Health Story Project: Making the Move to the EHR How to Cut the Paper Clutter Kim Stavrinaki Liora Alschuler Co-Founder, Health s Story Project CEO, Lantana Consulting Group Health Data Management Wednesday, March 14, 2012 2:00-3:00 ET
Goals of Today s Session Highlight the vision and goals of the Health Story Project Provide perspective on why HL7 CDA is ideally suited to be a Meaningful Use content standard Review the Health Story use case in the HIMSS Interoperability Showcase Demonstrate how Nuance Healthcare solutions can unlock valuable information in unstructured documents
Health Story Presenter Liora Alschuler CEO, Lantana Consulting Group Health Story Co Founder, Executive Committee Co-Editor, HL7 Clinical Document Architecture liora.alschuler@lantanagroup.com Led project that produced design of first XML-based exchange specification for healthcare Co-editor of HL7 CDA, Continuity of Care Document (CCD), and many HL7 guides that leverage CCD templates Founding member of Health Story and leads technical strategy and development
Meaningful Use
Meaningful Use meaningful use: thanks for the fax Meaningful Use: Certifiable! MEANINGFUL USE: Return on Investment
THE CHALLENGE
The Health Story Challenge A physician s practical need for fast and easy (30 sec) methods of creating clinical documentation The enterprise need for structured and coded information capture to support meaningful use
Health Story: Incremental Approach EHR Repository Clinical Applications Coded Discrete Data Elements HIM Applications HL7 CDA Structured Documents SNOMED CT Narrative Text Disease, DF- 00000 Metabolic Disease, D6-00000 Disorder of carbohydrate metabolism, D6-50000 Disorder of glucose metabolism, D6-50100 Neonatal, DB75110 Diabetes Mellitus, DB- 61000 Type 1, DB- 61010 Insulin dependant type IA, DB-61020 Carpenter Syndrome, DB-02324
Meaningful Use Data Reuse over the Full Health Story patient care quality reporting clinical decision support outcomes analysis billing/claims adjudication research
THE SOLUTION
Health Story Project Non profit, industry alliance Founded 2007 Associate Charter Agreement: HL7 Sponsored HL7 standards for common clinical documents (8!) Member organizations provide direction www.healthstory.com
Guides for 8 Common Documents
HOW IT WORKS
Based on HL7 CDA Standard HL7 Clinical Document Architecture Normative HL7 standard since 2000 Widely implemented Provides a gentle on-ramp to information exchange Abstract/generic specification covers all document/note/report types Meets use cases with constraints expressed as templates
Health Story Defines CDA Templates Templates are reusable building blocks Templates that are particularly relevant for CDA: 1. Constrain the document sections based on the type of document (section-level templates) 2. Constrain the entries within document sections (entry-level templates) <section>... <!-- template for Infection details section --> <templateid root="2.16.840.1.113883.10.20.5.5.6"/> <code codesystem="2.16.840.1.113883.6.1" codesystemname="loinc" code="51898-5" displayname="risk Factors"/> </section>
Health Story Relationship to HL7 CCD HL7 Continuity of Care Document CCD also based on CDA Health Story reuses CCD templates CCD Problem Observation (2.16.840.1.113883.10.20.1.28) CCD Procedure Activities (2.16.840.1.113883.10.20.1.29) CCD Medication Activities (2.16.840.1.113883.10.20.1.24) CDC s National Healthcare Safety Network reuses CCD templates CCD Reaction template (2.16.840.1.113883.10.20.1.54)
Clinical Document Standards Consolidation 0. HL7 Continuity of Care Document 1. HL7 History and Physical 2. HL7 Consult Note 3. HL7 Discharge Summary 4. HL7 Diagnostic Imaging Report 5. HITSP/C32 - Summary Documents Using HL7 CCD 6. HL7 Operative Note 7. HL7 Procedure Note 8. HL7 Unstructured Documents 9. HL7 Progress Notes 10. HITSP/C84 Consult and History & Physical Note Document 11. HITSP/C48 Encounter Document constructs 12. HITSP/C62 Scanned document Consolidated CDA HL7 Implementation Guide Health Story supported guides in blue
Creating Discrete Entries Methods for acquiring codes from notes: 1. Computer-assisted coding (CAC) 2. Natural language processing (NLP) 3. Data capture templates 4. Mobile and smartphone technology Applying standard HL7 CDA markup makes the discrete entries usable within an EHR and for the meaningful use program
Example: Discharge Summary
Benefit Health Story: Incremental Approach Retains patient story Preserves physician time for clinical care Supports meaningful use Enables data reuse Value Maintains primary role of documentation to clearly describe and communicate what is going on with patient. Makes efficient use of physician time by enabling choice of documentation methods and fosters EMR acceptance Interoperability: implements HL7 CDA document standards for electronic exchange of clinical information Structured narrative enables better outcomes reporting, data mining, and decision support Collaborative approach Developed by broad array of providers, vendors and IT organizations; Balloted process through HL7 supports harmonization Better documentation Supports better coding, DRG optimization = better reimbursement
Demonstrating Consolidated CDA on the floor at HIMSS12
Health Story Telling: HIMSS12 Clinical Document Ecosystem People Platforms Applications Clerk Imaging Dictating MD Transcriptionist Abstractor Integration Platform Voice capture Voice to text Desktop Telephone appliances PDR Transcription Scan-to- Smart Speech CDA phone recognition OCR Enrich NLP DRT CAC Standard format CDA ICD, CPT HL7 V2 Meaningful Use H e a l t h S t o r y HIE MRM EMR Billing Analytics Quality
Aldo Leopold(1887 1948) Author, scientist, ecologist, forester, and environmentalist, professor at the University of Wisconsin; wrote A Sand County Almanac (1949), which has sold over two million copies The key to intelligent tinkering is to keep all the parts. All the parts, HIMSS 2012: History & Physical Progress Note Unstructured Documents Referral Request Consult Note (Referral Response) Lab Report CCD Summary
WHERE TO START
Path to Meaningful Use A journey of a thousand miles begins with a single step. Lao-tzu, The Way of Lao-tzu Chinese philosopher (604 BX 531 BC)
Actionable Next Steps 1. Providers: Is your documentation vendor set up to deliver CDA documents? If no, when? Is your EHR vendor set up to receive CDA documents? If no, when? 2. Vendors: Check out the requirements here: www.healthstory.com 3. Join the Project!
UNSTRUCTURED CDA
Guides for 8 Common Documents
Standardizing Unstructured Documents Advantage: Standard Metadata Standard data for exchanges Index, Classify Search Catalog in standard repository (HIE, XDS, etc.) Advantage: Standard Display Single Stylesheet Constrained display formats Advantage: Consistent path to upgrade & enhance Transform Retain header/versioning
Paper to EMR Unstructured CDA
Contact Information Liora Alschuler CEO, Lantana Consulting Group Health Story Co Founder, Executive Committee Co-Editor, HL7 Clinical Document Architecture liora.alschuler@lantanagroup.com Led project that produced design of first XML-based exchange specification for healthcare Co-editor of HL7 CDA, Continuity of Care Document (CCD), and many HL7 guides that leverage CCD templates Founding member of Health Story and leads technical strategy and development