The document discusses the possibilities and implications of using the International Classification of Functioning (ICF) to power health information technology. It describes how incorporating standardized vocabularies like ICF and LOINC into electronic health records could allow for data reuse across settings, clinical decision support, and a more seamless exchange of health information. This would help realize the vision of a healthcare system with coordinated, consumer-centered care enabled by digital tools.

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. photo via Sadie Hernandez

3. The Future
Great Scott!

4. Complete,
longitudinal
information that
follows the consumer

5. Care that is
value-based and
coordinated
across settings
photos via meddygarnet and brykmantra

6. Health decisions made
with information tools that
assist and guide
Have you
considered…

7. Results
Fewer errors, waste, variations
Consumer-centered care
Lower spending

8. Meanwhile, back
on planet Earth…

10. Patients move
faster and further
than their health
information

11. Growing Recognition
1960’s
• 1st studies of
computers in
healthcare
1991
• IOM says
EHR’s are
essential
2003
• HHS promotes
widespread
use of HIT

12. Evidence for Health IT
92%
of 154 studies

14. e first priority in realizing
the benefits of health IT is to
achieve nationwide adoption
of EHRs and widespread
information exchange.
“

15. 3 Ways EHRs can Help
Accelerate that Vision
Data reuse
Decision support
Canopy computing

16. practice management, quality reporting,
accreditation, public health, research…
Collect once. Use many.

17. EHR Decision Support
A computer-generated
suggestion about care for
an individual patient
me

18. The secret sauce of the
HIT chicken soup
photo via Robert Couse-Baker

19. 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.

20. Indiana Network For Patient Care
A Unified Patient Record

21. How does all this relate to ICF?

23. Fundamental challenge:
local systems have
idiosyncratic ways of
identifying similar concepts

24. Vocabulary standards
provide the linuga franca.

25. Standards
^
Functional Status
ICF: categories of function
LOINC: assessments (observations)

26. We all know
about ICF…

27. Logical
Observation
Identifiers
Names and
Codes
A universal code system that facilitates exchange,
pooling, and processing of results

28. 15,500+ users in 145 countries

29. MEASUREMENTS
US

30. 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

31. How fast does my
patient usually walk?
41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon

32. 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.

33. Warning:
Long road ahead.

34. Getting Back to
the Future
Moving towards semantic
interoperability

35. Might start
with templates
photo via Marcin Wichary

36. 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

37. Some Advantages
ICF worldview
Same labels and meaning

38. 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”

39. 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

40. Now we have a powerful
set of coded data that
computers can operate on
and exchange between
independent systems in
an understandable way.

41. 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

42. 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

43. 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

44. Key Lesson
of Today
photo via IMLS DCC

45. 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