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www.hl7.org | www.healthstory.com

Using Standards to Get to Meaningful Use: Exchange

Basic Records and Meet Early Requirements

Kim Stavrinaki

sPresenters: Liora Alschuler, Alschuler Associates, LLC

Bob Dolin, MD, Semantically Yours, LLC

Facilitator: Joy Kuhl, Health Story Project

Wednesday, July 21, 2010

Welcome! Please note that your line is on mute due to the large number of participants


Agenda

Agenda review

Housekeeping

Purpose

Introductions

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Presentation

Dialogue with the speakers


Housekeeping

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Audio and Slide Presentation

Posted online by end of week at www.healthstory.com


Purpose


INTRODUCTIONS


Liora Alschuler

Principal, Alschuler Associates, LLC

Health Story Executive Committee

Led project that produced design of first XML-based exchange specification for healthcare

Co-editor of HL7 CDA, CCD and many HL7 implementation guides that leverage the CCD templates

Founding member of Health Story and leads technical strategy and development


Bob Dolin, MD

Principal, Semantically Yours, LLC

Chair, HL7

15 years experience with interoperability standards

Co-editor of HL7 CDA, CCD and Using SNOMED CT in HL7 V3

Member of ONC HIT Standards Committee, Vocabulary Task Force

Co-chaired HITSP Foundations Committee

Prior member of SNOMED International Editorial Board


Agenda

Agenda review

Housekeeping

Purpose

Introductions

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Presentation



Meaningful Use?


Meaningful Use!

Image courtesy of M*Modal


Session Overview

Health Story interoperability strategy

How Health Story leads to meaningful use

What this means for you


HEALTH STORY INTEROPERABILITY STRATEGY


What is Meaningful Use?

“Meaningful use, in the long-term, is when EHRs are

used by health care providers to

improve patient care, safety and

quality.”

David Blumenthal, MDNational Coordinator for HIT


Meaningful Use ≈ Data Reuse

patient care

billing/claims

adjudication

research

quality reporting

clinical decisio

n suppor

t

outcomes analysis


Meaningful Use ≈ Data Reuse

“If you can not measure it, you can not improve it.”

Lord Kelvin (1824-1907)


The Health Story Project

Non profit, industry alliance Founded 2007 Associate Charter

Agreement: HL7 Sponsor HL7 standards for

flow of information between narrative and EMR systems

Member organizations provide direction


Health Story Members

Founding Members

ParticipantsAll Type | Arrendale Associates | BayScribe

Documentation Services Group | Healthline, Inc.

Broward Sheridan Technical Center | MD-IT

New England Medical Transcription | Sten-Tel, Inc.

Contributors Aprima Software | Scribe Healthcare Technologies

Promoters


Health Story: Guiding Principles

7. Use proven technology

6. Base strategy on existing standards

5. Minimize disruption to clinician workflow

4. Provide a glide path for incremental interoperability

3. Enable broad stakeholder engagement

2. Leverage current technology investments

1. Inclusive and open process


EHR Repository

HIM Applications

Clinical Applications

SNOMED CT

Disease, DF-00000Metabolic Disease, D6-00000

Disorder of glucose metabolism, D6-50100

Diabetes Mellitus, DB-61000

Type 1, DB-61010

Insulin dependant type IA, DB-61020

Neonatal, DB75110

Carpenter Syndrome, DB-02324

Disorder of carbohydrate metabolism, D6-50000

Health Story: Incremental Interoperability


HL7 Clinical Document Architecture

Health Story specifications are based on HL7 CDA

CDA is “just right” Single standard for entire

EHR is too broad Multiple standards and/or

messages for each EHR function may be too difficult to implement


Other benefits of CDA: Normative HL7 standard since 2000 Widely implemented Provides a gentle on-ramp to information

exchange Provides mechanism for inserting evidence-

based medicine directly into the process of care

Top down strategy lets you implement once and reuse many times for new scenarios

HL7 Clinical Document Architecture


Based on HL7 CDA

Clinical Document Architecture supports: Human readable document Machine-processable data (e.g. discrete

reportable transcription) Cross platform and application independent

Health Story Approach Standardize through ANSI SDO (HL7 ballot)

Support Meaningful Use

Minimum Optimum

• CDA header • Standard section codes

• Broad industry agreement on clinical content

• Reuse of entry-level templates• “Templated CDA”


Health Story Documents

Blend between free form text and fully structured documentation that represent the thought process, and capture the clinical facts Health Story makes “discrete reportable transcription” work


Minimal Document for Exchange

<recordTarget> <patientRole> ... <patient> <name> <given>Adam</given> <family>Everyman</family> </name> </patient> </patientRole></recordTarget>


Achievable: Today

<component> <section> <templateId root="2.16.840.1.113883.10.20.2.8"/> <code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="46239-0" displayName="REASON FOR VISIT"/> <title>REASON FOR VISIT/CHIEF COMPLAINT</title> <text> <paragraph>Stomach ache.</paragraph> </text> </section></component>

Achievable: Meaningful Use

<entry typeCode="DRIV"> <observation classCode="OBS" moodCode="EVN"> <templateId root="2.16.840.1.113883.10.20.1.33"/>  <id extension="123456789" root="2.16.840.1.113883.19"/> <code codeSystem="2.16.840.1.113883.6.96" codeSystemName=”SNOMED” code="230056004" displayName="Cigarette smoking"/> <statusCode code="completed"/> <effectiveTime> <low value="1972"/> <high value="2000"/> </effectiveTime> <value xsi:type="ST">1 pack per day</value> </observation></entry>


Health Story and Meaningful Use

Required data is in clinical notes Physicians do not write summaries (CCR & CCD) Summary data is drawn from many sources, including clinical notes Some data may, increasingly, be direct-physician entered

Data required for Meaningful Use can be captured in clinical notes and integrated into the EHR Natural language processing: it’s real, it works, it’s available and it works

very well in the context of structured CDA templates Abstractors, computer assisted coding, transcription knowledge workers:

same workflow, altered coding focus

CDA templates ensure consistency, conformance

Template-driven dictation Standard templates give real-time feedback to dictation physicians

Ensure conformance, provide structured data


Templated CDA is the basis for ... Consult Note Continuity of Care Document Diagnostic Imaging Report Discharge Summary Healthcare-associated Infections, Public

Health Case Reports History and Physical Operative Note Personal Health Monitoring Plan-2-Plan Personal Health Record Procedure Note Quality Reporting Document Minimum Data Set Unstructured Documents … and more …

HITSP/C28 Emergency Care Summary

HITSP/C32 - Summary Documents Using HL7 CCD

HITSP/C38 - Patient Level Quality Data Document Using IHE Medical Summary (XDS-MS)

HITSP/C48 Encounter Document constructs

HITSP/C84 Consult and History & Physical Note Document

HITSP/C78 Immunization Document HITSP/C74 PHRM HITSP/C62 Scanned document


“The key to intelligent

tinkering is to keep all the

parts.”Aldo Leopold


Today’s Workflow


Growing Use of Clinician EMR Interaction


Evolving Dictation/Transcription

iPhone images courtesy of M*Modal


Path to Meaningful Use

“A journey of a thousand miles begins with a single step.”

Lao-tzu, The Way of Lao-tzuChinese philosopher (604 BX – 531 BC)


Health Story Meaningful Use

Meaningful Use

Health Story Interoperability Strategy

Delivers common clinical documents to the point of care

Standardizing document types and sections today makes it easier to agree on data elements tomorrow

Incrementally adding key data elements into narrative is attractive to clinicians

Partial structuring facilitates natural language processing

Health Story’s path to Meaningful Use

Hit the ground running with basic CDA, to meet the needs of front line clinicians

Incrementally layer discrete data elements into CDA documents


Incrementalism Works for the Internet


Why Health Story?

HL7 Implementation Guide for CDA R2: Procedure Note Sample: Endoscopy Report

Judy Logan

Associate Professor

Oregon Health & Science University


WHAT THIS MEANS FOR YOU


Actionable Next Steps

Is your transcription supplier capable of producing an HL7 CDA document?

Is your EHR/document management system capable of receiving an HL7 CDA document?

Requirements:


Actionable Next Steps

Get involved in Health Story

Lead the industry

Weigh in on development priorities

Project is interested in tracking and highlighting implementations


A physician’s practical need for fast and easy methods for creating clinical documentation

The enterprise need forstructured and codedinformation capture to support meaningful use

In Summary

Computer image courtesy of M*Modal


Agenda

Agenda review

Housekeeping

Purpose

Introductions

------------

Presentation



Q&A


Contact Information

Bob Dolin, MD

Semantically Yours, LLC

[email protected]

Liora Alschuler

Alschuler Associates, LLC

[email protected]

Joy Kuhl

Health Story Project

[email protected]

www.hl7.org | using standards to get to meaningful use: exchange basic records and meet early...

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