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Standardized Terminologies for EHRs

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

Published in: Health & Medicine
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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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