Harmony With Healthstory Clinical Narrative And Structured Data In The Ehr Himss


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Harmony with Healthstory - Clinical Narrative and Structured Data in the EHR

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  • But this presupposes that the time to enter this data is equivalentIn fact it is not andThe average physician spends 33 seconds dictating an establish office visit92% of all office visits are establishedIf 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
  • Why are we here today?
  • Hieb, Barry, MD. (2003). Taming medical text: five key CPR technologies emerge. Com-18-5157. Gartner Research.
  • Harmony With Healthstory Clinical Narrative And Structured Data In The Ehr Himss

    1. 1. The Health Story ProjectHarmony with Healthstory Clinical Narrative and Structured Data in the EHR<br />Kim Stavrinaki<br />s<br />HIMSS Conference, March 2010<br />Nick van Terheyden, MD<br />Board of Directors, MTIA<br />Chief Medical Officer, M*Modal<br />
    2. 2. Conflict of Interest DisclosureNick van Terheyden, MD<br />Employee of M*Modal Inc<br />
    3. 3. Presentation Primary Purpose<br />Raise awareness and encourage participation and adoption of available data standards that support continuity of care and enrich the EMR<br />
    4. 4. Presentation Overview<br />Background: The Current Situation<br />Enabling the EMR with the Missing Link<br />User Experiences<br />The Health Story Project<br />Conclusion<br />
    5. 5. Background<br />The Current Situation<br />
    6. 6. Electronic Health Record Universe<br /> Critical to the success of EHRs is to reconcile two opposing needs<br />Enterprise need for structured and coded information capture<br />Physician’s practical need for a fast and easy method for creating clinical notes.<br />Slide courtesy of M*Modal<br />
    7. 7. Current Methods for Data Capture<br />Direct data entry, physician<br />Direct data entry, not physician<br />Unstructured Data<br />Systemgenerated or interfaced data<br />Structured Data<br />Dictation and Transcription<br />Handwritten<br />
    8. 8. With apologies to Jim Klein, MS of Quadramed and John Gray, Ph.D. …<br />EMRs AREFROM MARS,HIM SystemsAre from Venus<br />A Practical Guide forImproving CollaborationBetween Documents and <br />Databases and Getting Physician Adoption of EMRs<br />Jim Klein, M.S.<br />Slide courtesy of Jim Klein, Quadramed<br />
    9. 9. The Current Situation – Structured<br />Tedious manual process<br />Time-consuming<br />Documentation lacks expressiveness of natural language<br />Lack of Flexibility<br />Poor user interface<br />Cost<br />Fails to Meet Individual Physician Time vs. Benefit Test<br />Cultural resistance<br />Oblivious to HIM Requirements<br />Incomplete and Inadequate Semantic Standards<br />Direct Data Entry: Structured and encoded information.<br />Slide courtesy of M*Modal<br />
    10. 10. Cost Comparisons<br />1 MGMA Dashboard, $340,000 collections for IM professional charges<br />2 Outsourced transcription at 16 cents per 65-character line<br />Source: Healthcare Ledger – March 2009: Medical Transcription Relevance in the EHR Age – What is DRThttp://www.healthcareledger.com/march2009.htmlhttp://www.healthcareledger.com/march2009/Medical%20Transcription%20Relevance%20in%20the%20EHR%20Age%20_%20What%20is%20DRT%20HCL%20Mar%202009.pdf<br />
    11. 11. The Current Situation <br />Transcription can be expensive<br />Subject to longer turn-around times<br />Clinical data lost, because documents are neither structured nor encoded<br />Majority of attested information is only in the document<br />Contains the detail and comprehensive scope of patient information<br />Support human decision making<br />Reimbursement is based on narrative documentation<br />Retains current workflow, favored by physicians<br />Interoperable<br />Under utilized source of data for EMR<br />Dictation: Fast and easy, expressive.<br />Slide courtesy of M*Modal<br />
    12. 12. The Current Situation<br />High cost of documentation<br />Cost of ownership and physician time vs. transcription cost<br />60% of the data lost to the EHR<br />Care process inefficiencies and impact on quality<br />Slide courtesy of M*Modal<br />
    13. 13. Home Planet of the EMR<br />Home to: Association of Computing Machinery, IEEE, HIMSS, EHR Vendors Assoc.,<br />Slide courtesy of Jim Klein, Quadramed<br />
    14. 14. Fails to MeetIndividual PhysiciansTime vs. BenefitTest<br />Lack of Flexibility<br />Obliviousto HIMRequirements<br />Incomplete and <br />Inadequate SemanticStandards<br />Poor Clinical<br />Documentation<br />Implementation<br />Significant Impediments to EMRs<br />Lack of Flexibility<br />Inadequate standards<br />Incomplete or lack of adoption of available standards<br />Poor facilities for clinical documentation<br />Weak clinical decision support system<br />Cost<br />Vendor viability and strategy changes<br />Cultural resistance<br />EMR<br />Weak Decision<br />Support<br />Slide courtesy of Jim Klein, Quadramed<br />
    15. 15. Home Planet of HIM<br />Organizations Headquartered on Venus: AHIMA, AHDI, MTIA …<br />Slide courtesy of Jim Klein, Quadramed<br />
    16. 16. Welcome to the HIM Department<br />ICD-9/10<br />H&P<br />Consent<br />Lawyers<br />CMS<br />HIPAA<br />JCAHO<br />Payers<br />Slide courtesy of Jim Klein, Quadramed<br />
    17. 17. Enabling the EMR<br />The Missing Link in <br />Information Capture in Healthcare<br />
    18. 18. 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?<br />Crossing the Chasm…<br />
    19. 19. What or who can federate these planets?<br />And unite theirinhabitants?<br />Slide courtesy of Jim Klein, Quadramed<br />
    20. 20. Health Story Project Vision<br />Comprehensive electronic clinical records that tell a patient’s complete health story<br />All of the clinical information required for<br />good patient care<br />administration<br />reporting and <br />research <br />will be readily available electronically, including information from narrative documents<br />
    21. 21. Based on HL7 CDA<br />Clinical Document Architecture Requirements<br />Human readable document<br />Must be presentable as a document<br />Rendered version covers clinical information intended by the author <br />Can contain machine-processable data<br />Cross platform and application independent<br />Can be transformed with style sheets<br />
    22. 22. Adoption<br />Incremental adoption overcomes the “not me first” dilemma<br />Not dependent on recipient’s ability to receive or process<br />Reverse adoption (can encode headers of existing documents)<br />Non-proprietary<br />Readable with any browser<br />
    23. 23. Accessible Clinical Data<br />Slide courtesy of M*Modal<br />
    24. 24. User Experience<br />The Missing Link in <br />Information Capture in Healthcare<br />Kim Stavrinakis<br />Sr. Manager, Product Definition, GE Healthcare<br />
    25. 25. Meaningful Clinical Documents<br /> Meaningful Clinical Documents are a blend between free form text and fully structured documentation that<br />represent the thought process, and<br />capture the clinical facts<br />Slide courtesy of M*Modal<br />
    26. 26. The Health Story Project and Meaningful Clinical Documents<br />The Missing Link in <br />Information Capture in Healthcare<br />Kim Stavrinakis<br />Sr. Manager, Product Definition, GE Healthcare<br />
    27. 27. EHR Repository<br />Disease, DF-00000<br />Metabolic Disease, D6-00000<br />Clinical Applications<br />Disorder of carbohydrate metabolism, D6-50000<br />Disorder of glucose metabolism, D6-50100<br />HIM Applications<br />Diabetes Mellitus, DB-61000<br />SNOMED CT<br />Type 1, DB-61010<br />Neonatal, DB75110<br />Carpenter Syndrome, DB-02324<br />Insulin dependant type IA, DB-61020<br />Meaningful Clinical Documents<br />Slide courtesy of V. "Juggy" Jagannathan PhD, Medquist<br />
    28. 28. Meaningful Clinical Documents vs. Text<br />Structured and encoded clinical content enables…<br />pre-signature alerts, <br />decision support, <br />best documentation practices,<br />multiple output formats, <br />multi-media reporting, <br />data mining<br />Implements HL7 CDA4CDT standard compliant document types<br />Increases quality of documentation<br />
    29. 29. Adoption<br />Medical transcription companies must support creation and delivery of standards-based meaningful documents<br />EHR vendors systems must have ability to receive, display, transform and parse these standards-based meaningful documents<br />Health Providers need to require support for import and export of standards-based meaningful clinical documents<br />Health Story helps by developing and publishing the technical implementation guides to support adoption<br />
    30. 30. Health Story Document Types<br />Implementation Guides<br />Completed<br />History & Physical <br />Consultation<br />Operative Report<br />DICOM Imaging Reports<br />Discharge Summary<br />Upcoming<br />Billing and Reimbursement Requirements <br />Progress Notes<br />.PDF work with Adobe<br />
    31. 31. Adoption<br />Health Story vendor members are generating (GE Medical, MedQuist, M*Modal) and others are planning to generate the standards in the next year<br />Radiology Imaging of Lakeland is live today<br />Included in HITSP1 requirements<br />On CCHIT2 roadmap<br />1 Healthcare Information Technology Standards Panel<br />2 Certification Commission for Healthcare Information Technology<br />
    32. 32. Project Members<br />Promoters<br />Participants<br />All Type | Dictation Services Group | Healthline, Inc. | MD-IT<br />
    33. 33. Our Advocacy To Date<br />Participation in public comment periods<br />NCVHS Hearing on Meaningful Use<br />HHS Request for Input on Meaningful Use<br />HITSP Request for Input on ARRA<br />Comments are posted on our site<br />www.healthstory.com<br />
    34. 34. Our Advocacy Messages<br />Dictation is the documentation method of choice for 85% of physician providers<br />Standardization of dictated notes is an achievable step for providers; Standards are available today<br />The current EHR systems certification process does not include requirements for integration with dictated notes per available standards<br />The current draft definition of meaningful use focuses on recording clinical documentation in the EHR through data entry<br />
    35. 35. Our Advocacy Requests<br />Actions Requested:<br />Require certified EHR systems to accept interfaced data from dictation/transcription process per available standards<br />Modify the definition of meaningful use to recognize use of certified EHR systems with the above capabilities<br />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<br />
    36. 36. Conclusion<br />
    37. 37. Crossing the Chasm…Babel Must Go<br />Medical text “typed” from dictation <br /> has “no meaning”<br />black marks on a page… <br />info must be tagged as discrete data <br /> elements in order to assign meaning <br />Clinical documentation uses wide variety of terms with same meaning….<br />and terms that sound the same that have different meanings…..<br />authors have a wide variety of styles, accents, methods of dictation…<br />
    38. 38. Health Story…<br />Captures meaningful clinical documents<br />Is the bridge between<br />free form narrative and expressive notes, and<br />fully structured clinical data<br />Improves the quality of clinical documentation<br />Generates semantically interoperable clinical data that will<br />solve the fundamental challenges with EMRs - allowingclinical decision support, alerts, decision support, data mining<br />enable interoperability, reporting, patient safety initiatives, PQRI (pay for performance), PSI (patient safety indicators) and improve billing data capture <br />
    39. 39. Impact<br />Allows providers to choose preferred workflow and documentation methods<br />Increases the value and usability of narrative documents<br />Accelerates the implementation of interoperable electronic health records<br />Allows intelligent and meaningful reuse of information<br />
    40. 40. Getting Involved<br />Share the Good News: Be an “Ambassador” <br />We need a grass roots effort to help spread the word<br />Educate your employers, clients, etc. about this pathway<br />Join the Effort<br />Varying membership levels, including individuals<br />Volunteer for a Project<br />See “data standards” section of www.healthstory.com<br />Encourage Implementation<br />See “data standards” section of www.healthstory.com for suggested requirements language for transcription and EMR vendors<br />
    41. 41. The Health Story ProjectHarmony with Healthstory Clinical Narrative and Structured Data in the EHR<br />Kim Stavrinaki<br />s<br />HIMSS Conference, March 2010<br />Nick van Terheyden, MD<br />Board of Directors, MTIA<br />Chief Medical Officer, M*Modal<br />
    42. 42. Nick van Terheyden, MD, CMO, M*Modal<br />Twitter http://twitter.com/drnic1<br />Technorati http://technorati.com/people/technorati/nvt1<br />RSSSpeech Understanding http://speechunderstanding.blogspot.com/feeds/posts/default<br />MyBlogLog http://www.mybloglog.com/buzz/members/nvt<br />LinkedIn http://www.linkedin.com/in/nickvt<br />Plaxo http://nvt.myplaxo.com<br />FaceBook http://profile.to/drnick<br />Digg http://digg.com/users/nvt1<br />Delicious http://delicious.com/nvt1<br />E-Mail nvt@mmodal.com<br />GrandCentral (301) 355-0877<br />Where You Can Find Me<br />