Standardized Terminologies for EHRs

Meaningful Use of Standardized Terminology to Support the Electronic Health Record Karen A. Monsen Health Informatics New Zealand, Inc. 29 March 2010

Key Concepts
Electronic Health Records
Value
Meaningful Use

Meaningful Use
- Workflow
- Interoperability
- Exchange of health information
- Use of information
- - inform clinical decisions
- - evaluate performance
- - improve health care quality

Cornerstones of Meaningful Use
- Improve quality, safety, efficacy, and reduce health disparities
- Engage patients and families
- Improve care coordination
- Improve population and public health
- Ensure privacy and security protections

Getting to Meaningful Use
Selecting meaningful interface standards
- documentation of client health needs assessments
- documenting health care services
- documenting health outcomes

Interface Terminology Standards
- Clinical Care Classification
- International Classification of Nursing Practice
- NANDA International
- Nursing Interventions Classification
- Nursing Outcomes Classification
- Omaha System
- Peri-operative Nursing Data Set

University Of Minnesota
- Community focused research in home care, hospice, and public health
- Comparing data across systems and disciplines
Natural language processing studies
Data mining methods
- Longitudinal analysis of intervention patterns

Objectives
Analyze the relationship between interface terminologies and meaningful use
Review existing projects using the Omaha System in New Zealand
- Describe current Omaha System research examples related to New Zealand goals and projects

The Omaha System
- Exists in the public domain
- Readily incorporated into the EHR
- Congruent with
- - SNOMED CT ®
- - Logical Observation Identifiers, Names, and Codes (LOINC®)
- Registered by
- - Health Level Seven (HL7®)

The Omaha System is very simple, easy to understand and use, and is available in the public domain. There are only 42 problems 4 actions 75 content descriptors

The Omaha System “stores” data describing:
Problems
Signs/symptoms
Modifiers
Interventions
Outcomes
Knowledge
Behavior
Status

Use Stored Data for:: Reporting activity Evaluating programs Researching quality and effectiveness

Data are easy to sort and match
We can compare across systems
Compile across services
Aggregate across agencies
And analyze around the globe!
The Omaha System Organizes Data But can the Omaha System reflect the Aotearoa perspective?

Nursing Interventions as Capsicum Red = Teaching, guidance, and counseling Yellow = Treatments and procedures Orange = Case Management Green = Surveillance

Cultural Safety Communication with community resources Neighborhood/workplace safety Health care supervision Spirituality

Kaitiakitanga
Protecting and caring
Holistic perspective
Partnership between nurse and client
Flexibility describing needs and care

The Omaha System in New Zealand
- Royal New Zealand Plunket Society
- Midwifery and Maternity Provider Organisation
- Nurse Maude
- Help4U

Plunket
ensuring that New Zealand families have the best health outcomes from a continuous wellness framework commencing in early pregnancy and continuing until children are aged five years

Plunket Desired Data Fields
Caretaking/parenting 5 x
Communication with community resources 5
Growth and development 5 x
Skin 4
Mental health 3 x
Oral health 3
Postpartum 3 x
Residence 3 x
Substance use 3 x
Abuse 2 x
Circulation 2
Hearing 2
Income 2 x

Family Health Problems
“ Top Ten” consistent across agencies
Growth and development (ranked 1 and 2; n=67-1011)
Antepartum/postpartum (ranked 1, 2, 3, and 4; n=86-770)
Caretaking/parenting (ranked 2, 3, and 5; n=44-838)
Income (ranked 3, 4, 5, and 9; n=11-471)
Family planning (ranked 3, 4, and 6; n=47-625)
Mental health (ranked 5, 6, 7, and 8; n=22-280)
Residence (ranked 5, 7, and 10; n=3-296)
Abuse (ranked 6, 7, and 9; n=9-391)
Substance use (ranked 6, 8, and 10; n=13-175)
Neglect (ranked 8, 9, and 10; n=4-269)

Identified Priority Needs: Neglect and Substance Use
Poorest outcomes
Need better intervention strategies
Meaningful Use: - Improve quality, safety, efficacy, and reduce health disparities

MMPO
The Midwifery and Maternity Provider Organisation has a well developed information system that captures 450 unique assessments and outcomes.

MMPO Care Plan Issues

MMPO Care Plan Targets

Asthma Care Plans
Evidence based care disseminated through the EHR*
Improving health for
Individuals
http://omahasystemmn.org/Careplans/resp_cardiac_end/Washington_Asthma_Individual.pdf
Populations
http://omahasystemmn.org/Careplans/resp_cardiac_end/Washington_Asthma_Community.pdf
*Any EHR using the Omaha System for interface terminology

Best Practices Translation and Dissemination
Applies to any health problem or discipline
Meaningful use:

Nurse Maude
Nurse Maude is a community based health services provider with a staff of 218 nurse and 631 health care workers who offer extensive nursing and home care services. The Nurse Maude informatics team selected the Omaha System as the point of care terminology for gathering data to show outcomes of care.

Core Problems in Home Care

Proposed Pathways
Diabetes
Wounds/ulcers
Palliative
Bowel
Urinary
Dementia
IV therapy

Problem Focused Care
Comprehensive Bowel Care
Comprehensive Neuro-musculo-skeletal Care
Comprehensive Ostomy Care
Comprehensive Teaching about Wounds
Comprehensive Wound Care
Comprehensive Health Care Supervision
Bowel and Bladder Management
Comprehensive Bladder Care
Comprehensive Cardiovascular Management
Basic Bowel Care
Basic Neuro-musculo-skeletal Care
Basic Ostomy Care
Basic Teaching about Wounds
Basic Wound Care
Health Care Management
Teaching about Bowel and Bladder

An Architecture to Support Home Care Practice and Data Quality
Structuring health care assessment, delivery, and data collection
Meaningful use

Help4U Help4U collaborates closely with health care providers and systems and enhance communication between customers and the health care system.

Adding the Patient’s Voice
Enables new research from a perspective that is currently missing in health care

PHN’s voice: Intervention Tailoring
Younger, less often married, lower outcome ratings
Omaha System Problems addressed more frequently: Income, Residence, Family Planning, Emotional Stability, Abuse, Communication with Community Resources
Higher attrition from services ( p <.05 for all)

Hearing the Patient’s Voice
Patient participation in health care communication
Meaningful use:
- Engage patients and families
- Ensure privacy and security protections

Weighing the Benefits
Omaha System users share their
Training tools
Practice standards and care plans
Analysis methods
Secrets to success

omahasystemmn.org
Users Web Site
Practice tools
Learning resources
Information sharing
omahasystem.org What it is How to access Scholarly resources

The Omaha System
Creates a interface terminology database that enables meaningful use of data

Questions?
Karen Monsen
[email_address]

Standardized Terminologies for EHRs

by Health Informatics New Zealand on Apr 04, 2010

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Standardized Terminologies for EHRs — Presentation Transcript