The Health Story Project
Dictation to Clinical Data: Automating the Production of
          Structured and Encoded Documen...
Presentation Overview

   Background: The Current Situation
   Enabling the EMR with the Missing Link
   A User Experie...
Background

The Current Situation




                        www.healthstory.com
Problems Facing Clinicians

According to an American College of Physician Executives survey, 6
in 10 physicians have consi...
Electronic Health Record Universe

                  Critical to the success
                  of EHRs is to reconcile
   ...
The Current Situation – Structured
 Tedious manual process
 Time-consuming
 Documentation lacks expressiveness
  of nat...
“Although completing such templates may help
physicians survive a report-card review, it directs
them to ask restrictive q...
The Current Situation
 Transcription can be expensive
 Subject to longer turn-around times
 Clinical data lost, because...
The Current Situation




 High cost of documentation
       Cost of ownership and physician time vs. transcription cost
...
Enabling the EMR

       The Missing Link in
Information Capture in Healthcare




                                    www...
Data Entry Time

           The average physician spends 33 seconds dictating an
            establish office visit
     ...
Crossing the Chasm…



  What if you could continue to use
narrative and dictation and at the same
 time increase usage of...
A word About Speech
                                               Recognition
 What speech recognition often means for p...
Health Story Project Vision


 Comprehensive electronic clinical records that
  tell a patient’s complete health story
 ...
Goals


 Bridge the gap between narrative documents
  and structured data
 Encourage proliferation of information for th...
Based on HL7 CDA

Clinical Document Architecture Requirements
 Human readable document
      Must be presentable as a doc...
Adoption

 Incremental adoption overcomes the “not me
  first” dilemma
 Not dependent on recipient’s ability to receive ...
Encoding

 Does not preclude “once and done” concept
 Compatible with Speech
  Understanding/Recognition
 Can be facili...
Accessible Clinical Data




                www.healthstory.com
User Experience
      GE/RISL
       The Missing Link in
Information Capture in Healthcare
  Kim Stavrinakis
  Sr. Manager...
Clinical Document Architecture


          Why CDA?


           Precision
           Reporting

       Radiology Imaging
...
Why CDA?

 Radiology results is key tool in providing diagnosis
 Results need to be:
      concise
  
      consistent ...
Precision Reporting
                       Building a reporting tool that
                       leverages standards for
 ...
Key Workflows

 Self Editing
      real time – read, proof, sign each exam
  
      batch mode - read multiple exams the...
Results Reporting Workflow
                                       Data Center

          Dictation Report in
             ...
Results Reporting Workflow 2
                                              Data Center


                           After ...
Results Reporting Batch Mode




                                   Report goes to
Dictating the                    medica...
Understanding Diagnostic Reporting




                 Values                        Benefits                            ...
Radiology Imaging of Lakeland Florida




Radiology & Imaging Specialists (RIS)
 physician-owned
 twenty board-certified...
“You didn’t change the radiologists’ work,
  and that is what made it easy on me.”
 David Marichal, CIO, Radiology and Ima...
Results
VOC:
     flexibility is key
 
      • full-time rads: 70% medical editor workflow/30% self-edit
      • part-tim...
Conversational Documentation
… transformation of dictation directly into
structured clinical documents while encoding
data...
Meaningful Clinical Documents

Meaningful Clinical Documents are a blend between
free form text and fully structured docum...
How it Works




    www.healthstory.com
The Health Story Project and
Meaningful Clinical Documents
           The Missing Link in
    Information Capture in Healt...
Meaningful Clinical Documents vs. Text

 Structured and encoded clinical content enables…
      pre-signature alerts,
  ...
Health Story Document Types

Implementation Guides
Completed
   History & Physical
   Consultation
   Operative Report
...
Project Members

Founders


Promoters


Original Benefactors:




Participants

                               www.healths...
Conclusion




             www.healthstory.com
Crossing the Chasm…Babel Must Go

 Medical text “typed” from dictation
  has “no meaning”
      black marks on a page…
  ...
Health Story…

 Captures meaningful clinical documents
 Is the bridge between
      free form narrative and expressive n...
Impact

 Allows providers to maintain preferred workflow
  and documentation methods
 Increases the value and usability ...
Getting Involved

 Join the Health Story Project
      www.healthstory.com
  

 Participate in HL7 Structured Document
...
Membership Options and Benefits




                       www.healthstory.com
Q&A


Kim Stavrinakis
Sr. Manager, Product Definition, GE Healthcare




                                                 ...
Where You Can Find Me
Nick van Terheyden, MD, CMO, M*Modal
Twitter                    http://twitter.com/drnic1
Technorati...
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Healthstory - Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents

  1. 1. The Health Story Project Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents Kim Stavrinaki WHIMA, May 8, 2009 Nick van Terheyden, MD s aka – SnakeDoctor Chief Medical Officer, M*Modal www.healthstory.com
  2. 2. Presentation Overview  Background: The Current Situation  Enabling the EMR with the Missing Link  A User Experience (GE/RISL)  The Health Story Project  Conclusion www.healthstory.com
  3. 3. Background The Current Situation www.healthstory.com
  4. 4. Problems Facing Clinicians According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to: burnout  low morale/depression  loss of autonomy  low reimbursement rates  patient overload  bureaucratic red tape  loss of respect, and  medical liability environment  Complexity and workload is crippling physicians and hindering their ability to deliver high quality care www.healthstory.com
  5. 5. Electronic Health Record Universe Critical to the success of EHRs is to reconcile two opposing needs Enterprise need for  structured and coded information capture Physician’s practical  need for a fast and easy method for creating clinical notes. www.healthstory.com
  6. 6. The Current Situation – Structured  Tedious manual process  Time-consuming  Documentation lacks expressiveness of natural language  Lack of Flexibility  Poor user interface  Cost Fails to Meet Individual Physician Time vs.  Benefit Test Cultural resistance   Oblivious to HIM Requirements Direct Data Entry:  Incomplete and Inadequate Semantic Structured and encoded information. Standards www.healthstory.com
  7. 7. “Although completing such templates may help physicians survive a report-card review, it directs them to ask restrictive questions rather than engaging in a narrative-based, open-ended dialogue.” Pamela Hartzband, M.D., and Jerome Groopman, M.D. n engl j med 358;16 april 17, 2008 www.healthstory.com
  8. 8. The Current Situation  Transcription can be expensive  Subject to longer turn-around times  Clinical data lost, because documents are neither structured nor encoded  Majority of attested information is only in the document  Contains the detail and comprehensive scope of patient information  Support human decision making  Reimbursement is based on narrative documentation  Retains current workflow, favored by physicians  Interoperable Dictation:  Under utilized source of data for EMR Fast and easy, expressive. www.healthstory.com
  9. 9. The Current Situation  High cost of documentation Cost of ownership and physician time vs. transcription cost   60% of the data lost to the EHR  Care process inefficiencies and impact on quality www.healthstory.com
  10. 10. Enabling the EMR The Missing Link in Information Capture in Healthcare www.healthstory.com
  11. 11. Data Entry Time  The average physician spends 33 seconds dictating an establish office visit  92% of all office visits are established  If 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 www.healthstory.com Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group
  12. 12. Crossing the Chasm… 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? www.healthstory.com
  13. 13. A word About Speech Recognition  What speech recognition often means for physicians… Disruption of their workflow  Change in their dictation style  More time spent on documentation  “Typing with your tongue”   The real world of dictation: Disorganized speakers  Mumbled/fast speech  Corrections  Instructions to transcriber  Different dictation habit  www.healthstory.com
  14. 14. Health Story Project Vision  Comprehensive electronic clinical records that tell a patient’s complete health story  All of the clinical information required for good patient care  administration  reporting and  research   will be readily available electronically, including information from narrative documents www.healthstory.com
  15. 15. Goals  Bridge the gap between narrative documents and structured data  Encourage proliferation of information for the EHR www.healthstory.com
  16. 16. Based on HL7 CDA Clinical Document Architecture Requirements  Human readable document Must be presentable as a document  Rendered version covers clinical information intended by the  author  Can contain machine-processable data  Cross platform and application independent  Can be transformed with style sheets www.healthstory.com
  17. 17. Adoption  Incremental adoption overcomes the “not me first” dilemma  Not dependent on recipient’s ability to receive or process  Reverse adoption (can encode headers of existing documents)  Non-proprietary  Readable with any browser www.healthstory.com
  18. 18. Encoding  Does not preclude “once and done” concept  Compatible with Speech Understanding/Recognition  Can be facilitated by Natural Language Processing  Leverage existing relationships with transcriptionists/editors/knowledge based workers  Potential for automated coding (billing)  Supports data abstraction/research www.healthstory.com
  19. 19. Accessible Clinical Data www.healthstory.com
  20. 20. User Experience GE/RISL The Missing Link in Information Capture in Healthcare Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare www.healthstory.com
  21. 21. Clinical Document Architecture Why CDA? Precision Reporting Radiology Imaging of Lakeland Florida www.healthstory.com
  22. 22. Why CDA?  Radiology results is key tool in providing diagnosis  Results need to be: concise  consistent representing the highest quality  precipitate alerts before the report is distributed   Radiology Information System rich in data  eliminates redundancy  streamlines workflow   CDA benefits standard for clinical communication  foundation for structuring data  www.healthstory.com
  23. 23. Precision Reporting Building a reporting tool that leverages standards for structuring data that  drives patient care Screen  drives outcomes for best shot of practices report  drives research for better patient with halo care and outcomes Utilizing data at each point of care that culminates in rich information for the radiologist www.healthstory.com
  24. 24. Key Workflows  Self Editing real time – read, proof, sign each exam  batch mode - read multiple exams then sign via signature queue  VR edits  Option to send to medical editor during reporting process   Batch Option – dynamic combinations of workflow based on confidence models user based thresholds that determines how report is  returned/reviewed to signature queue preliminary/draft to signature queue  transcriptionist then preliminary to signature queue   Transcriptionist – medical editor workflow www.healthstory.com
  25. 25. Results Reporting Workflow Data Center Dictation Report in Edit Mode using conversational local capture tool – speaking can either type to correct or voice commands When dictation is Report is returned Dictating the complete and ready for edits Procedure EOL is pushed www.healthstory.com
  26. 26. Results Reporting Workflow 2 Data Center After final sign the report is Edit Mode using local capture tool – processed in voice in selection the NLP engine between brackets for learning Voice in options for brackets, sign report, add via voice more dictation in the sections, then sign www.healthstory.com
  27. 27. Results Reporting Batch Mode Report goes to Dictating the medical editor or When Procedure signature queue, dictation is Radiologist moves complete on to next exam www.healthstory.com
  28. 28. Understanding Diagnostic Reporting Values Benefits Attributes Means (Why?) Does (How?) Is (What?) • Enables easy Radiologist • Easy to create reports using a • Multiple modes of workflow adoption by adjusting to your variety of workflow models around dictation workflow • Focus time on findings and • Speedy process • Pre-configured document models results • Capture a competitive advantage • No re-dictate existing information • Compliance alerts over other RAD groups • Increase revenue with more • Easily identify items to be • Pre-populated patient information reports / day confirmed or corrected; Deliver reports to referring MDs faster Source: GE analysis www.healthstory.com
  29. 29. Radiology Imaging of Lakeland Florida Radiology & Imaging Specialists (RIS)  physician-owned  twenty board-certified radiologists  many sub-specialized  live since November 12, 2008 www.healthstory.com
  30. 30. “You didn’t change the radiologists’ work, and that is what made it easy on me.” David Marichal, CIO, Radiology and Imaging Spec. of Lakeland, FL www.healthstory.com
  31. 31. Results VOC: flexibility is key  • full-time rads: 70% medical editor workflow/30% self-edit • part-time rads can use it in batch digital dictation mode rads love not having to dictate accession #,  name, signs/symptoms, etc… quality of the engine is very good  self-edit for stat exams has reduced # of calls  from the hospital www.healthstory.com
  32. 32. Conversational Documentation … transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs EHR www.healthstory.com
  33. 33. Meaningful Clinical Documents Meaningful Clinical Documents are a blend between free form text and fully structured documentation that represent the thought process, and  capture the clinical facts  www.healthstory.com
  34. 34. How it Works www.healthstory.com
  35. 35. The Health Story Project and Meaningful Clinical Documents The Missing Link in Information Capture in Healthcare Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare www.healthstory.com
  36. 36. Meaningful Clinical Documents vs. Text  Structured and encoded clinical content enables… pre-signature alerts,  decision support,  best documentation practices,  multiple output formats,  multi-media reporting,  data mining   Implements HL7 CDA4CDT standard compliant document types  Increases quality of documentation www.healthstory.com
  37. 37. Health Story Document Types Implementation Guides Completed  History & Physical  Consultation  Operative Report  DICOM Imaging Reports Upcoming  Discharge Summary w/IHE  Billing and Reimbursement Requirements  Progress Notes  .PDF work with Adobe www.healthstory.com
  38. 38. Project Members Founders Promoters Original Benefactors: Participants www.healthstory.com
  39. 39. Conclusion www.healthstory.com
  40. 40. Crossing the Chasm…Babel Must Go  Medical text “typed” from dictation has “no meaning” black marks on a page…  info must be tagged as discrete data  elements in order to assign meaning  Clinical documentation uses wide variety of terms with same meaning…. and terms that sound the same that have  different meanings….. authors have a wide variety of styles, accents,  methods of dictation… www.healthstory.com
  41. 41. Health Story…  Captures meaningful clinical documents  Is the bridge between free form narrative and expressive notes, and  fully structured clinical data   Improves the quality of clinical documentation  Generates semantically interoperable clinical data that will solve the fundamental challenges with EMRs - allowingclinical  decision support, alerts, decision support, data mining enable interoperability, reporting, patient safety initiatives, PQRI  (pay for performance), PSI (patient safety indicators) and improve billing data capture www.healthstory.com
  42. 42. Impact  Allows providers to maintain preferred workflow and documentation methods  Increases the value and usability of narrative documents (dictation/trans, SRT)  Accelerates the implementation of interoperable electronic health records  Allows reuse of information www.healthstory.com
  43. 43. Getting Involved  Join the Health Story Project www.healthstory.com   Participate in HL7 Structured Document work group  Participate in HL7 ballots  Encourage implementation EHR vendor adoption  provider preference  transcription RFPs  www.healthstory.com
  44. 44. Membership Options and Benefits www.healthstory.com
  45. 45. Q&A Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare www.healthstory.com
  46. 46. Where You Can Find Me Nick van Terheyden, MD, CMO, M*Modal Twitter http://twitter.com/drnic1 Technorati http://technorati.com/people/technorati/nvt1 RSSSpeech Understanding http://speechunderstanding.blogspot.com/feeds/posts/default MyBlogLog http://www.mybloglog.com/buzz/members/nvt LinkedIn http://www.linkedin.com/in/nickvt Plaxo http://nvt.myplaxo.com FaceBook http://profile.to/drnick Digg http://digg.com/users/nvt1 Delicious http://delicious.com/nvt1 E-Mail nvt@mmodal.com GrandCentral (301) 355-0877 www.healthstory.com

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