2012 02 10 - Vreeman - Possibilities and Implications of ICF-powered Health Information Technology

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2012 02 10 - Vreeman - Possibilities and Implications of ICF-powered Health Information Technology

  1. 1. Possibilities and Implications of ICF-powered Health Information Technology Assistant Research Professor, Indiana University School of Medicine Research Scientist, Regenstrief Institute, Inc CSM 2012 – The ICF and PT 10 Years Later 02.10.2012 © 2012 dvreeman@regenstrief.org Daniel J. Vreeman, PT, DPT, MSc
  2. 2. photo via Sadie Hernandez
  3. 3. The Future Great Scott!
  4. 4. Complete, longitudinal information that follows the consumer
  5. 5. Care that is value-based and coordinated across settings photos via meddygarnet and brykmantra
  6. 6. Health decisions made with information tools that assist and guide Have you considered…
  7. 7. Results Fewer errors, waste, variations Consumer-centered care Lower spending
  8. 8. Meanwhile, back on planet Earth…
  9. 9. Patients move faster and further than their health information
  10. 10. Growing Recognition 1960’s •  1st studies of computers in healthcare 1991 •  IOM says EHR’s are essential 2003 •  HHS promotes widespread use of HIT
  11. 11. Evidence for Health IT 92% of 154 studies
  12. 12. e first priority in realizing the benefits of health IT is to achieve nationwide adoption of EHRs and widespread information exchange. “
  13. 13. 3 Ways EHRs can Help Accelerate that Vision Data reuse Decision support Canopy computing
  14. 14. practice management, quality reporting, accreditation, public health, research… Collect once. Use many.
  15. 15. EHR Decision Support A computer-generated suggestion about care for an individual patient me
  16. 16. The secret sauce of the HIT chicken soup photo via Robert Couse-Baker
  17. 17. photo via nosha e rain forest canopy is a seamless web through which arboreal creatures efficiently move to reach the edible fruits without any attention to the individual trees. McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.
  18. 18. Indiana Network For Patient Care A Unified Patient Record
  19. 19. How does all this relate to ICF?
  20. 20. Fundamental challenge: local systems have idiosyncratic ways of identifying similar concepts
  21. 21. Vocabulary standards provide the linuga franca.
  22. 22. Standards ^ Functional Status ICF: categories of function LOINC: assessments (observations)
  23. 23. We all know about ICF…
  24. 24. Logical Observation Identifiers Names and Codes A universal code system that facilitates exchange, pooling, and processing of results
  25. 25. 15,500+ users in 145 countries
  26. 26. MEASUREMENTS US
  27. 27. If an observation is a question and the observation value is an answer… LOINC provides codes for questions Other vocabularies provide codes for the answers
  28. 28. How fast does my patient usually walk? 41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated photo via Ed Yourdon
  29. 29. Standardized Assessments in LOINC Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC®. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095. Vreeman DJ, McDonald CJ, Huff SM. LOINC® - a universal catalog of individual clinical observations and uniform representation of enumerated collections. Int J Funct Inform Personal Med. 2010;3(4):273-291.
  30. 30. Warning: Long road ahead.
  31. 31. Getting Back to the Future Moving towards semantic interoperability
  32. 32. Might start with templates photo via Marcin Wichary
  33. 33. An ICF-based Template Escorpizo R et al. Creating an interface between the International Classification of Functioning, Disability and Health and physical therapist practice. Phys Ther. 2010 Jul;90(7):1053-63. PMID: 20448104 could be coded with LOINC ICF Intervention Targets
  34. 34. Some Advantages ICF worldview Same labels and meaning
  35. 35. photo via Ed Yourdon 41957-2:Walking speed 24 hour mean Walking speed: 1 m/s 64098-7:Distance walked in 6 minutes 6 min walk distance: 600m Fall risk: Mod NNN-N:More than 2 falls in last 1Y ICF: walking short distances d4500.1 “mild difficulty with walking short distances with the use of assistive devices that are available to the person in their current environment”
  36. 36. photo via Menage a Moi b2804 “Radiating pain in a segment or region” Classifying measures: •  Upper limb tension tests •  Spurling’s tests •  Distraction test Imaging 24937-5:Cervical spine MRI W & WO Contrast IV LOINC codes TBD
  37. 37. Now we have a powerful set of coded data that computers can operate on and exchange between independent systems in an understandable way.
  38. 38. ICF-powered EHRs Get patient reported data before the clinical encounter, with logic to help drive evaluation Rauch A et al. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability and Health during multidisciplinary patient management. Phys Ther. 2010 Jul;90(7):1039-52. PMID: 20508027
  39. 39. ICF-powered EHRs Computerized reminders to clinicians for following ICF-based intervention guidelines Rauch A et al. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability and Health during multidisciplinary patient management. Phys Ther. 2010 Jul;90(7):1039-52. PMID: 20508027
  40. 40. ICF-powered EHRs Rauch A et al. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability and Health during multidisciplinary patient management. Phys Ther. 2010 Jul;90(7):1039-52. PMID: 20508027
  41. 41. Key Lesson of Today photo via IMLS DCC
  42. 42. By incorporating vocabulary standards into our clinical information systems we can: leverage the EHR’s potent capabilities and move closer towards the healthcare system we dream of

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