healthstory project overview - dictation to clinical data for ahdi
DESCRIPTION
Healthstory overview presented to AHDI at the ACE 2009 conference in Nashville, TNTRANSCRIPT
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Welcome!The Health Story Project
Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents
Kim Stavrinaki
s
AHDI Conference, July 2009Nick van Terheyden, MD, Chief Medical Officer, M*Modal
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Presentation Overview
Background: The Current Situation Enabling the EMR with the Missing Link A User Experience (GE/RISL) The Health Story Project Conclusion
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Background
The Current Situation
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Electronic Health Record Universe
Critical to the success of EHRs is to reconcile two opposing needs Enterprise need for
structured and coded information capture
Physician’s practical need for a fast and easy method for creating clinical notes.
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The Current Situation – Structured
Tedious manual process Time-consuming Documentation lacks expressiveness
of natural language Lack of Flexibility Poor user interface Cost
Fails to Meet Individual Physician Time vs. Benefit Test
Cultural resistance Oblivious to HIM Requirements Incomplete and Inadequate Semantic
Standards
Direct Data Entry: Structured and encoded information.
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The Current Situation
Transcription can be expensive Subject to longer turn-around times Clinical data lost, because documents
are neither structured nor encoded Majority of attested information is only
in the document Contains the detail and
comprehensive scope of patient information
Support human decision making Reimbursement is based on narrative
documentation Retains current workflow, favored by
physicians Interoperable Under utilized source of data for EMR
Dictation: Fast and easy, expressive.
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The Current Situation
High cost of documentation Cost of ownership and physician time vs. transcription cost
60% of the data lost to the EHR
Care process inefficiencies and impact on quality
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Enabling the EMR
The Missing Link in Information Capture in Healthcare
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Data Entry Time
The average physician spends 33 seconds dictating an establish office visit
92% of all office visits are established If the average physician sees 40 patients a day, total
dictation time of 30 minutes plus time to search for the data.
Using a traditional EHR application, the same number of patients would require 140 minutes of data entry time.
Physicians are not willing to spend an additional 90 minutes per day for data entry.
(40 X 92% x 33 seconds) + (40 x 8% x 125) = < 30 minutes per day
Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group
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What if you could continue to use narrative and dictation and at the same time increase usage of the EMR and make more records available for the
health information exchange?
Crossing the Chasm…
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Health Story Project Vision
Comprehensive electronic clinical records that tell a patient’s complete health story
All of the clinical information required for good patient care administration reporting and research
will be readily available electronically, including information from narrative documents
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Based on HL7 CDA
Clinical Document Architecture Requirements Human readable document
Must be presentable as a document Rendered version covers clinical information intended by the
author Can contain machine-processable data Cross platform and application independent Can be transformed with style sheets
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Adoption
Incremental adoption overcomes the “not me first” dilemma
Not dependent on recipient’s ability to receive or process
Reverse adoption (can encode headers of existing documents)
Non-proprietary Readable with any browser
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Accessible Clinical Data
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User ExperienceGE/RISL
Kim Stavrinakis
Sr. Manager, Product Definition, GE Healthcare
The Missing Link in Information Capture in Healthcare
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Key Workflows
Self Editing real time – read, proof, sign each exam batch mode - read multiple exams then sign via signature queue VR edits Option to send to Medical Editor during reporting process
Batch Option – dynamic combinations of workflow based on confidence models user based thresholds that determines how report is
returned/reviewed to signature queue preliminary/draft to signature queue transcriptionist then preliminary to signature queue
Transcriptionist – Medical Editor workflow
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Results Reporting Workflow
Dictation Report in conversational speaking
Edit Mode using local capture tool – can either type to correct or voice commands
Dictating the Procedure
When dictation is complete and EOL is
pushed
Report is returned ready
for edits
Data Center
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Results Reporting Workflow 2
Edit Mode using local capture tool – voice in selection between brackets
Voice in options for
brackets, sign report, add via
voice more dictation in the sections, then
sign
After final sign the report is
processed in the NLP
engine for learning
Data Center
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Results Reporting Batch Mode
Dictating the Procedure When
dictation is
complete
Report goes to Medical Editor or signature queue,
Radiologist moves on to next exam
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Radiology & Imaging Specialists (RIS) physician-owned twenty board-certified radiologists many sub-specialized live since November 12, 2008
Radiology Imaging of Lakeland Florida
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“You didn’t change the radiologists’ work, and that is what made it easy on me.”
David Marichal, CIO, Radiology and Imaging Spec. of Lakeland, FL
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Conversational Documentation
… transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs
EHR
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Results
VOC: flexibility is key
• full-time rads: 70% Medical Editor workflow/30% self-edit• part-time radiologists can use it in batch digital dictation mode
radiologist love not having to dictate accession #, name, signs/symptoms, etc…
quality of the engine is very good self-edit for stat exams has reduced # of calls
from the hospital
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The Health Story Project and Meaningful Clinical Documents
Kim Stavrinakis
Sr. Manager, Product Definition, GE Healthcare
The Missing Link in Information Capture in Healthcare
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Meaningful Clinical Documents vs. Text
Structured and encoded clinical content enables… pre-signature alerts, decision support, best documentation practices, multiple output formats, multi-media reporting, data mining
Implements HL7 CDA4CDT standard compliant document types
Increases quality of documentation
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Health Story Document Types
Implementation GuidesCompleted History & Physical Consultation Operative Report DICOM Imaging Reports
Upcoming Discharge Summary in progress through HL7 Billing and Reimbursement Requirements Progress Notes .PDF work with Adobe
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Project Members
Founders
Promoters
Participants
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Our Advocacy To Date
Participation in public comment periods NCVHS Hearing on Meaningful Use HHS Request for Input on Meaningful Use HITSP Request for Input on ARRA
Comments are posted on our site www.healthstory.com
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Our Advocacy Messages
Dictation is the documentation method of choice for 85% of physician providers
Standardization of dictated notes is an achievable step for providers; Standards are available today
The current EHR systems certification process does not include requirements for integration with dictated notes per available standards
The current draft definition of meaningful use focuses on recording clinical documentation in the EHR through data entry
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Our Advocacy Requests
Actions Requested: Require certified EHR systems to accept interfaced
data from dictation/transcription process per available Healthstory standards
Modify the definition of meaningful use to recognize use of certified EHR systems with the above capabilities
Assist in spreading the word about this avenue for getting important information into the EHR that allows physicians to continue dictating and that provides patients with comprehensive electronic records
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Conclusion
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Crossing the Chasm…Babel Must Go
Medical text “typed” from dictation has “no meaning” black marks on a page… info must be tagged as discrete data
elements in order to assign meaning Clinical documentation uses wide variety
of terms with same meaning…. and terms that sound the same that have
different meanings….. authors have a wide variety of styles, accents,
methods of dictation…
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Health Story…
Captures meaningful clinical documents Is the bridge between
free form narrative and expressive notes, and fully structured clinical data
Improves the quality of clinical documentation Generates semantically interoperable clinical
data that will solve the fundamental challenges with EMRs - allowing clinical
decision support, alerts, decision support, data mining enable interoperability, reporting, patient safety initiatives, PQRI
(pay for performance), PSI (patient safety indicators) and improve billing data capture
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Impact
Allows providers to maintain preferred workflow and documentation methods
Increases the value and usability of narrative documents
Accelerates the implementation of interoperable electronic health records
Allows reuse of information
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Getting Involved
Become an “Ambassador” We need a grass roots effort to help spread the word; Support
our advocacy messages You can help educate your employers, clients, etc. about Health
Story
Joint the Effort Varying membership levels, including individuals
Volunteer for a Project Currently developing data standards for discharge summary Participate in HL7 ballots on project draft standards
Encourage Implementation E.g. Include requirements for standards in transcription RFPs
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Membership Options and Benefits
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Q&A
Kim Stavrinakis
Sr. Manager, Product Definition, GE Healthcare
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Nick van Terheyden, MD, CMO, M*Modal
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