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Meaningful Use has entered the vernacular, and the political rhetoric is onthe healthcare pathway. But, what does it mean to me? As Victor Franklsaid, "One can choose one\'s attitude in any given set of circumstances," andwhile the picture of what Meaningful Use means to Clinical Documentationremains unclear you cannot just add water and go! To continue to be anintegral part of the successful and safe delivery of healthcare thedocumentation industry must understand the impact of healthcare legislationand Meaningful Use criteria and incorporate this into the solutions andservices they offer. This presentation will decode the requirements andtranslate these into individual and business actions to execute over thecoming year to deliver on the vision of Meaningful Use for ClinicalDocumentation.
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Health Story Project:Meaningful UseDay of Reckoning: Exchange Basic Records and Meet Early Requirements
Kim Stavrinaki
sCDIA PresentationThursday, April 14, 11:00 am-12:00 pm
Nick van Terheyden, MDChief Medical Information Officer - CLU, Nuance CommunicationsExecutive Committee, Healthstory ProjectBoard of Directors, CDIA
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Session Overview
1. Meaningful Use
2. Current Legislation and Requirements
3. The Current Healthcare Challenges
4. Health Story Project Solution
5. Where to Start
6. Q&A
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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.”
“HIT is the means, but not the end. Getting an EHR up and running
in health care is not the main objective behind the incentives
provided by the federal government under ARRA.
Improving Health is. Promoting health care reform is.
David Blumenthal, MDNational Coordinator for HIT
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Meaningful Use EHR Goals
Improve quality, safety, efficiency, and reduce health disparities
Engage patients and families
Improve care coordination
Improve population and public health
Ensure adequate privacy and security protections for personal health information
Largely aimed at driving healthcare organizations to collect and report on quality and safety metrics
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Meaningful Use: Core Set
Vital signs – structured data (>50%)
Problem List (1 entry for >80%)
Active Medication List (1 entry for >80%)
Smoking status (>50%)
Drug/Drug and Drug/Allergy Checking
e-Prescribing (>40%)
CPOE for medication (1 medication >30%)
Medication Allergy (1 entry >80%)
Patient Demographics (>50%)
Electronic Exchange (1 test exchange)
One clinical decision support rule
Implement privacy and security
Report Clinical quality Measures through attestation in 2011
Generate Electronic Summary (>50% within 3 days)
Provide e-copy to patients (>50% within 3 days)
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Meaningful Use – Menu Set
Medication Reconciliation (>50% of transitions of care)
Drug Formulary Checks (one internal or external formulary check)
Incorporate Labs as Structured Data (>40%)
Patients specific education (>10%)
Generate Lists of Patients by Condition
Summary of Care record (>50%)
Electronic Immunization Reporting (1 test submission)
Electronic syndrome surveillance (1 test submission)
Record Advance Directives (Hosp >50%)
Electronic submission of lab data (Hosp 1 test submission)
Patient Reminders for Preventative/f/u care (EP >20%)
Provide Patients with electronic access to Health Record (EP >105 within 4 days)
Summary of MU Measures available fromhttp://mycourses.med.harvard.edu/ec_res/nt/26F568D6-E6F3-418A-96B9-497666DEF5C0/MUQuick.pdf
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Paper is no longer fit for
purpose
Slide Courtesy of Dr Michael Bainbridge
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Meaningful Use!
Slide Courtesy of Nuance Communications
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CHALLENGE
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Source: Harvard Medical School, 2001Source: Harvard Medical School, 2001
Challenge – “Major” Medical Advances 1600 to 2000
Slide Courtesy of Dr Michael Bainbridge
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Reading to Keep up – Information Overload
Today's experienced clinician needs close to 2 million pieces of information to practice medicine
Doctors subscribe to an average of seven journals representing over 2,500 new articles each year, making it literally impossible to keep up-to-date with the latest information about diagnosis, prognosis and therapy
Comparison of the time required for reading (for general medicine, enough to examine 19 articles per day, 365 days per year ) with the time available (well under an hour per week by British medical consultants, even on self-reports ).
Furthermore, the interpretation of patient data is difficult and complicated, mainly because the required expert knowledge in each of the many different medical fields is enormous and the information available for the individual patient is multi-disciplinary, imprecise and very often incomplete.
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Years ago Today
This gap injures patients
Knowledge processing capacity
Knowledge processing requirement
“Current medical practice relies heavily on the
unaided mind to recall a great
amount of detailed knowledge – a
process which, to the detriment of all stakeholders, has repeatedly been
shown unreliable”
Crane and RaymondThe Permanente Journal
Winter 2003 Volume 7 No.1Kaiser Permanente Institute for
Health Policy
Challenge – Clinical Knowledge-Processing Burden
Slide Courtesy of Dr Michael Bainbridge
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Unstructured Data
Structured Data Dictation
and Transcripti
on
System generated
or interfaced data
Direct data entry, not physician
Direct data entry,
physician
Handwritten
Current Methods for Data Capture
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The Challenge of Narrative vs. Discrete dataBeyond convenience, quality of care at risk
The patient is a 74-year-old female who presents with a complaint of fall, she woke up this morning and had a donut for breakfast instead of her usual cheese bagel, while eating breakfast she heard the phone ringing in the upstairs bedroom. She ran upstairs to get it. She felt dizzy and fell down the stairs and broke her left foot.
Narrative Dictation Structured Entry
97% Narrative is more valuable to treating patients
96% May lose the patient’s unique story
Source: Nuance Survey with nearly 1,000 responses from physicians, Dec 2009
93% EHR does not reduce time spent documenting care
67% Reliance on keyboard and mouse […] is a major hurdle
The patient is a 74-year-old female who presents with a complaint of fall, she was playing soccer with her grandkids in the backyard and slipped and broke her left foot
Ex
am
ple
1E
xa
mp
le 2
The occurrence was one hour prior to arrival
The course of pain is constant
Location of pain: Left foot
Location of bleeding: None
Assessment: Broken Left Foot
The occurrence was one hour prior to arrival
The course of pain is constant
Location of pain: Left foot
Location of bleeding: None
Assessment: Broken Left Foot
donut
ran upstairs dizzy
Slide Courtesy of Nuance Communications
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Narrative
Text
Structured Documents
Extracted, Coded Discrete Data Elements
EHR Repository
HIM Applications
Clinical Applications
SNOMED CTDisease, DF-00000
Metabolic 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
Meaningful Clinical Documents
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The Challenge
Current Situation
• Wide variety of specialties/ settings/workflows
• Want to focus on patient care
• Value rich patient narrative• Want improved productivity• Comfortable with dictation
Goal: EHR Meaningful Use
Better care with accessible, up-to-date and codified patient info
Structured data for appropriate coding, billing and compliance
Reduced cost
Faster TAT
Clinician Adoption
93% EHR does not reduce time spent documenting care
67% Reliance on keyboard and mouse within an EHR is a major hurdle
97% Narrative is more valuable to treating patients
96% May lose the patient’s unique story with transition to point-and-click EHRs
Physicians say:
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Healthstory: The Bridge to EHR Adoption, Meaningful Use & Improved Operational Performance
Current Situation
• Wide variety of specialties/ settings/workflows
• Want to focus on patient care
• Value rich patient narrative• Want improved productivity• Comfortable with dictation
Goal: EHR Meaningful Use
Better care with accessible, up-to-date and codified patient info
Structured data for appropriate coding, billing and compliance
Reduced cost
Faster TAT
Clinician Adoption
We can get here today
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We Can Get Here TodayMRN: 00000
DOS: 11/11/2001
CHIEF COMPLAINT:Fatigue
SUBJECTIVE:Patient is a 25 year old woman complaining of feeling fatigued. Occasional dizziness. Sleeping difficulties and morning headaches.
OBJECTIVE:Recent bout with the flu
PHYSICAL EXAMINATION:Vital signs are normal with a blood pressure of 120/80, pulse 62, temperature 98.6, weight 108 pounds.
ASSESSMENT:Although flu symptoms were in remission, patient has not fully recovered.
PROBLEM:Flu
PLAN:Place patient on Biaxin for the next two weeks. The patient will call us if there is no improvement, any worsened or new symptoms.
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Meaningful Use
“If you can not measure it, you can not improve it.”
Lord Kelvin (1824-1907)
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The Solution
Support development of the industry standards needed to move information from notes into the EHR
Promote the adoption of these standards
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
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Health Story Project Members
Founding Members
ParticipantsAll Type - Arrendale Associates - BayScribe - Chase TranscriptionsDictateIT, Ltd - Dispersive Medical - Documentation Services Group
eMTS - Healthline, Inc. - MedEDocs - MD-ITNew England Medical Transcription - Phoenix Medcom
Sten-Tel, Inc. - Webmedx
Contributors Aprima Software - Scribe Healthcare Technologies
Promoters
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Based on HL7 CDA
Single standard for entire EHR is too broad
Multiple standards and/or messages for each EHR function may be too difficult to implement
CDA is “just right”HL7 Clinical Document Architecture
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CDA is the basis for ...
1. HL7 Consult Note
2. HL7 Diagnostic Imaging Report
3. HL7 Discharge Summary
4. HL7 History and Physical
5. HL7 Operative Note
6. HL7 Procedure Note
7. HL7 Unstructured Documents
8. HL7 Progress Notes
9. HL7 Continuity of Care Document
10. HL7 Healthcare-associated Infections, Public Health Case Reports
11. HL7 Personal Health Monitoring
12. HL7 Plan-2-Plan Personal Health Record
13. HL7 Quality Reporting Document
14. HL7 Minimum Data Set
and more …
1. HITSP/C84 Consult and History & Physical Note Document
2. HITSP/C32 - Summary Documents Using HL7 CCD
3. HITSP/C38 - Patient Level Quality Data Document Using IHE Medical Summary (XDS-MS)
4. HITSP/C48 Encounter Document constructs
5. HITSP/C62 Scanned document
6. HITSP/C28 Emergency Care Summary
7. HITSP/C78 Immunization Document
8. HITSP/C74 PHRM
Health Story supported guides in blue
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Consolidation Project Underway!
1. HL7 Consult Note
2. HL7 Diagnostic Imaging Report
3. HL7 Discharge Summary
4. HL7 History and Physical
5. HL7 Operative Note
6. HL7 Procedure Note
7. HL7 Unstructured Documents
8. HL7 Progress Notes
9. HL7 Continuity of Care Document
10. HITSP/C84 Consult and History & Physical Note Document
11. HITSP/C32 - Summary Documents Using HL7 CCD
12. HITSP/C38 - Patient Level Quality Data Document Using IHE Medical Summary (XDS-MS)
13. HITSP/C48 Encounter Document constructs
14. HITSP/C62 Scanned document
One master implementati
on guide
Health Story supported guides in blue
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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
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WHERE TO START
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Actionable Next Steps
1. Providers: 1. Is your documentation vendor set
up to deliver CDA documents? If no, when?
2. Is your EHR vendor set up to receive CDA documents? If no, when?
2. Vendors: Check out the requirements here: www.healthstory.com
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Actionable Next Steps
Join the Health Story Project
Project is interested in tracking and highlighting implementations
1. More information: visit the Health Story websitewww.healthstory.com
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Summary
Healthcare Technology has reached a “Tipping Point” or a “Perfect Storm”
Narrative remains the Foundation of the Clinical Record and Incorporating this into the Future is Essential
Capturing Meaningful clinical documentation is the foundation
Bridging from Narrative to Structured Clinically Actionable Data is Possible today with Healthstory
Improving the Overall Quality and Efficiency of Documentation by Offering Clinicians a Range of Tools and Services to Capture and Generate Clinical Information
These initiatives are working together to accelerate EMR adoption and can help guide successful healthcare reform
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Nick van Terheyden, MD Chief Medical Information Officer, CLU
Nuance Communications
Twitter http://twitter.com/drnic1
Voice of the Doctor http://drvoice.blogspot.com/
LinkedIn http://www.linkedin.com/in/nickvt
Plaxo http://nvt.myplaxo.com
FaceBook http://profile.to/drnick
E-Mail [email protected], [email protected], [email protected]
GrandCentral (301) 355-0877
Where You Can Find Me
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Health Story Project:Meaningful UseDay of Reckoning: Exchange Basic Records and Meet Early Requirements
Kim Stavrinaki
sCDIA PresentationThursday, April 14, 11:00 am-12:00 pm
Nick van Terheyden, MDChief Medical Information Officer - CLU, Nuance CommunicationsExecutive Committee, Healthstory ProjectBoard of Directors, CDIA
