www.hl7.org | using standards to get to meaningful use: exchange basic records and meet early...
TRANSCRIPT
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www.hl7.org | www.healthstory.com
Using Standards to Get to Meaningful Use: Exchange
Basic Records and Meet Early Requirements
Kim Stavrinaki
sPresenters: Liora Alschuler, Alschuler Associates, LLC
Bob Dolin, MD, Semantically Yours, LLC
Facilitator: Joy Kuhl, Health Story Project
Wednesday, July 21, 2010
Welcome! Please note that your line is on mute due to the large number of participants
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www.hl7.org | www.healthstory.com
Agenda
Agenda review
Housekeeping
Purpose
Introductions
------------
Presentation
Dialogue with the speakers
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Housekeeping
Please enter your “audio pin”
Please use “Questions” tool for questions and comments
Please submit questions and comments at any time
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Audio and Slide Presentation
Posted online by end of week at www.healthstory.com
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Purpose
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INTRODUCTIONS
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www.hl7.org | www.healthstory.com
Liora Alschuler
Principal, Alschuler Associates, LLC
Health Story Executive Committee
Led project that produced design of first XML-based exchange specification for healthcare
Co-editor of HL7 CDA, CCD and many HL7 implementation guides that leverage the CCD templates
Founding member of Health Story and leads technical strategy and development
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www.hl7.org | www.healthstory.com
Bob Dolin, MD
Principal, Semantically Yours, LLC
Chair, HL7
15 years experience with interoperability standards
Co-editor of HL7 CDA, CCD and Using SNOMED CT in HL7 V3
Member of ONC HIT Standards Committee, Vocabulary Task Force
Co-chaired HITSP Foundations Committee
Prior member of SNOMED International Editorial Board
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www.hl7.org | www.healthstory.com
Agenda
Agenda review
Housekeeping
Purpose
Introductions
------------
Presentation
Dialogue with the speakers
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www.hl7.org | www.healthstory.com
Meaningful Use?
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Meaningful Use!
Image courtesy of M*Modal
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www.hl7.org | www.healthstory.com
Session Overview
Health Story interoperability strategy
How Health Story leads to meaningful use
What this means for you
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www.hl7.org | www.healthstory.com
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, MDNational Coordinator for HIT
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Meaningful Use ≈ Data Reuse
patient care
billing/claims
adjudication
research
quality reporting
clinical decisio
n suppor
t
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
ParticipantsAll Type | Arrendale Associates | BayScribe
Documentation Services Group | Healthline, Inc.
Broward Sheridan Technical Center | MD-IT
New England Medical Transcription | Sten-Tel, Inc.
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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EHR Repository
HIM Applications
Clinical Applications
SNOMED CT
Disease, DF-00000Metabolic Disease, D6-00000
Disorder of glucose metabolism, D6-50100
Diabetes Mellitus, DB-61000
Type 1, DB-61010
Insulin dependant type IA, DB-61020
Neonatal, DB75110
Carpenter Syndrome, DB-02324
Disorder of carbohydrate metabolism, D6-50000
Health Story: Incremental Interoperability
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www.hl7.org | www.healthstory.com
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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www.hl7.org | www.healthstory.com
Based on HL7 CDA
Clinical Document Architecture supports: Human readable document Machine-processable data (e.g. discrete
reportable transcription) Cross platform and application independent
Health Story Approach Standardize through ANSI SDO (HL7 ballot)
Support Meaningful Use
Minimum Optimum
• CDA header • Standard section codes
• Broad industry agreement on clinical content
• Reuse of entry-level templates• “Templated CDA”
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Health Story Documents
Blend between free form text and fully structured documentation that represent the thought process, and capture the clinical facts Health Story makes “discrete reportable transcription” work
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Minimal Document for Exchange
<recordTarget> <patientRole> ... <patient> <name> <given>Adam</given> <family>Everyman</family> </name> </patient> </patientRole></recordTarget>
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Achievable: Today
<component> <section> <templateId root="2.16.840.1.113883.10.20.2.8"/> <code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="46239-0" displayName="REASON FOR VISIT"/> <title>REASON FOR VISIT/CHIEF COMPLAINT</title> <text> <paragraph>Stomach ache.</paragraph> </text> </section></component>
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Achievable: Meaningful Use
<entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.33"/> <!-- Social history observation template --> <id extension="123456789" root="2.16.840.1.113883.19"/> <code codeSystem="2.16.840.1.113883.6.96" codeSystemName=”SNOMED” code="230056004" displayName="Cigarette smoking"/> <statusCode code="completed"/> <effectiveTime> <low value="1972"/> <high value="2000"/> </effectiveTime> <value xsi:type="ST">1 pack per day</value> </observation></entry>
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www.hl7.org | www.healthstory.com
Health Story and Meaningful Use
Required data is in clinical notes Physicians do not write summaries (CCR & CCD) Summary data is drawn from many sources, including clinical notes Some data may, increasingly, be direct-physician entered
Data required for Meaningful Use can be captured in clinical notes and integrated into the EHR Natural language processing: it’s real, it works, it’s available and it works
very well in the context of structured CDA templates Abstractors, computer assisted coding, transcription knowledge workers:
same workflow, altered coding focus
CDA templates ensure consistency, conformance
Template-driven dictation Standard templates give real-time feedback to dictation physicians
Ensure conformance, provide structured data
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Templated 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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“The key to intelligent
tinkering is to keep all the
parts.”Aldo Leopold
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Today’s Workflow
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Growing Use of Clinician EMR Interaction
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Evolving Dictation/Transcription
iPhone images courtesy of M*Modal
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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-tzuChinese 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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www.hl7.org | www.healthstory.com
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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www.hl7.org | www.healthstory.com
WHAT THIS MEANS FOR YOU
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Actionable Next Steps
Is your transcription supplier capable of producing an HL7 CDA document?
Is your EHR/document management system capable of receiving an HL7 CDA document?
Requirements:
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www.hl7.org | www.healthstory.com
Actionable Next Steps
Get involved in Health Story
Lead the industry
Weigh in on development priorities
Project is interested in tracking and highlighting implementations
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A physician’s practical need for fast and easy methods for creating clinical documentation
The enterprise need forstructured and codedinformation capture to support meaningful use
In Summary
Computer image courtesy of M*Modal
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www.hl7.org | www.healthstory.com
Agenda
Agenda review
Housekeeping
Purpose
Introductions
------------
Presentation
Dialogue with the speakers
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Q&A
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Contact Information
Bob Dolin, MD
Semantically Yours, LLC
Liora Alschuler
Alschuler Associates, LLC
Joy Kuhl
Health Story Project