Clinical coding, patient portals, and national health priorities
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Clinical coding, patient portals, and national health priorities
- 1. &beyond_
- 2. National priorities Clinical coding at point of care Record locator service Patient portals
- 3. This tree represents the solution space
- 5. 100.00% 90.00% 80.00% 70.00% Bay of Plenty Read-coded emergency visits, 2010-12 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 1 501 1001 1501 2001 2501 3001 Code set size versus coding rate 3501 4001
- 7. Code as you go
- 8. SNOMED for emergency care
- 9. SNOMED for ambulance clinical impressions 9
- 10. SNOMED for procedures and body sites 10
- 12. ePRF shared at handover to hospital CWS + ED whiteboard + ePRF portal view CDR
- 13. How we tend to support transfer of care
- 14. One index over n repositories Registrations of interest Evaluated Oct 2013 Two vendors shortlisted
- 15. Single instance Software as a service National contract Inter-regional governance Early adopter
- 16. Comprehensive clinical assessments for older people
- 17. 10043 CDA Common Templates 10041.1 Discharge Summaries 10047 Assessments 10052 Ambulance ePRF GP2GP / NZePS 17
- 20. Referrals for hospital services Faster cancer treatment
- 21. Cancer registry Acute coronary syndrome Cardiac surgery Spinal cord impairment Conditions, interventions and outcomes data What’s the ideal care pathway for the patient?
- 23. SELF CARE PORTAL Real Me user identity Linked to NHI number Robust and secure Cross browser support Government web standards CDR interfaces CDA and other content types
- 24. NZPOCS v 2.0 Haematology coded and reviewed Biochemistry coded and review underway Microbiology coded Immunology coded Blood service coding underway Toxicology results next to be coded Orders coding underway all specialties
- 25. Thanks for your time
Editor's Notes
- New Zealanders have access to their own health information----- Meeting Notes (25/11/13 13:08) -----New Zealanders having online access to their own health information is the 2014 vision
- What this year’s and next’s national priorities areWe will look at some of the underpinning technology, and how standards will be part of the solution
- National priorities for the remainder of this year and nextFor 2014/15, patient self-care portal replaces COE as one of the six priorities
- Weight of expectations around architecture and standards
- A story worth telling, begins with some numbers from Bay of Plenty hospitalsTells us what people were treated for, and something about the coverage of a code setA choice of 1000 codes will cover almost 90% of patients, and you reach over 99% of cases with 3000-4000 codes
- St John will be rolling out in 2014 a new application used by paramedics in the ambulance, called the ‘electronic patient report form’ or ‘ePRF’Wellington Free Ambulance will use the same centrally-hosted systemThis project is a great vehicle for demonstrating new ideas about how interoperability should be done
- How does this work?Paramedics code as they go, to create a clinical impression of one, two or three clinical findings or provisional diagnosesThey will also code the common procedures
- Ambulance clinical impressions as part of a broader emergency care reference setWho have we stolen this from, and how much have we had to create for ourselves?Provenance of our reference sets for clinical impressions is NeHTA’s emergency department reference set
- 1500 clinical impressions among about 3000 finding and diagnosis conceptsGetting the W out of SNOMED
- Relatively few individual concepts, but requiring post-coordination of procedure, body site and laterality
- Circle of integrated care
- Hospital ED uses the same emergency care reference setInitially, hospital will be able to display ePRF via a portletBut later the CDR will be usedAmbulance will have access to discharge summaries via CDR
- Got handover docBut where do I share it from? Can’t use referral system because they’re all different, not built to a standard and not the right fit anyhowAmbulance also want discharge summaries
- Evaluation panel recommendations
- interRAI home care and residential care assessmentsThe registrar had to create us some LOINC codes
- But we are working on standards for transfer of careCDA is our canonical form for information exchanged at transfer of careThe ambulance project will deliver another CDA based standard
- Beyond discharge summaries, is the concept of My List of Medicines
- Here’s how a My List of Medicines would look
- Might also hear about surgical site infection surveillance
- Rick Hansen spinal cord impairment registryKnow what you want to askCollect only the data elements you needMake it useful for the serviceCulture of cooperative longitudinal data collecting
- Covering all commonly ordered lab tests used by DHBsCloser to its LOINC origins than beforeIncluding order codes for common test groups (eg liver function test) as well as result codesTarget for standards adoption