Health Story Project: Using Standards to Get to Meaningful Use: Exchange Basic Records and Meet Early Requirements Kim Stavrinaki s HIMSS11 Interoperability Showcase Wednesday, February 23, 11:45 am-12:05 pm Bob Dolin, MD President & CMO, Lantana Consulting Group Chair, HL7 International

Meaningful Use?

Meaningful Use!

Session Overview 1.Challenge 2.Health Story Project Solution 3.Where to Start 4.Q&A

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 Challenge Computer image courtesy of M*Modal

We Can Get Here Today MRN:00000 DOS:11/11/2001 CHIEF COMPLAINT: Fatigue SUBJECTIVE: Patient is a 25 year old woman complaining of feeling frequently fatigues. She reported also 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 degrees, weight 108 pounds. ASSESSMENT: Although flu symptoms were in remission, patient has not fully recovered yet. 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. MRN:00000 DOS:11/11/2001 CHIEF COMPLAINT: Fatigue SUBJECTIVE: Patient is a 25 year old woman complaining of feeling frequently fatigues. She reported also 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 degrees, weight 108 pounds. ASSESSMENT: Although flu symptoms were in remission, patient has not fully recovered yet. 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.

Meaningful Use “If you can not measure it, you can not improve it.” Lord Kelvin ( )

Narrative Text HL7 CDA Structured Documents Coded Discrete Data Elements EHR Repository HIM Applications Clinical Applications SNOMED CT Disease, DF Metabolic Disease, D Disorder of glucose metabolism, D Diabetes Mellitus, DB Type 1, DB Insulin dependant type IA, DB Neonatal, DB75110 Carpenter Syndrome, DB Disorder of carbohydrate metabolism, D Health Story Approach

THE SOLUTION

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 Project Members Founding Members Participants All Type - Arrendale Associates - BayScribe - Chase Transcriptions DictateIT, Ltd - Dispersive Medical - Documentation Services Group eMTS - Healthline, Inc. - MedEDocs - MD-IT New England Medical Transcription - Phoenix Medcom Sten-Tel, Inc. - Webmedx Contributors Aprima Software - Scribe Healthcare Technologies Promoters

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

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

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 implementation guide Health Story supported guides in blue

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

WHERE TO START

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:

Actionable Next Steps  Join the Health Story Project  Project is interested in tracking and highlighting implementations’  More information: visit the Health Story kiosk in the Interoperability Showcase

A physician’s practical need for fast and easy methods for creating clinical documentation The enterprise need for structured and coded information capture to support meaningful use In Summary Computer image courtesy of M*Modal

Q&A