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Meaningful Use of Standardized Terminology to Support the  Electronic Health Record   Karen A. Monsen Health Informatics N...
Key Concepts <ul><li>Electronic Health Records </li></ul><ul><li>Value </li></ul><ul><li>Meaningful Use </li></ul>
Meaningful Use <ul><li>- Workflow </li></ul><ul><li>- Interoperability </li></ul><ul><li>- Exchange of health information ...
Cornerstones of Meaningful Use <ul><li>- Improve quality, safety, efficacy, and reduce health disparities </li></ul><ul><l...
Getting to Meaningful Use <ul><li>Selecting meaningful interface standards </li></ul><ul><li>- documentation of client hea...
Interface Terminology Standards <ul><li>- Clinical Care Classification </li></ul><ul><li>- International Classification of...
University Of Minnesota   <ul><li>- Community focused research in home care, hospice, and public health </li></ul><ul><li>...
Objectives <ul><li>Analyze the relationship between interface terminologies and meaningful use </li></ul><ul><li>Review ex...
The Omaha System <ul><li>- Exists in the public domain </li></ul><ul><li>- Readily incorporated into the EHR </li></ul><ul...
The Omaha System is very simple, easy to understand and use, and is available in the public domain. There are only 42 prob...
 
The Omaha System “stores” data describing: <ul><li>Problems </li></ul><ul><li>Signs/symptoms </li></ul><ul><li>Modifiers <...
Use Stored Data for:: Reporting activity Evaluating programs Researching quality and effectiveness
Data are easy to sort and match <ul><li>We can compare across systems </li></ul><ul><li>Compile across services </li></ul>...
Nursing Interventions as Capsicum Red = Teaching, guidance, and counseling Yellow = Treatments and procedures Orange = Cas...
 
Cultural Safety Communication with community resources Neighborhood/workplace safety Health care supervision Spirituality
Kaitiakitanga <ul><li>Protecting and caring  </li></ul><ul><li>Holistic perspective </li></ul><ul><li>Partnership between ...
The Omaha System in New Zealand <ul><ul><ul><li>-  Royal New Zealand Plunket Society </li></ul></ul></ul><ul><ul><ul><li>-...
Plunket <ul><li>ensuring that New Zealand families have the best health outcomes from a continuous wellness framework comm...
Plunket Desired Data Fields <ul><li>Caretaking/parenting 5 x </li></ul><ul><li>Communication with community resources 5 </...
Family Health Problems <ul><li>“ Top Ten” consistent across agencies </li></ul><ul><ul><li>Growth and development  (ranked...
Identified Priority Needs:  Neglect and Substance Use <ul><li>Poorest outcomes </li></ul><ul><li>Need better intervention ...
MMPO <ul><li>The Midwifery and Maternity Provider Organisation has a well developed information system that captures 450 u...
MMPO Care Plan Issues
MMPO Care Plan Targets
Asthma Care Plans <ul><li>Evidence based care disseminated through the EHR* </li></ul><ul><li>Improving health for </li></...
Best Practices Translation and Dissemination <ul><li>Applies to any health problem or discipline </li></ul><ul><li>Meaning...
Nurse Maude <ul><li>Nurse Maude is a community based health services provider with a staff of 218 nurse and 631 health car...
Core Problems in Home Care
Proposed Pathways <ul><li>Diabetes </li></ul><ul><li>Wounds/ulcers </li></ul><ul><li>Palliative </li></ul><ul><li>Bowel </...
Problem Focused Care <ul><li>Comprehensive Bowel Care </li></ul><ul><li>Comprehensive Neuro-musculo-skeletal Care </li></u...
An Architecture to Support Home Care Practice and Data Quality <ul><li>Structuring health care assessment, delivery, and d...
Help4U Help4U collaborates closely with health care providers and systems and enhance communication between customers and ...
Adding the Patient’s Voice <ul><li>Enables new research from a perspective that is currently missing in health care </li><...
PHN’s voice: Intervention Tailoring <ul><li>Younger, less often married, lower outcome ratings </li></ul><ul><li>Omaha Sys...
Hearing the Patient’s Voice  <ul><li>Patient participation in health care communication </li></ul><ul><li>Meaningful use: ...
Weighing the Benefits <ul><li>Omaha System users share their  </li></ul><ul><li>Training tools </li></ul><ul><li>Practice ...
<ul><li>omahasystemmn.org </li></ul><ul><li>Users Web Site </li></ul><ul><li>Practice tools </li></ul><ul><li>Learning res...
<ul><li>The Omaha System </li></ul>Creates a interface terminology database that enables meaningful use of data
Questions? <ul><li>Karen Monsen </li></ul><ul><li>[email_address] </li></ul>
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Standardized Terminologies for EHRs

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Dr Karen Monsen PhD RN
Assistant Professor at the University of Minnesota

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  • Adoption of electronic health records (EHR) is thought to be a strategy for obtaining the best value for each health care dollar invested. Value comes from meaningful use of the electronic record, and health data within the record.
  • Meaningful use is a multidimensional concept that incorporates complex processes; workflow; interoperability; the exchange and use of health information to best inform clinical decisions; evaluate performance; and improve health care quality (Markle Foundation, 2010; Mosquera, 2009).
  • The cornerstones meaningful use have been defined by the National Quality Forum as: (a) Improve quality, safety, efficiency, and reduce health disparities, (b) Engage patients and families, (c) Improve care coordination, (d) Improve population and public health, and (e) Ensure privacy and security protections (United States Department of Health and Human Services, 2010).
  • Achieving meaningful use of data is dependent on selecting interface standards for point of care documentation of health needs assessments and health care services and outcomes.
  • Nurses have led efforts to develop such standards over the past four decades. The American Nurses Association (ANA) currently recognizes seven interface terminologies: Clinical Care Classification, International Classification of Nursing Practice, NANDA International, Nursing Interventions Classification, Nursing Outcomes Classification, Omaha System, and Peri-operative Nursing Data Set.(ANA, 2006; Lundberg, Warren, Brokel, Bulechek, Butcher, 2008 ) These systems are being implemented in EHRs globally. New clinical data sets that provide essential health assessment and service data are becoming available, and methods for meaningful use of the data are emerging. (Monsen, Martin, Christensen, &amp; Westra, 2009; Monsen, Westra, Yu, Ramadoss, &amp; Kerr, 2009; Monsen, Banerjee, &amp; Das, in press)
  • Adoption of electronic health records (EHR) is thought to be a strategy for obtaining the best value for each health care dollar invested. Value comes from meaningful use of the electronic record, and health data within the record.
  • The Omaha System exists in the public domain, is readily incorporated into electronic documentation systems, and is congruent with standards already selected by New Zealand government. For example, the Omaha System is integrated into SNOMED CT® and Logical Observation Identifiers, Names, and Codes (LOINC®); and registered by Health Level Seven (HL7®) (Omaha System, 2010).
  • Adoption of electronic health records (EHR) is thought to be a strategy for obtaining the best value for each health care dollar invested. Value comes from meaningful use of the electronic record, and health data within the record.
  • Adoption of electronic health records (EHR) is thought to be a strategy for obtaining the best value for each health care dollar invested. Value comes from meaningful use of the electronic record, and health data within the record.
  • Adoption of electronic health records (EHR) is thought to be a strategy for obtaining the best value for each health care dollar invested. Value comes from meaningful use of the electronic record, and health data within the record.
  • Adoption of electronic health records (EHR) is thought to be a strategy for obtaining the best value for each health care dollar invested. Value comes from meaningful use of the electronic record, and health data within the record.
  • Adoption of electronic health records (EHR) is thought to be a strategy for obtaining the best value for each health care dollar invested. Value comes from meaningful use of the electronic record, and health data within the record.
  • Nurses and other stakeholders in New Zealand have begun to adopt the Omaha System for point of care documentation in electronic health records. Some examples of emerging information systems and projects using or considering the Omaha System are the Royal New Zealand Plunket Society, the Midwifery and Maternity Provider Organisation, Nurse Maude, and Help4U.
  • The Royal New Zealand Plunket Society (Plunket) is a nurse-led well child care provider serving 80% of children ages 0-5 in New Zealand, with the goal of 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. The Plunket project envisions consistent collection of health information and use of a shared language for health professionals involved, so that population outcomes can be compared.
  • Mapping Plunket data requirements to the Omaha System demonstrated that the Omaha System could be used for documenting the desired assessment and intervention data.
  • Based on the data, we can see that the most commonly addressed problems in family health were We are serving childbearing and childrearing families. They face challenges with poverty, housing, and family planning. Public health nurses are helping them deal with mental health, substance use, abuse, and neglect issues. This is the order in which the problems were identified and addressed across agencies.
  • The Midwifery and Maternity Provider Organisation has a well developed information system that captures 450 unique assessments and outcomes. Currently there is no standardized system for gathering data on the services midwives provide. Preliminary mapping of Omaha System terms to the MMPO Plan of Care was successful in describing midwifery’s continuity of care focus and holistic approach. There is potential to use the Omaha System to map data fields to Omaha System within the existing record, and to add structured Omaha System documentation to replace free text clinical notes. 90% of midwives currently use this system in paper or electronic format, and the system is also being adopted by other obstetrics providers.
  • Meaningful use of Omaha System data to advance health care knowledge and improve health care is expanding globally. New Zealand is in a position to capitalize on a sound infrastructure to support an EHR.
  • Transcript of "Standardized Terminologies for EHRs"

    1. 1. Meaningful Use of Standardized Terminology to Support the Electronic Health Record Karen A. Monsen Health Informatics New Zealand, Inc. 29 March 2010
    2. 2. Key Concepts <ul><li>Electronic Health Records </li></ul><ul><li>Value </li></ul><ul><li>Meaningful Use </li></ul>
    3. 3. Meaningful Use <ul><li>- Workflow </li></ul><ul><li>- Interoperability </li></ul><ul><li>- Exchange of health information </li></ul><ul><li>- Use of information </li></ul><ul><li>- - inform clinical decisions </li></ul><ul><li>- - evaluate performance </li></ul><ul><li>- - improve health care quality </li></ul>
    4. 4. Cornerstones of Meaningful Use <ul><li>- Improve quality, safety, efficacy, and reduce health disparities </li></ul><ul><li>- Engage patients and families </li></ul><ul><li>- Improve care coordination </li></ul><ul><li>- Improve population and public health </li></ul><ul><li>- Ensure privacy and security protections </li></ul>
    5. 5. Getting to Meaningful Use <ul><li>Selecting meaningful interface standards </li></ul><ul><li>- documentation of client health needs assessments </li></ul><ul><li>- documenting health care services </li></ul><ul><li>- documenting health outcomes </li></ul>
    6. 6. Interface Terminology Standards <ul><li>- Clinical Care Classification </li></ul><ul><li>- International Classification of Nursing Practice </li></ul><ul><li>- NANDA International </li></ul><ul><li>- Nursing Interventions Classification </li></ul><ul><li>- Nursing Outcomes Classification </li></ul><ul><li>- Omaha System </li></ul><ul><li>- Peri-operative Nursing Data Set </li></ul>
    7. 7. University Of Minnesota <ul><li>- Community focused research in home care, hospice, and public health </li></ul><ul><li>- Comparing data across systems and disciplines </li></ul><ul><li>Natural language processing studies </li></ul><ul><li>Data mining methods </li></ul><ul><li>- Longitudinal analysis of intervention patterns </li></ul>
    8. 8. Objectives <ul><li>Analyze the relationship between interface terminologies and meaningful use </li></ul><ul><li>Review existing projects using the Omaha System in New Zealand </li></ul><ul><li>- Describe current Omaha System research examples related to New Zealand goals and projects </li></ul>
    9. 9. The Omaha System <ul><li>- Exists in the public domain </li></ul><ul><li>- Readily incorporated into the EHR </li></ul><ul><li>- Congruent with </li></ul><ul><li>- - SNOMED CT ® </li></ul><ul><li>- - Logical Observation Identifiers, Names, and Codes (LOINC®) </li></ul><ul><li>- Registered by </li></ul><ul><li>- - Health Level Seven (HL7®) </li></ul>
    10. 10. 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
    11. 12. The Omaha System “stores” data describing: <ul><li>Problems </li></ul><ul><li>Signs/symptoms </li></ul><ul><li>Modifiers </li></ul><ul><li>Interventions </li></ul><ul><li>Outcomes </li></ul><ul><ul><li>Knowledge </li></ul></ul><ul><ul><li>Behavior </li></ul></ul><ul><ul><li>Status </li></ul></ul>
    12. 13. Use Stored Data for:: Reporting activity Evaluating programs Researching quality and effectiveness
    13. 14. Data are easy to sort and match <ul><li>We can compare across systems </li></ul><ul><li>Compile across services </li></ul><ul><li>Aggregate across agencies </li></ul><ul><li>And analyze around the globe! </li></ul>The Omaha System Organizes Data But can the Omaha System reflect the Aotearoa perspective?
    14. 15. Nursing Interventions as Capsicum Red = Teaching, guidance, and counseling Yellow = Treatments and procedures Orange = Case Management Green = Surveillance
    15. 17. Cultural Safety Communication with community resources Neighborhood/workplace safety Health care supervision Spirituality
    16. 18. Kaitiakitanga <ul><li>Protecting and caring </li></ul><ul><li>Holistic perspective </li></ul><ul><li>Partnership between nurse and client </li></ul><ul><li>Flexibility describing needs and care </li></ul>
    17. 19. The Omaha System in New Zealand <ul><ul><ul><li>- Royal New Zealand Plunket Society </li></ul></ul></ul><ul><ul><ul><li>- Midwifery and Maternity Provider Organisation </li></ul></ul></ul><ul><ul><ul><li>- Nurse Maude </li></ul></ul></ul><ul><ul><ul><li>- Help4U </li></ul></ul></ul>
    18. 20. Plunket <ul><li>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 </li></ul>
    19. 21. Plunket Desired Data Fields <ul><li>Caretaking/parenting 5 x </li></ul><ul><li>Communication with community resources 5 </li></ul><ul><li>Growth and development 5 x </li></ul><ul><li>Skin 4 </li></ul><ul><li>Mental health 3 x </li></ul><ul><li>Oral health 3 </li></ul><ul><li>Postpartum 3 x </li></ul><ul><li>Residence 3 x </li></ul><ul><li>Substance use 3 x </li></ul><ul><li>Abuse 2 x </li></ul><ul><li>Circulation 2 </li></ul><ul><li>Hearing 2 </li></ul><ul><li>Income 2 x </li></ul>
    20. 22. Family Health Problems <ul><li>“ Top Ten” consistent across agencies </li></ul><ul><ul><li>Growth and development (ranked 1 and 2; n=67-1011) </li></ul></ul><ul><ul><li>Antepartum/postpartum (ranked 1, 2, 3, and 4; n=86-770) </li></ul></ul><ul><ul><li>Caretaking/parenting (ranked 2, 3, and 5; n=44-838) </li></ul></ul><ul><ul><li>Income (ranked 3, 4, 5, and 9; n=11-471) </li></ul></ul><ul><ul><li>Family planning (ranked 3, 4, and 6; n=47-625) </li></ul></ul><ul><ul><li>Mental health (ranked 5, 6, 7, and 8; n=22-280) </li></ul></ul><ul><ul><li>Residence (ranked 5, 7, and 10; n=3-296) </li></ul></ul><ul><ul><li>Abuse (ranked 6, 7, and 9; n=9-391) </li></ul></ul><ul><ul><li>Substance use (ranked 6, 8, and 10; n=13-175) </li></ul></ul><ul><ul><li>Neglect (ranked 8, 9, and 10; n=4-269) </li></ul></ul>
    21. 23. Identified Priority Needs: Neglect and Substance Use <ul><li>Poorest outcomes </li></ul><ul><li>Need better intervention strategies </li></ul><ul><li>Meaningful Use: - Improve quality, safety, efficacy, and reduce health disparities </li></ul><ul><li>- Improve population and public health </li></ul>
    22. 24. MMPO <ul><li>The Midwifery and Maternity Provider Organisation has a well developed information system that captures 450 unique assessments and outcomes. </li></ul>
    23. 25. MMPO Care Plan Issues
    24. 26. MMPO Care Plan Targets
    25. 27. Asthma Care Plans <ul><li>Evidence based care disseminated through the EHR* </li></ul><ul><li>Improving health for </li></ul><ul><li>Individuals </li></ul><ul><li>http://omahasystemmn.org/Careplans/resp_cardiac_end/Washington_Asthma_Individual.pdf </li></ul><ul><li>Populations </li></ul><ul><li>http://omahasystemmn.org/Careplans/resp_cardiac_end/Washington_Asthma_Community.pdf </li></ul><ul><li>*Any EHR using the Omaha System for interface terminology </li></ul>
    26. 28. Best Practices Translation and Dissemination <ul><li>Applies to any health problem or discipline </li></ul><ul><li>Meaningful use: </li></ul><ul><li>- Improve quality, safety, efficacy, and reduce health disparities </li></ul><ul><li>- Improve care coordination </li></ul><ul><li>- Improve population and public health </li></ul>
    27. 29. Nurse Maude <ul><li>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. </li></ul>
    28. 30. Core Problems in Home Care
    29. 31. Proposed Pathways <ul><li>Diabetes </li></ul><ul><li>Wounds/ulcers </li></ul><ul><li>Palliative </li></ul><ul><li>Bowel </li></ul><ul><li>Urinary </li></ul><ul><li>Dementia </li></ul><ul><li>IV therapy </li></ul>
    30. 32. Problem Focused Care <ul><li>Comprehensive Bowel Care </li></ul><ul><li>Comprehensive Neuro-musculo-skeletal Care </li></ul><ul><li>Comprehensive Ostomy Care </li></ul><ul><li>Comprehensive Teaching about Wounds </li></ul><ul><li>Comprehensive Wound Care </li></ul><ul><li>Comprehensive Health Care Supervision </li></ul><ul><li>Bowel and Bladder Management </li></ul><ul><li>Comprehensive Bladder Care </li></ul><ul><li>Comprehensive Cardiovascular Management </li></ul><ul><li>Basic Bowel Care </li></ul><ul><li>Basic Neuro-musculo-skeletal Care </li></ul><ul><li>Basic Ostomy Care </li></ul><ul><li>Basic Teaching about Wounds </li></ul><ul><li>Basic Wound Care </li></ul><ul><li>Health Care Management </li></ul><ul><li>Teaching about Bowel and Bladder </li></ul>
    31. 33. An Architecture to Support Home Care Practice and Data Quality <ul><li>Structuring health care assessment, delivery, and data collection </li></ul><ul><li>Meaningful use </li></ul><ul><li>- Improve quality, safety, efficacy, and reduce health disparities </li></ul><ul><li>- Improve care coordination </li></ul><ul><li>- Improve population and public health </li></ul>
    32. 34. Help4U Help4U collaborates closely with health care providers and systems and enhance communication between customers and the health care system.
    33. 35. Adding the Patient’s Voice <ul><li>Enables new research from a perspective that is currently missing in health care </li></ul>
    34. 36. PHN’s voice: Intervention Tailoring <ul><li>Younger, less often married, lower outcome ratings </li></ul><ul><li>Omaha System Problems addressed more frequently: Income, Residence, Family Planning, Emotional Stability, Abuse, Communication with Community Resources </li></ul><ul><li>Higher attrition from services ( p <.05 for all) </li></ul>
    35. 37. Hearing the Patient’s Voice <ul><li>Patient participation in health care communication </li></ul><ul><li>Meaningful use: </li></ul><ul><li>- Improve quality, safety, efficacy, and reduce health disparities </li></ul><ul><li>- Engage patients and families </li></ul><ul><li>- Improve care coordination </li></ul><ul><li>- Improve population and public health </li></ul><ul><li>- Ensure privacy and security protections </li></ul>
    36. 38. Weighing the Benefits <ul><li>Omaha System users share their </li></ul><ul><li>Training tools </li></ul><ul><li>Practice standards and care plans </li></ul><ul><li>Analysis methods </li></ul><ul><li>Secrets to success </li></ul>
    37. 39. <ul><li>omahasystemmn.org </li></ul><ul><li>Users Web Site </li></ul><ul><li>Practice tools </li></ul><ul><li>Learning resources </li></ul><ul><li>Information sharing </li></ul><ul><li>omahasystem.org What it is How to access Scholarly resources </li></ul>
    38. 40. <ul><li>The Omaha System </li></ul>Creates a interface terminology database that enables meaningful use of data
    39. 41. Questions? <ul><li>Karen Monsen </li></ul><ul><li>[email_address] </li></ul>

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