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1September, 2005 What IHE Delivers
Connecting Health Information Connecting Health Information Technology Standards to the Technology Standards to the
Point-of-Care: The IHE MethodPoint-of-Care: The IHE Method
Audrey E. Dickerson RN MSAudrey E. Dickerson RN MS
Manager Standards Initiatives, HIMSSManager Standards Initiatives, HIMSS
ISO/TC 215 Health Informatics SecretaryISO/TC 215 Health Informatics Secretary
Marcia Veenstra RN, MSNMarcia Veenstra RN, MSN
Consortium Practice ManagerConsortium Practice Manager
CPM Resource CenterCPM Resource Center
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Digital Age of InformationDigital Age of Information
In the digital age there is a fundamental In the digital age there is a fundamental difference in the generation, distribution difference in the generation, distribution and consumption of data, information, and and consumption of data, information, and knowledgeknowledge
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ObjectivesObjectives
Differentiate quality nursing care from Differentiate quality nursing care from non-quality carenon-quality care
Recognize currently nurses do not have Recognize currently nurses do not have cross enterprise nor intra-enterprise cross enterprise nor intra-enterprise interoperability documentation as part of interoperability documentation as part of their electronic workflowtheir electronic workflow
Discover how nursing could have Discover how nursing could have interoperable documentationinteroperable documentation
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What is Nursing Care?What is Nursing Care?
Treating the human response toTreating the human response to::
Illness and diseaseIllness and diseaseMedical care and treatmentMedical care and treatmentSurgery and recoverySurgery and recoveryMedicinal products such as medications Medicinal products such as medications
and other products that can be and other products that can be prescribed for illness and diseaseprescribed for illness and disease
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Nursing DocumentionNursing Documention
Health AssessmentHealth Assessment Vital signs and measurements, including PainVital signs and measurements, including Pain Heart and lung sounds and other body soundsHeart and lung sounds and other body sounds Internal and external patient fluid managementInternal and external patient fluid management Activities of daily livingActivities of daily living
Educate the patient and familyEducate the patient and family Disease, medication and treatment managementDisease, medication and treatment management Life style changes and disease preventionLife style changes and disease prevention Safety in health and illnessSafety in health and illness Pain managementPain management
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Why Standardized Terminology?Why Standardized Terminology?
Describes all aspects of nursing careDescribes all aspects of nursing care Reflects the knowledge and skills that are essential to Reflects the knowledge and skills that are essential to
nursing practice in a semantic waynursing practice in a semantic way
Provides consistent conceptsProvides consistent concepts Describe assessments, interventions and outcomes of their Describe assessments, interventions and outcomes of their
actionsactions
Facilitates critical thinkingFacilitates critical thinking at the point of care at the point of care
Provides a reduction of errorProvides a reduction of error by providing alerts by providing alerts for critical observations and interventionsfor critical observations and interventions
Evaluates the impactEvaluates the impact of nursing care of nursing care
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An established initiative improving the An established initiative improving the quality, safety, efficiency, and effectiveness quality, safety, efficiency, and effectiveness of care by agreeing on standardized ways of care by agreeing on standardized ways
to implement existing standards, and to implement existing standards, and inventing the processes for making it inventing the processes for making it
happen.happen.
http://www.ihe.net
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The PlanThe Plan
GoalGoal: Move nursing data between care : Move nursing data between care settings across timesettings across time
Year 1Year 1: Move data from ambulatory care : Move data from ambulatory care into acute care and back to ambulatory into acute care and back to ambulatory care electronically without regard for care electronically without regard for vendor application.vendor application.
Year 2Year 2: Move data from ambulatory care to : Move data from ambulatory care to acute care, though all acute care, in acute care, though all acute care, in hospital care transfers and back to hospital care transfers and back to ambulatory care without regard for vendor ambulatory care without regard for vendor application.application.
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Three Use Case’sThree Use Case’s
A diabetic nursing home patient is transferring A diabetic nursing home patient is transferring from the LTC environment to an in-patient from the LTC environment to an in-patient acute care hospital based on deteriorating acute care hospital based on deteriorating functional status assessments. functional status assessments.
A normally active, older adult in an assisted A normally active, older adult in an assisted living community has an accidental fall living community has an accidental fall requiring admission to an acute care facility.requiring admission to an acute care facility.
A recently widowed 75 year old woman is A recently widowed 75 year old woman is admitted to an adult inpatient floor of a admitted to an adult inpatient floor of a behavior health hospital for depression post behavior health hospital for depression post suicide attemptsuicide attempt
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Hand Off/Transfer of Care: Use Case # 1Hand Off/Transfer of Care: Use Case # 1
Daily Assessment & call to providerDaily Assessment & call to provider
Hand off to TransportHand off to Transport
Assessment in the TransportAssessment in the Transport
Hand off Transport to Acute CareHand off Transport to Acute Care
Assessment on admission to Acute care/Med-Surg Assessment on admission to Acute care/Med-Surg UnitUnit
Daily Assessments on UnitDaily Assessments on Unit
Hand off and Assessment to TransportHand off and Assessment to Transport
Hand off to LTC Hand off to LTC
Daily AssessmentDaily Assessment
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Scale CharacteristicsScale CharacteristicsQualities reviewed in scalesQualities reviewed in scales
Scales chosen are evidence-based with strong reliability Scales chosen are evidence-based with strong reliability and validity.and validity.
Widely accepted cross-enterprise or Widely accepted cross-enterprise or required/recommended by accrediting agenciesrequired/recommended by accrediting agencies
Content ScalesContent Scales
Numeric Rating Scale (NRS-11) for PainNumeric Rating Scale (NRS-11) for Pain
Braden Scale for Predicting Pressure Sore RiskBraden Scale for Predicting Pressure Sore Risk©©
Geriatric Depression Scale (GDS)Geriatric Depression Scale (GDS)
Minimum Data Set – Section GMinimum Data Set – Section G
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MDS section GMDS section GPhysical Functional and Structural ProblemsPhysical Functional and Structural Problems
Activities of Daily Living self performance Activities of Daily Living self performance
Activities of Daily Living (ADL) support providedActivities of Daily Living (ADL) support provided
Test for balanceTest for balance
Limitation for Range of MotionLimitation for Range of Motion
Modes of locomotionModes of locomotion
Modes of transferModes of transfer
Task SegmentationTask Segmentation
Rehabilitation potentialRehabilitation potential
Change in ADL functionChange in ADL function
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Geriatric Depression ScaleGeriatric Depression Scale
Subjective Questions: Subjective Questions: (Examples listed)(Examples listed)
Are you basically satisfied with life?Are you basically satisfied with life? Do you feel that your life is empty?Do you feel that your life is empty? Do you often get bored?Do you often get bored? Are you hopeful about the future?Are you hopeful about the future? Do you often feel helpless?Do you often feel helpless?
Yes / No answers that may have a number score Yes / No answers that may have a number score
Numbers are totaled Numbers are totaled
Totals are used to find where the patient is in a Totals are used to find where the patient is in a range, Normal, Mild or Severe Depressionrange, Normal, Mild or Severe Depression
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Braden Scale for Predicting Pressure Sore RiskBraden Scale for Predicting Pressure Sore Risk
Vertical Axis:Vertical Axis: Sensory Sensory
perceptionperception MoistureMoisture Activity Activity MobilityMobility NutritionNutrition Friction and ShearFriction and Shear
Horizontal AxisHorizontal Axis Very limited (x2), Very moist, Very limited (x2), Very moist,
chairfastchairfast, , very probably very probably inadequate, potential probleminadequate, potential problem
Slightly limited (x2), Slightly limited (x2), occasionally moist, walks occasionally moist, walks occasionally, adequate, no occasionally, adequate, no apparent problemapparent problem
No impairmentNo impairment Completely, constantly, Completely, constantly,
bedfast, very poor, problembedfast, very poor, problem
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Numeric Rating Scale for PainNumeric Rating Scale for Pain
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Standards for Technical UseStandards for Technical UseIHE Integration Profiles (XDS-MS)IHE Integration Profiles (XDS-MS)
Continuity of Care Record (CCR)Continuity of Care Record (CCR)
Continuity of Care Document (CCD)Continuity of Care Document (CCD)
Clinical Document Architecture (CDA)Clinical Document Architecture (CDA)
HL7 Care Record SummaryHL7 Care Record Summary
Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC)
Systematized Nomenclature of Medicine Clinical Terms Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT)(SNOMED-CT)
BPPH consents BPPH consents
In context of Continuity of Care Document, the In context of Continuity of Care Document, the functional status is the patient’s status at the time functional status is the patient’s status at the time the document was created. Medical Summary or the document was created. Medical Summary or XPHR Extract will contain FSA if available.XPHR Extract will contain FSA if available.
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Standard Building Blocks forNarrative and Tabular Health Documents
A healthcare “document” is a composite of structured and coded health information, both narrative and tabular, that describes acts, observations and services for the purpose of exchange
CDAM
eds
Alle
rgies
ASTM/HL7 CCD
Insurance
XX
Xn
arra
tive
YY
YY
Na
rrativ
e &
tab
ula
r
. . . .
Person
al Info
Chief
Com
plaint
Discha
rgeD
iagnosis
Prob
lems
Mode of
Transport
TT
TT
Na
rrativ
e &
tab
ula
r
Templates from CCRTemplates from CCR Templates fromTemplates fromIHE Content Modules & HL7 Implementation GuidesIHE Content Modules & HL7 Implementation Guides
TT
T
Narra
tive an
d T
abular
September, 2005CDA
Meds
Alle
rgies
Insurance
XX
Xn
arra
tive
YY
YY
Na
rrativ
e &
tab
ula
r
. . . .
Person
al Info
Chief
Com
plaint
Discha
rgeD
iagnosis
Prob
lems
Mode of
transport
FS
A
TT
TT
Na
rrativ
e &
tab
ula
r
Template content from CCRTemplate content from CCR
CDA: foundation standard enabling the definition of templates for a broad range of healthcare documents
CCD: collection of templates, including CCR that represent the core data elements for healthcare summary documents
Building on the Foundation
A CCD based Document A CDA based document compatible with CCD
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Interoperability OutcomesInteroperability Outcomes
Early intervention minimizes complications and reduces length Early intervention minimizes complications and reduces length of stay. of stay.
Ensure all pertinent data will be available immediately prior/at the Ensure all pertinent data will be available immediately prior/at the time of transfer without concern about lost data.time of transfer without concern about lost data.
Complete clinical information promotes safety, adequate after-Complete clinical information promotes safety, adequate after-care, improved outcomes and patient satisfaction.care, improved outcomes and patient satisfaction.
Receipt of data prior to transfer allows receiving facility to plan Receipt of data prior to transfer allows receiving facility to plan for appropriate staffing resources based on patient acuity, and for appropriate staffing resources based on patient acuity, and early critical thinking for admitting nurse. (Resource early critical thinking for admitting nurse. (Resource maximization)maximization)
Continuity of interdisciplinary plan of care promotes early Continuity of interdisciplinary plan of care promotes early discharge and increased patient satisfaction.discharge and increased patient satisfaction.
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Advancing the Agenda for Patient CareAdvancing the Agenda for Patient Care
Understand and embrace this initiativeUnderstand and embrace this initiative
Get involved with Profile developmentGet involved with Profile development
Respond to public comment opportunitiesRespond to public comment opportunities
Attend educational workshopsAttend educational workshops
Attend the HIMSS08 Interoperability ShowcaseAttend the HIMSS08 Interoperability Showcase
Include IHE Integration Profiles in your RFP’sInclude IHE Integration Profiles in your RFP’s
Participate in IHE CommitteesParticipate in IHE Committees
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How YOU canHow YOU can participateparticipate
IHE Needs Nurses! Even if you could IHE Needs Nurses! Even if you could participate part of the time, IHE would be participate part of the time, IHE would be HAPPY!HAPPY!
Please contact:Please contact: Joyce Sensmeier Joyce Sensmeier jsensmeier@himss.orgjsensmeier@himss.org Audrey Dickerson Audrey Dickerson adickerson@himss.orgadickerson@himss.org Marcia Veenstra Marcia Veenstra marciaveenstra@cpmrc.commarciaveenstra@cpmrc.com
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