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w w w . h e a l t h s t o r y . c o m
Pathway to Meaningful Use:
Unlocking Valuable Information in
Unstructured Documents
Kim Stavrinaki
s
Liora Alschuler Co-Founder, Health Story Project CEO, Lantana Consulting Group
HIMSS Virtual Briefing Wednesday, March 14, 2012
11:15 a.m. ET
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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
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Health Story Presenter
Liora Alschuler
CEO, Lantana Consulting Group
Health Story Co Founder, Executive Committee
Co-Editor, HL7 Clinical Document Architecture
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
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Meaningful Use
meaningful use: thanks for the fax
Meaningful Use: Certifiable!
MEANINGFUL USE: Return on Investment
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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
The Health Story Challenge
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Narrative
Text
HL7 CDA Structured Documents
Coded Discrete Data Elements
EHR Repository
HIM Applications
Clinical Applications
SNOMED CT
Disease, 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
Health Story: Incremental Approach
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Meaningful Use ≈ Data Reuse over the Full Health Story
patient care
billing/claims adjudication
research
quality reporting
clinical decision support
outcomes analysis
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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
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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”
Based on HL7 CDA Standard
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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>
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HL7 Continuity of Care Document
CCD also based on CDA
Health Story Relationship to HL7 CCD
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)
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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
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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
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Health Story: Incremental Approach
Benefit Value
Retains patient story Maintains primary role of documentation to clearly
describe and communicate what is going on with
patient.
Preserves physician
time for clinical care
Makes efficient use of physician time by enabling
choice of documentation methods and fosters EMR
acceptance
Supports meaningful
use
Interoperability: implements HL7 CDA document
standards for electronic exchange of clinical
information
Enables data reuse 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
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Health Story Telling: HIMSS12
Integration Platform
Dictating MD Transcriptionist Abstractor
Voice capture
Voice to text
Enrich Standard format
Telephone
PDR
Smart phone
Transcription
Speech recognition
NLP
DRT
CAC
CDA
ICD, CPT…
HL7 V2
HIE
MRM
EMR
Billing
Analytics
Quality
People
Platforms
Applications
H
e
a
l
t
h
S
t
o
r
y
Meaningful Use Clinical Document Ecosystem
Clerk
Imaging
Desktop appliances
Scan-to-CDA
OCR
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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
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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)
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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!
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Contact Information
Liora Alschuler
CEO, Lantana Consulting Group
Health Story Co Founder, Executive Committee
Co-Editor, HL7 Clinical Document Architecture
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