The Health Story ProjectHarmony with Healthstory Clinical Narrative and Structured Data in the EHR<br />Kim  Stavrinaki<br...
Conflict of Interest DisclosureNick van Terheyden, MD<br />Employee of M*Modal Inc<br />
Presentation Primary Purpose<br />Raise awareness and encourage participation and adoption of available data standards tha...
Presentation Overview<br />Background: The Current Situation<br />Enabling the EMR with the Missing Link<br />User Experie...
Background<br />The Current Situation<br />
Electronic Health Record Universe<br />	Critical to the success of EHRs is to reconcile two opposing needs<br />Enterprise...
Current Methods for Data Capture<br />Direct data entry, physician<br />Direct data entry, not physician<br />Unstructured...
With apologies to Jim Klein, MS of Quadramed and John Gray, Ph.D. …<br />EMRs AREFROM MARS,HIM SystemsAre from Venus<br />...
The Current Situation – Structured<br />Tedious manual process<br />Time-consuming<br />Documentation lacks expressiveness...
Cost Comparisons<br />1 MGMA Dashboard, $340,000 collections for IM professional charges<br />2 Outsourced transcription a...
The Current Situation <br />Transcription can be expensive<br />Subject to longer turn-around times<br />Clinical data los...
The Current Situation<br />High cost of documentation<br />Cost of ownership and physician time vs. transcription cost<br ...
Home Planet of the EMR<br />Home to: Association of Computing Machinery, IEEE, HIMSS, EHR Vendors Assoc.,<br />Slide court...
Fails to MeetIndividual PhysiciansTime vs. BenefitTest<br />Lack of Flexibility<br />Obliviousto HIMRequirements<br />Inco...
Home Planet of HIM<br />Organizations Headquartered on Venus:  AHIMA, AHDI, MTIA …<br />Slide courtesy of Jim Klein, Quadr...
Welcome to the HIM Department<br />ICD-9/10<br />H&P<br />Consent<br />Lawyers<br />CMS<br />HIPAA<br />JCAHO<br />Payers<...
Enabling the EMR<br />The Missing Link in <br />Information Capture in Healthcare<br />
What if you could continue to use narrative and dictation and at the same time increase usage of the EMR and make more rec...
What or who can federate these planets?<br />And unite theirinhabitants?<br />Slide courtesy of Jim Klein, Quadramed<br />
Health Story Project Vision<br />Comprehensive electronic clinical records that tell a patient’s complete health story<br ...
Based on HL7 CDA<br />Clinical Document Architecture Requirements<br />Human readable document<br />Must be presentable as...
Adoption<br />Incremental adoption overcomes the “not me first” dilemma<br />Not dependent on recipient’s ability to recei...
Accessible Clinical Data<br />Slide courtesy of M*Modal<br />
User Experience<br />The Missing Link in <br />Information Capture in Healthcare<br />Kim Stavrinakis<br />Sr. Manager, Pr...
Meaningful Clinical Documents<br />	Meaningful Clinical Documents are a blend between free form text and fully structured ...
The Health Story Project and Meaningful Clinical Documents<br />The Missing Link in <br />Information Capture in Healthcar...
EHR Repository<br />Disease, DF-00000<br />Metabolic Disease, D6-00000<br />Clinical Applications<br />Disorder of carbohy...
Meaningful Clinical Documents vs. Text<br />Structured and encoded clinical content enables…<br />pre-signature alerts, <b...
Adoption<br />Medical transcription companies must support creation and delivery of standards-based meaningful documents<b...
Health Story Document Types<br />Implementation Guides<br />Completed<br />History & Physical <br />Consultation<br />Oper...
Adoption<br />Health Story vendor members are generating (GE Medical, MedQuist, M*Modal) and others are planning to genera...
Project Members<br />Promoters<br />Participants<br />All Type | Dictation Services Group | Healthline, Inc. | MD-IT<br />
Our Advocacy To Date<br />Participation in public comment periods<br />NCVHS Hearing on Meaningful Use<br />HHS Request fo...
Our Advocacy Messages<br />Dictation is the documentation method of choice for 85% of physician providers<br />Standardiza...
Our Advocacy Requests<br />Actions Requested:<br />Require certified EHR systems to accept interfaced data from dictation/...
Conclusion<br />
Crossing the Chasm…Babel Must Go<br />Medical text “typed” from dictation <br />	has “no meaning”<br />black marks on a pa...
Health Story…<br />Captures meaningful clinical documents<br />Is the bridge between<br />free form narrative and expressi...
Impact<br />Allows providers to choose preferred workflow and documentation methods<br />Increases the value and usability...
Getting Involved<br />Share the Good News: Be an “Ambassador” <br />We need a grass roots effort to help spread the word<b...
The Health Story ProjectHarmony with Healthstory Clinical Narrative and Structured Data in the EHR<br />Kim  Stavrinaki<br...
Nick van Terheyden, MD, CMO, M*Modal<br />Twitter			http://twitter.com/drnic1<br />Technorati		http://technorati.com/peopl...
Upcoming SlideShare
Loading in …5
×

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

1,031 views

Published on

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

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
1,031
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • 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) = &lt; 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 />

    ×