The document discusses the Health Story Project, which aims to automatically generate structured and encoded clinical documents from dictation. This would enable dictation to continue as physicians' preferred documentation method while also making the information accessible in electronic health records. The project transforms dictation into clinical documents compliant with HL7 standards. Members advocate expanding meaningful use to recognize use of EHRs integrated with dictation via Health Story standards. This would bridge narrative notes and structured data, improving documentation quality and enabling uses like clinical decision support.
Healthstory Enabling The Emr - Dictation To Clinical DataNick van Terheyden
EHRs are database centric while medical records are document centric. The conventional wisdom is that documents are bad and discrete data is good. Historically, clinicians have resisted efforts to establish structured data standards for dictated reports. This lack of an industry-wide standard for report content and format confounds interoperability efforts. For nearly two decades, information system specialists have attempted to impose new documentation methods that are more suited to database management but do not meet the needs of the practicing physician. Achieving physician buy-in for electronic record systems that do not accommodate narrative documentation methods such as dictation and transcription has proven to be quite difficult for many EHR vendors.
The Health Story Project (formerly the CDA4CDT initiative Clinical Document Architecture for Common Data Types) is an alliance of organizations that have been working together with HL7 for nearly two years to develop and publish data standards for electronic clinical documents. The initiative is based on Clinical Document Architecture (CDA) - a balloted HL7 document markup standard that specifies the structure and semantics of a clinical document for the purpose of exchange. Document templates for the most commonly dictated report types (H&P, Consult, Operative Note, etc) specify required and optional headings. Templates are developed based on prevailing practice and establish consensus on content and format
Speech Understanding Dictation To Clinical Data - TEPR 2009Nick van Terheyden
Speech Understanding automatically converts the spoken work into structured and encoded clinical data that provides access to relevant diagnostic support, evidence based medicine and real time alerts.
Unlocking the data tucked away in the vast mountain of documents produced as part of delivering care to patients is possible today with Speech Understanding, the next generation of speech recognition technology that not only improves the overall efficiency of the documentation process by producing higher quality, more accurate clinical data but also produces structured encoded clinical data that can populate EMR’s that are crying out for high quality input. This information is encoded using the HL7’s Clinical Document Architecture (CDA) and Common Document Types (CDA4CDT).
With knowledge of the meaning the output from Speech Understanding is now able to identify concepts, organize documents into meaningful categories and create a semantically interoperable document .
Presented a paper by Mario Kovac on E Health. Where He proposed a very comprehensive framework for healthcare interoperability. These slides contain brief description of mario's work.
Healthstory Enabling The Emr - Dictation To Clinical DataNick van Terheyden
EHRs are database centric while medical records are document centric. The conventional wisdom is that documents are bad and discrete data is good. Historically, clinicians have resisted efforts to establish structured data standards for dictated reports. This lack of an industry-wide standard for report content and format confounds interoperability efforts. For nearly two decades, information system specialists have attempted to impose new documentation methods that are more suited to database management but do not meet the needs of the practicing physician. Achieving physician buy-in for electronic record systems that do not accommodate narrative documentation methods such as dictation and transcription has proven to be quite difficult for many EHR vendors.
The Health Story Project (formerly the CDA4CDT initiative Clinical Document Architecture for Common Data Types) is an alliance of organizations that have been working together with HL7 for nearly two years to develop and publish data standards for electronic clinical documents. The initiative is based on Clinical Document Architecture (CDA) - a balloted HL7 document markup standard that specifies the structure and semantics of a clinical document for the purpose of exchange. Document templates for the most commonly dictated report types (H&P, Consult, Operative Note, etc) specify required and optional headings. Templates are developed based on prevailing practice and establish consensus on content and format
Speech Understanding Dictation To Clinical Data - TEPR 2009Nick van Terheyden
Speech Understanding automatically converts the spoken work into structured and encoded clinical data that provides access to relevant diagnostic support, evidence based medicine and real time alerts.
Unlocking the data tucked away in the vast mountain of documents produced as part of delivering care to patients is possible today with Speech Understanding, the next generation of speech recognition technology that not only improves the overall efficiency of the documentation process by producing higher quality, more accurate clinical data but also produces structured encoded clinical data that can populate EMR’s that are crying out for high quality input. This information is encoded using the HL7’s Clinical Document Architecture (CDA) and Common Document Types (CDA4CDT).
With knowledge of the meaning the output from Speech Understanding is now able to identify concepts, organize documents into meaningful categories and create a semantically interoperable document .
Presented a paper by Mario Kovac on E Health. Where He proposed a very comprehensive framework for healthcare interoperability. These slides contain brief description of mario's work.
Excellent deck making the case that exchange of health data (interoperation, interoperability) should be encouraged through simple exchange mechanisms.
In light of Cloud Computing System CDA Generation and Integration for Health ...IJAEMSJORNAL
Theoretical Successful sending of Electronic Health Record enhances tolerant security and nature of care, however it has the essential of interoperability between Health Information Exchange at various doctor's facilities. The Clinical Document Architecture (CDA) created by HL7 is a center record standard to guarantee such interoperability, and engendering of this archive configuration is basic for interoperability. Lamentably, clinics are hesitant to receive interoperable HIS because of its organization fetched with the exception of in a modest bunch nations. An issue emerges notwithstanding when more healing facilities begin utilizing the CDA archive arrange on the grounds that the information scattered in various reports are difficult to oversee. In this paper, we portray our CDA report era and incorporation Open API benefit in light of distributed computing, through which doctor's facilities are empowered to advantageously create CDA archives without purchasing restrictive programming. Our CDA archive combination framework incorporates various CDA records per tolerant into a solitary CDA report and doctors and patients can peruse the clinical information in sequential request. Our arrangement of CDA report era and joining depends on distributed computing and the administration is offered in Open API. Engineers utilizing distinctive stages along these lines can utilize our framework to improve interoperability.
An overview of clinical healthcare data analytics from the perspective of an interventional cardiology registry. This was initially presented as part of a workshop at the University of Illinois College of Computer Science on April 20, 2017.
Summary of Recommendations on Provider and Patient Identity ManagementBrian Ahier
Deven McGraw, Center for Democracy & Technology (Co-Chair, Tiger Team)
Walter Suarez, Kaiser Permanente, (Co-Chair, Privacy & Security Working Group, HITSC)
Peter Tippett, Chief Medical Officer, Verizon
Elizabeth Franchi, Director, Veterans Health Administration Data Quality Program
Paul Uhrig, Chief Administrative, Legal & Privacy Officer, Surescripts
Medical Transcription Service: Critical to the Success of a Healthcare FacilityChampak Pol
Professional Hi-Tech Transcription Services propose all kinds of transcription services such as medical transcription, education transcription, financial, focus group transcription, etc.…
Medical transcription services to abroad various industries like healthcare industry, hospitals, clinics, physician and government healthcare departments depends heavily.
Healthcare Integration | Opening the Doors to CommunicationBizTalk360
Integration plays the central role in connecting health systems to effortlessly communicate and share data, ultimately improving the quality and outcomes of health services. With an integration system in place, healthcare organizations can improve communication within their enterprise, connect to external entities, such as HIEs, laboratories, and long-term care facilities, and to patient platforms, such as Microsoft HealthVault. With established and evolving standards, such as HL7 v2 & v3, CDA, XDS, and FHIR, healthcare organizations now more than ever need a robust interoperability solution to meet and support these requirements.
Challenges and Opportunities Around Integration of Clinical Trials DataCitiusTech
Conducting a Clinical Trial is a complex process, consisting of activities such as protocol preparation, site selection, approval of various authorities, meticulous collection and management of data, analysis and reporting of the data collected
Each activity is benefited from the development of point applications which ease the process of data collection, reporting and decision making. The recent advancements in mobile technologies and connectivity has enabled the generation and exchange of a lot more data than previously anticipated. However, the lack of interoperability and proper planning to leverage this data, still acts as a roadblock in allowing organizations truly harness their data assets. This document will help life sciences IT professionals and decision makers understand challenges and opportunities around clinical data integration
Slide Presentation for the Week10 Activity of HI 201. Some of the pictures used in the presentation are from http://all-free-download.com/free-photos/.
This presentation will provide insight into Watson’s DeepQA process, the complexities and
details of the DeepQA challenge, and how these tools and techniques can be applied in a clinical setting. Prototype tools will be presented that open conceptual frameworks for
delivering advanced analytics in the radiologist’s workplace that offer rapid access to critical, specific and highly relevant data with corresponding links to underlying evidence.
Excellent deck making the case that exchange of health data (interoperation, interoperability) should be encouraged through simple exchange mechanisms.
In light of Cloud Computing System CDA Generation and Integration for Health ...IJAEMSJORNAL
Theoretical Successful sending of Electronic Health Record enhances tolerant security and nature of care, however it has the essential of interoperability between Health Information Exchange at various doctor's facilities. The Clinical Document Architecture (CDA) created by HL7 is a center record standard to guarantee such interoperability, and engendering of this archive configuration is basic for interoperability. Lamentably, clinics are hesitant to receive interoperable HIS because of its organization fetched with the exception of in a modest bunch nations. An issue emerges notwithstanding when more healing facilities begin utilizing the CDA archive arrange on the grounds that the information scattered in various reports are difficult to oversee. In this paper, we portray our CDA report era and incorporation Open API benefit in light of distributed computing, through which doctor's facilities are empowered to advantageously create CDA archives without purchasing restrictive programming. Our CDA archive combination framework incorporates various CDA records per tolerant into a solitary CDA report and doctors and patients can peruse the clinical information in sequential request. Our arrangement of CDA report era and joining depends on distributed computing and the administration is offered in Open API. Engineers utilizing distinctive stages along these lines can utilize our framework to improve interoperability.
An overview of clinical healthcare data analytics from the perspective of an interventional cardiology registry. This was initially presented as part of a workshop at the University of Illinois College of Computer Science on April 20, 2017.
Summary of Recommendations on Provider and Patient Identity ManagementBrian Ahier
Deven McGraw, Center for Democracy & Technology (Co-Chair, Tiger Team)
Walter Suarez, Kaiser Permanente, (Co-Chair, Privacy & Security Working Group, HITSC)
Peter Tippett, Chief Medical Officer, Verizon
Elizabeth Franchi, Director, Veterans Health Administration Data Quality Program
Paul Uhrig, Chief Administrative, Legal & Privacy Officer, Surescripts
Medical Transcription Service: Critical to the Success of a Healthcare FacilityChampak Pol
Professional Hi-Tech Transcription Services propose all kinds of transcription services such as medical transcription, education transcription, financial, focus group transcription, etc.…
Medical transcription services to abroad various industries like healthcare industry, hospitals, clinics, physician and government healthcare departments depends heavily.
Healthcare Integration | Opening the Doors to CommunicationBizTalk360
Integration plays the central role in connecting health systems to effortlessly communicate and share data, ultimately improving the quality and outcomes of health services. With an integration system in place, healthcare organizations can improve communication within their enterprise, connect to external entities, such as HIEs, laboratories, and long-term care facilities, and to patient platforms, such as Microsoft HealthVault. With established and evolving standards, such as HL7 v2 & v3, CDA, XDS, and FHIR, healthcare organizations now more than ever need a robust interoperability solution to meet and support these requirements.
Challenges and Opportunities Around Integration of Clinical Trials DataCitiusTech
Conducting a Clinical Trial is a complex process, consisting of activities such as protocol preparation, site selection, approval of various authorities, meticulous collection and management of data, analysis and reporting of the data collected
Each activity is benefited from the development of point applications which ease the process of data collection, reporting and decision making. The recent advancements in mobile technologies and connectivity has enabled the generation and exchange of a lot more data than previously anticipated. However, the lack of interoperability and proper planning to leverage this data, still acts as a roadblock in allowing organizations truly harness their data assets. This document will help life sciences IT professionals and decision makers understand challenges and opportunities around clinical data integration
Slide Presentation for the Week10 Activity of HI 201. Some of the pictures used in the presentation are from http://all-free-download.com/free-photos/.
This presentation will provide insight into Watson’s DeepQA process, the complexities and
details of the DeepQA challenge, and how these tools and techniques can be applied in a clinical setting. Prototype tools will be presented that open conceptual frameworks for
delivering advanced analytics in the radiologist’s workplace that offer rapid access to critical, specific and highly relevant data with corresponding links to underlying evidence.
Friendticker 2010 Slideshare Information 2servtag GmbH
Friendticker is a location-based mobile marketing platform that puts brands in front of customers by adding virtual check-ins to their brand or venue. Friendticker gives real-life value to a customer's mobile actions beyond the gaming aspect of first generation virtual check-in technology.
WIH Resource Group, Inc. (WIH) is leading independent provider of environmental, waste management, recycling, transportation, alternative fuels, financial and logistical matters. WIH provides its clients with fully integrated solutions to day to day business challenges and offers Clients creative solutions to solve complex business issues and related matters for government municipalities, industrial companies, environmental, engineering firms, non-profits and commercial customers alike.
WIH Staff takes our Client relationships seriously and strive to exceed our client’s individual expectations and stated needs. We look to establish long term relationships with our clients, ones where we are called on regularly to assist our clients in developing viable and sustainable solutions.
www.edilnotizie.it Si allegano gli atti del corso tenuto, presso la sala riunione dell'Ordine il giorno 11 ottobre 2008, dagli ingg.Roberto Conti e Vincenzo Scuto sugli impianti fotovoltaici nell'ambito dei minicorsi sui PRINCIPI BASILARI PER LA PROGETTAZIONE: IMPIANTI TECNICI NELL’EDILIZIA CIVILE E COMMERCIALE .
Netwerken doen we eigenlijk dagelijks. We doen het op de gekste plaatsen zoals de sportschool, het pompstation, via LinkedIn of Twitter.
Toch willen veel ondernemers zich nog binden aan een netwerk waar ze vooraf voor moeten betalen met geen garantie op succes. "Waarom?"
Door anders naar netwerken te kijken is WeConnect een jong en fris netwerk voor ondernemers geworden.
We geven op aanvraag een training, coaching, brainstormsessie en/of zorgen voor concept realisatie en koppelen deze aan spraakmakende bijeenkomsten en deelnemers.
Wij zorgen dat ondernemers verbonden worden voor samenwerkingen, om leads te genereren en om kennis te delen.
WeConect is hierdoor hét daadkrachtige netwerk in dé branche voor ondernemers geworden.
Healthstory Enabling The Emr Dictation To Clinical DataNick van Terheyden
EHRs are database centric while medical records are document centric. The conventional wisdom is that documents are bad and discrete data is good. Historically, clinicians have resisted efforts to establish structured data standards for dictated reports. This lack of an industry-wide standard for report content and format confounds interoperability efforts. For nearly two decades, information system specialists have attempted to impose new documentation methods that are more suited to database management but do not meet the needs of the practicing physician. Achieving physician buy-in for electronic record systems that do not accommodate narrative documentation methods such as dictation and transcription has proven to be quite difficult for many EHR vendors
The Health Story Project (formerly the CDA4CDT initiative Clinical Document Architecture for Common Data Types) is an alliance of organizations that have been working together with HL7 for nearly two years to develop and publish data standards for electronic clinical documents. The initiative is based on Clinical Document Architecture (CDA) - a balloted HL7 document markup standard that specifies the structure and semantics of a clinical document for the purpose of exchange. Document templates for the most commonly dictated report types (H&P, Consult, Operative Note, etc) specify required and optional headings. Templates are developed based on prevailing practice and establish consensus on content and format
Clinical Narrative And Structured Data In The Ehr Venus And Mars Live In Harm...Nick van Terheyden
For nearly two decades healthcare technology has attempted to impose new documentation methods that are more suited to database management but do not meet the needs of the busy practicing physician. Conventional wisdom is that documents are bad and discrete data is good but historically clinicians have resisted efforts to establish structured data entry methodologies trying to replace the clinician preferred method of data capture – dictation. Clinical Document Architecture for Common Document Types (CDA4CDT) offers a bridge between the two opposing worlds of clinical documentation creating semantically interoperable data while retaining the precise clinical content contained in free flowing narrative
Anne Casey RN MSc FRCN
Editor, Paediatric Nursing
Royal College of Nursing Adviser on Information Standards
Clinical Domain Lead, NHS Information Standards Board for Health and Social Care
(17/10/08, Plenary session 2)
Exploring the potential of technology and innovation - everything from wearables, genomics and robotics that are washing over healthcare at an exponential rate and influencing every aspect of our lives and what it will mean to our healthcare system and in particular to how we deliver healthcare to the population.
What are the next big innovations that will affect telehealth and how might they affect you and your organization. How should you plan for these changes and what can you do to incorporate them into your business? What small incremental improvements can you take to move you along the path towards the next leap in innovation.
Predictive Modeling is Here - Dance with the Dragon of Artificial IntelligenceNick van Terheyden
Presentation at AHIMA on Predictive Modeling given on September 24, 2018:
Welcome to the age of data – the revolution has arrived made possible by new sources of data available in every industry and every walk of life. No area has been untouched and we see examples from baseball to the steady stream of customized adverts and content. Big data is improving the utilization of resources, efficiency, capacity, and ultimately access to healthcare. The next frontier is predicting futures. Can we identify the patients that are sickest and mitigate their disease progression? Traditional population health programs have focused on the high utilization patients predicting their progression and applying interventions to improve their health and decrease the costs associated with treating their disease progression. But the analysis of data has its perils risking false discoveries as our unconscious bias impacts our search of these huge troves of data in a modern-day version of “I know the facts, now let’s find ‘em” to “confirm” our facts. But the reality of healthcare and increasing insights into a precision-guided healthcare system it is increasingly clear that no membership population is “average”. The interplay between even a couple of input factors and comorbidities can be very non-linear.
Dr Nick will explore the potential for technology and innovation - everything from wearables, genomics and robotics that are washing over our world at an exponential rate and influencing every aspect of our activities and what it will mean to our lives and in particular to the delivery of healthcare.
How can this technology revolution change the cost profile and democratize access to healthcare? Join Dr Nick as he takes you on an exciting journey into the future of healthcare and the exciting developments that will increase accessibility to healthcare and will revolutionize the way care is delivered.
Patients’ own expectations for technology are growing and they have shared that digital technologies need to become more integral in the care delivery process. In the U.S., nearly half of Americans would opt for online capabilities vs. handling over the phone, such as getting lab test results, filling out paperwork ahead of a doctor’s appointment, accessing their medical records, and filling prescriptions. Given the increasing desire for a tech-driven care experience, patients are helping to spur technology adoption by their providers.
As the population ages, technology adoption and information exchange within the long term and post-acute care settings becomes increasingly more important. How can post-acute care agencies overcome challenges of limited resources (financial and workforce) to bring patient care delivery into the 21st century? Patients who take prescription medications for chronic conditions are also feeling the pain from a lack of tech-adoption when their doctors typically don’t offer them access to online condition management tools or make themselves available online or via email for questions. Dr. Van Terheyden will discuss what needs to happen to break down these barriers.
Digital health summit - Baylor Scott & White innovation panelNick van Terheyden
Overview of the status and need for Digital Health delivered at the Baylor Scott and White Digital Health Summit focusing on innovation and the risks and rewards and the innovation process
Will healthcare be delivered by george jetson in the futureNick van Terheyden
Gartner ranked Dell the #1 worldwide IT services provider in healthcare in 2014. Dell sees global disruptions in healthcare delivery and continues to invest in strategies to address these rapid changes. They are actively enhancing development, implementation and adoption of novel technologies, services, and applications that will revolutionize information-driven care, resulting in improved patient outcomes and overall cost savings worldwide. Dr. Nick is responsible for providing strategic insight and will discuss some Dell’s strategies to achieve an IT environment that is interconnected, efficient and patient-focused.
Gartner ranked Dell the #1 worldwide IT services provider in healthcare in 2014. Dell sees global disruptions in healthcare delivery and continues to invest in strategies to address these rapid changes. They are actively enhancing development, implementation and adoption of novel technologies, services, and applications that will revolutionize information-driven care, resulting in improved patient outcomes and overall cost savings worldwide. Dr. Nick is responsible for providing strategic insight and will discuss some Dell’s strategies to achieve an IT environment that is interconnected, efficient and patient-focused.
AHIMA Game of documentation - dance with the icd10 dragonNick van Terheyden
Following on from AHIMA 2014 this AHIMA 2015 session will follow last years Successful Presentation “Game of Documentation: Winter is Coming – Surviving ICD-10” to address the genuine concerns of clinicians and demonstrate to them why they must not just accept ICD10 but should be demanding it. As Yoda said
“Always in motion is the future…a little more knowledge lights our way.”
ICD-10 has been implemented but resistance remains high and in a recent remarks by the AMA president that said
“If it was a droid, ICD-10 would serve Darth Vader… For more than a decade, the AMA kept ICD-10 at bay – and we want to freeze it in carbonite!”
But despite this the financial viability and performance of hospitals and physicians are impacted by poor quality of data that is captured with an outdated 1970s-era coding system
The first leap into big data is collecting information with precision and clarity – something that cannot be achieved with a coding system that does not capture Ebola nor the basic classification of myocardial infarction STEMI and Non-STEMI. Everyone – ICD10 supporters and opponents wants the best possible care when they access our healthcare system – but how do they know they are receiving this if we are unable to accurately collect information about diseases and treatments and link outcomes to treatments.
https://ahima.confex.com/ahima/87am/webprogram/Session6176.html
I manage my health with digital tools and I’m not alone. An estimated and growing 69% of consumers and patients are also engaged in monitoring their own healthcare . The interest in personal wellness combined with the proliferation of healthcare ‘wearables’ available to consumer puts us on the cusp of an extraordinary shift in healthcare: Technology enabled patients are empowered to change their lifestyle to prevent or stop chronic disease, and become healthier than ever before. The implications of this on every aspect of the healthcare industry –from delivery and population health to access and cost will be astounding.
But wearable technology is still in its infancy, quite complex and limited in what it can do. The next generation will be intelligent and voice-enabled and go beyond tracking to interacting with and assisting consumers with their healthcare choices, and changing behaviors for the better. Imagine a wearable that could warn you of risks developing, nudge you towards better choices for that day based on your health profile, and keep you engaged in a treatment regime.
Connected Health - The small matter of price - Nick van Terheyden, MDNick van Terheyden
The Centers of Medicare & Medicaid Services decision to include some reimbursement in 2015 for remote monitoring is hailed as a revolutionary step for mHealth. Here are some insights from the different ecosystem players.
- With more insurance plans being open to telemedicine coverage and remote patient monitoring, see how you can take advantage of these new payments and partner with the right groups
- With Medicare fining a record number of hospitals - 2,610 - for having too many patients returning within a month. See how hospitals are adapting to the charges and changes
- Explore the advantages of preventative care at a population management and enterprise level, creating healthier workforces with less strain on the medical system and lowering insurance pay outs
An exploration of Social media through the eyes of a Chief Medical Officer and clinicians. How can they effectively leverage resources in healthcare marketing and social media. Learn about the roles, responsibilities and activities of these clinical professionals and how they can be effectively used to extend marketing reach and build market thought leadership programs
Your health is personal, and largely your responsibility. It’s good to know then that growing numbers of people are increasingly interested in their health and are taking matters into their own hands – especially when it comes to behaviors they can change that benefit their wellbeing
Wearable’s can be always present and personal offering ease of use but more importantly using voice to reinforce good behaviors and maybe even admonish bad.. What if you could have your physician or some other personal inspirational figure record a reminder for you take your medicine on your wearable?
This presentation will bring together the concepts of wearable devices, the connectivity of the internet of things and the importance of intelligent voice in turning this exciting vision of our future into the reality of tomorrow
Master chef in healthcare- integrating social media - @DrNic1Nick van Terheyden
Social Media is rapidly becoming an integral part of our lives. Despite the pervasive nature of the communication channel healthcare remains a technology laggard. This presentation will offer insights to help understand why they should join the community,
Whether the user is interacting with a mobile device, a web site, or a phone-based health technology system, there is often a large gap between what the user wants to accomplish and how they want to accomplish it, and what they actually get from the system. The interface can be challenging and capturing any feedback or user interactions is difficult using on keyboards and point and click tools. Speech Recognition is changing this interaction by capturing the clinical input and allowing clinicians and healthcare users to access systems that listen and responds seamlessly understanding the context and the intent turning what the users wants into what they get.
In this billion dollar industry, there is no shortage of investment. How to make these investments grow is an area where more clarity is required.
See facts & stats about how mHealth services e.g. remote monitoring reduces pay outs for both the single (gov) and private (insurer) payers to develop an irresistible pitch and win payer clients
Explore the payment model The Centre of Medicaid has adopted for telemedicine services to see if this can be extended for broader health management and expand your services
Assess how corporations are rolling out mHealth services throughout their workforce to reduce absenteeism and health plan payouts to align sales strategies and build market momentum
Game of documentation, Winter is coming Surviving ICD10Nick van Terheyden
Accurate clinical documentation is a prerequisite for high quality patient care, medical record and billing compliance,
accuracy of quality metrics, and support of revenue cycle and HIM functions. While current EMRs address many of the issues surrounding
aggregation of clinical data, they present significant challenges to physicians especially as they try to capture accurate and the clinically
relevant information necessary to deliver high quality care. The resulting smorgasbord of content is left to CDI specialists and HIM staff to
review abstract and assess for completeness and compliance. Additionally as ICD-10 implementation require increasingly complex and
detail content with specific terminology to meet the more detailed coding requirements placing a burden on everyone involved in the care
and capture of clinical patient information.
Discuss challenges of EMR content awareness and analysis, and current disconnected documentation clarification processes;
Explain methodologies to engage physicians in the CDI process
Describe how technology can assist with documentation improvement and acceptance
Identify status of current advanced CDI programs and the opportunity for integration of evolving technological innovations
Pipeline session speech and medical intelligence – revolutionizing the doctor...Nick van Terheyden
speech and medical intelligence – revolutionizing the doctor and patient experience
Speech is delivering efficiencies and improves EHR adoption
Adding Clinical Language Understanding is set to revolutionize healthcare delivery allowing the clinician to focus on the patient not the technology delivering real time medical intelligence at the point of care.
Medical Intelligence helps healthcare providers transform patient stories into high-value clinically actionable medical information
Improving the quality, efficiency and value of documentation and help drive better care without burdening the clinicians with data entry tasks
Pipeline session speech and medical intelligence – revolutionizing the doctor...
Healthstory Project Overview - Dictation To Clinical Data For AHDI
1. Welcome!The Health Story ProjectDictation to Clinical Data: Automating the Production of Structured and Encoded Documents Kim Stavrinaki s AHDI Conference, July 2009 Nick van Terheyden, MD, Chief Medical Officer, M*Modal
2. Presentation Overview Background: The Current Situation Enabling the EMR with the Missing Link A User Experience (GE/RISL) The Health Story Project Conclusion
4. 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.
5. 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 Incomplete and Inadequate Semantic Standards Direct Data Entry: Structured and encoded information.
6. 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 Under utilized source of data for EMR Dictation: Fast and easy, expressive.
7. 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
8. Enabling the EMR The Missing Link in Information Capture in Healthcare
9. 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 Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group
10. 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? Crossing the Chasm…
11. 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
12. 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
13. 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
15. User ExperienceGE/RISL Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare The Missing Link in Information Capture in Healthcare
16. 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
17. Results Reporting Workflow Data Center Dictation Report in conversational speaking Edit Mode using local capture tool – can either type to correct or voice commands When dictation is complete and EOL is pushed Report is returned ready for edits Dictating the Procedure
18. Results Reporting Workflow 2 Data Center After final sign the report is processed in the NLP engine for learning Edit Mode using local capture tool – voice in selection between brackets Voice in options for brackets, sign report, add via voice more dictation in the sections, then sign
19. Results Reporting Batch Mode Report goes to Medical Editor or signature queue, Radiologist moves on to next exam Dictating the Procedure When dictation is complete
24. Conversational Documentation EHR … transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs
25.
26. part-time radiologists can use it in batch digital dictation moderadiologist 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
27. The Health Story Project and Meaningful Clinical Documents Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare The Missing Link in Information Capture in Healthcare
28. 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
29. Health Story Document Types Implementation Guides Completed History & Physical Consultation Operative Report DICOM Imaging Reports Upcoming Discharge Summary in progress through HL7 Billing and Reimbursement Requirements Progress Notes .PDF work with Adobe
31. Our Advocacy To Date Participation in public comment periods NCVHS Hearing on Meaningful Use HHS Request for Input on Meaningful Use HITSP Request for Input on ARRA Comments are posted on our site www.healthstory.com
32. Our Advocacy Messages Dictation is the documentation method of choice for 85% of physician providers Standardization of dictated notes is an achievable step for providers; Standards are available today The current EHR systems certification process does not include requirements for integration with dictated notes per available standards The current draft definition of meaningful use focuses on recording clinical documentation in the EHR through data entry
33. Our Advocacy Requests Actions Requested: Require certified EHR systems to accept interfaced data from dictation/transcription process per available Healthstory standards Modify the definition of meaningful use to recognize use of certified EHR systems with the above capabilities 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
35. 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…
36. 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
37. Impact Allows providers to maintain preferred workflow and documentation methods Increases the value and usability of narrative documents Accelerates the implementation of interoperable electronic health records Allows reuse of information
38. Getting Involved Become an “Ambassador” We need a grass roots effort to help spread the word; Support our advocacy messages You can help educate your employers, clients, etc. about Health Story Joint the Effort Varying membership levels, including individuals Volunteer for a Project Currently developing data standards for discharge summary Participate in HL7 ballots on project draft standards Encourage Implementation E.g. Include requirements for standards in transcription RFPs