




Use Case 1

Use Cases

#=8 #=?

2014



IG Principle

HIM Principles




Use Case 2

Use Case 1

Use Case 1: Standards for Record’s State(s)Medical records states from ARMA Model:

(6) Availability(7) Retention(8) Disposition

Activities1. Select one of these record states based on priorities (e.g.,

record lifecycle model, other)2. Develop HIM action checklist(s) by state(s)3. Conduct IHE and other HIT standards gap analysis for the

selected record state4. Develop a roadmap for IHE standards development by

record state

Use Case 2: Standards for State Attribute(s)Medical records states and states’ attributes from ARMA

Model: (6) Availability(7) Retention(8) Disposition

Activities1. Select an attribute(s) for a record’s state (e.g., protection, integrity)

based on priorities (e.g., lifecycle model, stakeholder value, other) 2. Model the attribute in the record lifecycle and information exchanges

between systems3. Conduct IHE and other HIT standards gap analysis for the selected

attribute(s)4. Develop a roadmap for IHE standards development by attribute (s)

(1) Accountability(2) Transparency(3) Integrity(4) Protection(5) Compliance

Systems

The White Paper will apply to a variety of HIS:• Electronic Health Record Systems (EHRs)• Laboratory Information Management Systems (LIMS)• Pharmacy• Public Health• Research• Personal Electronic Health Record Systems (PEHRs)

Note: Originally we will focus on EHRs

Systems: Record Lifecycle

*HL7 EHR Lifecycle Model Release 1, Draft Standard for Trial Use. 27 January 2008

Record Lifecycle Model*

Systems: Document Sharing/Exchange

HIE

System 2System 1

Record Building/Sharing Environment*Clinical Encounter Records/Documents Flow

Patient Registration

Chief Complaint Orders Test

ResultsDiagnosis &

Care Plan

IHE XDW,SWF,

Cardiology Profiles

CCD

Prescriptions

HIM PRACTICE

S*

HIM

HIM

HIM

HIM

CCD CCD CCD


Standards

1. AHIMA Information Governance Principles for Healthcare, September 2014

2. AHIMA First Information Governance Benchmarking White Paper, May 2014

1. Cohasset Associates | AHIMA 2014 Information Governance in Healthcare: Benchmarking White Paper. URL: www.ahima.org

2. AHIMA Information Governance Principles for Healthcare (IGPHC). URL: www.ahima.org

HIM Business Standards

http://www.ahima.org/

Standards


Record Lifecycle Model*

Standards

ISO Technical Committee (TC) 215 Health Informatics

Standards

IHE ITI

URL: http://ihe.net/Technical_Frameworks/#IT

StandardsIHE ITI 2014-2015 Development Cycle

URL: http://ihe.net/Technical_Frameworks/#IT

Discussed with Experts (by country)1. Trish Williams (Australia, IHE)2. Vincent McCauley (Australia, IHE)3. Grant Gillis (Canada, COACH)4. Mike Nusbaum (Canada, IHE)5. Don Newsham (Canada, JIC)6. Charles Parisot (France, GE, IHE)7. Jeremy Thorp (UK, NHS)8. Harry Solomon (USA, DICOM)

Commitment1. Two AHIMA Staff persons (Harry Rhodes and

Diana Warner)2. SMEs:

a. AHIMA Practice Councils, HIM Advisory Panel, HIM Standards Task Force

b. Healthcare Organizations (AHIMA alliance groups)

3. We need ITI Expert(s) to assist with modeling and ITI standards gap analysis such as Karen Witting, John Moehrke, Charles Parisot, Mike Nusbaum

© 2014 white paper: hit standards for him practices anna orlova, lisa spellman diana warner, harry...

Documents

healthcare enterprise

information management

performedhim practices

practices anna orlova

xds integration profile

clinical records

delivery activities

record management matching