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Modernizing Patient Records

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This is a presentation I delivered at AIIM 2010 in Philadelphia. It presents a holistic look at the make up of a patient record and the challenges in moving to a digital environment.

This is a presentation I delivered at AIIM 2010 in Philadelphia. It presents a holistic look at the make up of a patient record and the challenges in moving to a digital environment.

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  • Modernizing Patient Records: Will it really work?Thinking about process and how healthcare providers interact with the insurance industry is one of the areas where I get stuck. As an example, my family Physician has made the move to digital records already. He saw and understood the benefit early on. Where it falls flat for him is the majority of insurers and benefits administration firms he deals with require that he send hard copy rather than digital records for processing, partially defeating the purpose of going digital. Secondly, there appears to be no standard as yet for hospitals, clinics and practitioners to correspond and exchange information. Within the ECM world, we have dealt with this for many years and the time is now that things are changing with the emerging Content Management Interoperability Standard (CMIS). Looking at this historically, and the scenario I faced with my own records, I have no choice but to wonder if the efforts for patient records while admirable and much needed will fall short. We need to move in this direction and I fully support it but I also feel we need to step back and look at the bigger picture. How long has it taken our industry to work out a standard and how long will it take for the healthcare system? I know that standards develop over time but is there a way to leverage what has been done already even if it is not specific to an industry like healthcare and wouldn’t it make sense to begin there? I am not hearing a lot about this.In order for this effort to be effective in healthcare there needs to be:A set of universally accepted interoperability standards established for information and content of all types and formatsConsideration for the on and off ramps of information within a processA plan as to how other entities like the insurance and benefit claims segments will interact with healthcare providers so they too will be part of the solution and not be seen as part of the problemNow I know I have not covered everything but the point I am trying to make is that the opportunity is here today for the ECM and Healthcare communities to come together and work toward the common goal of managing information and content regardless of format and type. The objective of universal access to patient records in a secure environment is nothing new nor is it out of reach. What remains to be seen is how this transition is approached, planned and executed.What say you on this topic? I look forward to hearing from you and remember, AIIM provides the training you need to jump start your information management projects. www.aiim.org/trainingBob Larrivee – AIIM
  • Modernizing Patient Records: Will it really work?January 12, 2009President Obama announces digital health records for all within 5 yearsAugust 19, 2009HHS announces “Information Breach” regulationsAs I have said in the past, I think the efforts by our current administration and President Obama is highly commendable. I think the suggestion and action to move our healthcare system into a digital state is long overdue but I just can’t help feeling that making patient records digital is not going far enough.
  • In an ideal world, the patient would not need to be concerned about how records are handled and if the provider can access his/her information.Regardless of where you go, each entity in the healthcare arena could access your information as needed and when needed.
  • As an example, my family Physician has made the move to digital records already. He saw and understood the benefit early on. Where it falls flat for him is in the handoff and more specifically with the Insurance industry. The majority of insurers and benefits administration firms he deals with require that he send hard copy rather than digital records for processing, partially defeating the purpose of going digital.
  • The reality of this today is that there are major disconnects.This is such an important issue that Microsoft and even Google with Google Health are creating areas where you can upload and store your personal health information, making it accessible to you and/or medical staff as needed.In this case, you are the responsible steward of your own information and this trend is getting clearer as labs and other facilitators of healthcare services no provide you with your records and a message they will destroy their copy within so many days.
  • This progress is a wonderful thing and I am excited to see it coming into focus but from a holistic perspective, I am thinking about process and how healthcare providers interact with the pharma and insurance industries as one of the areas where I get stuck. As an example, my family Physician has made the move to digital records already. He saw and understood the benefit early on. Where it falls flat for him is in the handoff and more specifically with the Insurance industry. The majority of insurers and benefits administration firms he deals with require that he send hard copy rather than digital records for processing, partially defeating the purpose of going digital.
  • There appears to be no fully accepted standard as yet for hospitals, clinics and practitioners to correspond and exchange information. Recently, I was injured in a fall. I went to a local hospital for treatment and was given electronic files of the x-rays and diagnosis to take back for the follow-up visit with my Physician. Knowing my Physician had transitioned to the digital age; I had high hopes and was excited that this was really happening. My excitement soon came back to reality when I presented the CD to my Physician who looked at it and determined he could not import the information to his system. Not compatible, not surprising.There is agreement however that the 3 main areas of focus need to be functionality, security and interoperability.
  • In the case of User 1 on the left, the IA has not been developed strategically, if at all. The individual functional components exist as silos and can be repeated, that is to say functions such as authoring/capture, document management and portals can occur multiple times in multiple standalone applications. As a result, User 1 is burdened with being the point of integration. User 1 must learn and interface with several search tools, process interfaces and content/records management tools, for example. From a content delivery perspective, this means that User 1 must take on the burden of not only locating and assembling all relevant content, but in arranging and organising them to provide the level of insight cutting across all resources to support his current business issue.User 2, on the other hand, has the benefit of a well-defined and orchestrated IA, including a well-defined content delivery strategy that dynamically assembles various pieces of content based on a particular business need. As a result, User 2 accesses content within the context of a business processes as a single cross-organizational resource, simplifying access, eliminating frustration and increasing productivity and effectiveness.
  • Consideration for the on and off ramps of information within a processA plan as to how other entities like the insurance and benefit claims segments will interact with healthcare providers so they too will be part of the solution and not be seen as part of the problem
  • There are some works in progress and standards available in this space likeISO 18308Requirements for an Electronic Health Record Reference ArchitectureElectronic Health Records(EHR)- HL7EHR – S Functional Model (HER-S FM)EHR – Interoperability Model (EHR/IM)Personal Health Record Systems Functional Model (PHR-S FM)Digital Imaging and Communications in Medicine (DICOM)More….But the problem is that not all vendors or facilities adhere to them, so therefore we must conclude that they are not fully adopted standards.
  • Examples of meaningful use objectives:Implement drug/allergy checkMaintain active medication/allergy listRecord and chart changes in vital signsIncorporate clinical lab-test results into EHR as structured dataCheck insurance eligibility electronically Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request This last bullet is of particular interest to me…
  • CMIS stands for “Content Management Interoperability Services,” and is an ECM interoperability standard developed and supported by the who’s who in ECM, including Microsoft, IBM, EMC, Oracle, Alfresco, Day Software and Open Text. Initial release of the standard occurred in late 2008.The purpose of the specification is to define a common Web services interface that will allow developers to build applications that can talk uniformly to many different content repositories – the task that the early web services and Service-Oriented Architecture movements have been explicitly hinting at for close to a decade.What separates CMIS from previous attempts is that it is not tied down with the baggage or overhead of a “heavy-handed” approach, such as SOA, which we will define in more detail on the following slide.The “Standards-oriented suite” approach does NOT assume that there is a well-defined architecture in place BEFORE attempting to tackle cross-repository integration. Instead, the CMIS standard is targeted at the commonalities across repositories rather than separate, specific integration with EACH repository in a one-at-a-time manner. Simply put, CMIS is aimed at simplifying to a common set of expected interface or integration points that are SPECIFIC to ECM environments.There have been previous attempts at such a standard, and the mere rise of a new standard is no reason to assume that it will be successful, nor that it will cure all ills. However, given the other trends in the ECM market which are pushing for broader adoption, at a wider variety of price points and capabilities, the timing is right for a “real” standard to assist organisations bridging BCS offerings versus the larger and more specialised deployment of ECM that they may have already put in place.The death of any standard is the lack of awareness and demand for the adoption of a standard. Keep an eye on CMIS and how any solutions you are examining work with this standard. If you are a buyer of ECM solutions, make sure that your contacts within your suppliers of your choice understand your interest in making this or any other standard a working reality.
  • Transcript

    • 1. Can it rally happen?
      Presented by:
      Bob Larrivee
      AIIM Director/Industry Advisor
      Digital Patient Records:
    • 2. January 12, 2009
      President Obama announces digital health records for all within 5 years
      August 19, 2009
      HHS announces “Information Breach” regulations
      36+ Breaches listed by HHS as of 03/2010
      Affecting 500+ individuals
      The Mandate
    • 3. Many in the Electronic Health Records (EHR) space
      Over 70 vendors listed in a single site
      Includes:
      GE Healthcare
      Advanced Data Systems
      Cerner Corporation
      McKesson
      Source: http://www.ehr-software.net/comparison.htm
      The Players
    • 4. Medical
      History and demographics
      Medications, immunizations and allergies
      Lab results and radiological images
      Insurance
      Coverage and claims
      Financial
      Billing Information
      Patient Requests
      Living Will
      What is a Patient Record?
    • 5. Nirvana
    • 6. Acceptance of electronic information
      Healthcare
      Physicians
      Hospitals
      Labs
      Insurance
      Claims
      Billings
      Pharmaceutical
      Prescriptions
      Global Adoption
    • 7. Reality
    • 8. Multi-faceted Environment
      Healthcare
      Insurance
      Pharmaceutical
      Legal
      Process Issue
      Hand-offs
      On-ramps and off-ramps
      Healthcare - Extended
    • 9. Standardization
      Functionality – ensuring that the systems can support the activities and perform the functions for which they are intended
      Security – ensuring that systems can protect and maintain the confidentiality of data entrusted to them
      Interoperability – ensuring systems implement the recognized standards and can exchange information and work with other systems.
      The Challenge
    • 10. Dynamic integration of content
      From this
      To this
      10
    • 11. Hand-offs
      Should be clean
      Well defined
      Automated
      On-Ramps and Off-Ramps
      Information and Records
      Entering a process
      Handled in the process
      Exiting a process
      Note: The end of one process begins the next
      Process
    • 12. ISO 18308
      Requirements for an Electronic Health Record Reference Architecture
      Electronic Health Records(EHR)- HL7
      EHR – S Functional Model (HER-S FM)
      EHR – Interoperability Model (EHR/IM)
      Personal Health Record Systems Functional Model (PHR-S FM)
      Digital Imaging and Communications in Medicine (DICOM)
      More….
      Existing Work and Standards
    • 13. Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Medicaid Services
      Defined “meaningful use” of EHR Solutions
      Improving quality, safety, efficiency, care coordination, population and public health;
      Reducing health disparities;
      Engaging patients and their families; and,
      Ensuring adequate privacy and security protections for personal health information
      Certification Commission for Health Information Technology
      Updated Certification Programs
      Progress
    • 14. The issue is large
      Extends beyond healthcare alone
      Standards need to be adopted and adhered to
      Process within and beyond an organization must be designed and documented
      Looking Ahead
    • 15. A Lesson from ECM
      ECM can be the umbrella
      Leverage Content Management Interoperability Services (CMIS) Standard
      A common web services interface to support uniform access across different content repositories
      Leverage ERM Standards
      Leverage BPM Best Practices
    • 16. We are getting there but there is a lot of work ahead
      Standards need to be set and adopted
      EHR should be part of your ECM Environment
      Included as a content/records source
      Strong and seamless processes are key
      Identify the on and off ramps of patient records
      Digital Patient records can and is becoming a reality
      Look at it holistically
      My Opinion
    • 17. Bob Larrivee – Director and Industry Advisor – AIIM
      Email – blarrivee@aiim.org
      Twitter - @BobLarrivee
      Visit:
      AIIM.ORG
      InformationZen.org
      AIIM Knowledge Center
      AIIMCommunities.org
      Thank you

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