i5021 Technology-Enabling Digital Documentation
i5021 Innovation: Technology-Enabling Digital
Documentation (TEDD)
Jorge A. Ferrer M.D., M.B.A. | Medical Informaticist | VHA OIA Office of
Health Informatics-Knowledge Based Systems-Standards & Interoperability | E
mail: jorge.ferrer@va.gov
Adjunct Assistant Professor School of Biomedical Informatics University of Texas
Health Science Center at Houston
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
VHA 2012 VAi2 Employee Innovation
Voted 20 out of 3,841 innovation competition ideas by
VA employees
A HITIDE initiative within the VA portfolio
Oversight provided by a team of established
informaticians and administrators drawn from the VHA,
DOD, Federal agencies, academia and industry
Department of Veterans Affairs
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Federal-Academia-Industry Innovation Advisory Team
Dr. Clayton Curtis, VHA; Dr. Paul Nichol, VHA; Dr. Steve Brown,
VHA; Dr. Murielle Beene, OHI; Dr. Neil Evans, VHA; Dr.
Michael Weiner, VHA; Donna Harrigan-Thrailkill, VHA; Mike Davis,
VA; Dr. Jonathan Nebeker, VHA; Dan Marsh, RN, VHA; Dr. Bill
Rudman, AHIMA; Dr. Bria Bria, AMDIS; Dr. Caitlin Cusack,
AMIA; Dr. Larry Ozeran, Clinical Informatics Inc; Dr. Doug
Rosendale, CAIRNformatics; Dr. Jiajae Zhang, UT; Dr. Chris
Gibbons, JHU; Marc Wynne, CMS; Dr. Jon White, AHRQ; Dr.
Lana Lowry, NIST; Wei Ma, NLM; Dr. Suzie Burke-Bebee, ASPE;
Dr. Alicia Morton, ONC; Dr. Ross Koppel, U of Penn; Matt Reid,
AMA; Rocco Bagala, VHA; John Edge R.N., VHA; Lois Hooper,
VHA; Angelica Midgett, VHA; Dr. Susan Woods, VHA; Teresa
Paguio-Palarca R.N., VHA; Thomas Shelton R.N., VHA; Dr. Alan
Calvitti, UCSD; Dr. Zia Agha, UCSD; Dale Marie Ryan, MS, RN,
VHA; Dr. Debora Simmons, St. Luke's Health System, Dr. Paul
Latkany, DoD.
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
VHA 2012 VAi2 Employee Innovation
A HITIDE initiative within the VA portfolio
• Health Information Technology Innovation and
Development Environments (HITIDE): A Model for
Health Information Technology Innovation
• HITIDE represents an “active innovation ecosystem
that fosters collaboration of federal and private
partners health IT-electronic health record
innovations”.
 http://www.nitrd.gov/nitrdgroups/index.php?title=Health_IT_R
%26D_SSG/Health_Information_Technology_Innovation_and_D
evelopment_Environments_Subgroup_(HITIDE)#title
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
Problem Statement
The purpose of the innovation is to build a new clinical
documentation platform including annotation and
structured data capture that overcomes the major
limitations and drawbacks of the traditional GUI
workstation. The primary design objectives are to provide
tight integration with any defined workflow, improve
usability with a new generation of technical solutions,
enable portability of a familiar user experience (UX) across
disparate EHR systems, and enhance the patient experience
(PX) at the point of service.
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
Project Goals and Design Principles
•
•
Objective: Fundamentally improve clinical documentation at
the point of service
First Principles:
– Tell the patient’s story
– Fill in knowledge gaps
– Minimize the intrusiveness of information technology in
the exam room and points of care
– Let the workflow process drive the technology – not the
other way around
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
Veterans Health Administration Strategic Plan FY 2013 –
2018
VHA Goals and Objectives: Provide Veterans Personalized, Proactive,
Patient-Driven Health Care.
a. VA Health Care Delivery
b. Communication
c. Awareness & Understanding
d. Access to Information & Resources
e. Quality & Equity
f. Innovation & Improvement – VHA will drive an improvement culture by advancing
innovation trials, emerging health technologies, and experimentation, through
exploration of both constructive failures and dynamic successes, adopting practices that
improve care while minimizing and managing acceptable risk.
g. Collaboration – VHA will strengthen collaborations within communities, and with
organizations such as the Department of Defense, the Department of Health and
Human Services, academic affiliates, and other service organizations.
Department of Veterans Affairs
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PRINCIPLES OF HEALTH INFORMATICS REDESIGN
Robert L. Jesse, MD, PhD, Principal Deputy Under Secretary for
Health
1.If data is important enough that it is needed to manage the patient
and/or the system, then it must be acquired as an integral part of
the work process and not through retrospective data collection.
–Data should be acquired in real-time, and in concert with the
documentation of clinical activities.
2.Solutions must make the work easier and not impose undue burden or
re-work.
–Technology must facilitate the workflow, but not drive it.
3.Real-time visibility into the system must be available, and it must be
transparent across the enterprise.
–Manage all patient-health system interactions (e.g. location and times,
waits and delays); manage patient staff relationship (e.g. handoffs);
manage all tests and procedures in real-time (from scheduling to
completion with concurrent documentation)
Department of Veterans Affairs
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PRINCIPLES OF HEALTH INFORMATICS REDESIGN
Robert L. Jesse, MD, PhD, Principal Deputy Under Secretary for
Health
Continue:
4.To deliver evidence-based care we must have evidence-based
management.
–Clinical and Administrative processes support
5.To effectively manage the delivery of evidence-based care we must
manage complexity
–Data>Information>Knowledge>Wisdom
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
AMIA’s Invitational Health Policy Meetings
2006: Toward a National Framework for the Secondary
Use of Health Data
2007: Advancing the Framework: Use of Health Data
2008: Informatics, Evidence-based Care, and Research;
Implications for National Policy
2009: Anticipating and Addressing Unintended
Consequences of HIT and Policy
2010: Future of Health IT Innovation and Informatics
2011: Future State of Clinical Data Capture and
Documentation
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
AMIA’s 6thAnnual Policy Meeting The Future State of
Clinical Data Capture and Documentation
December 6-7, 2011, Washington, D.C.
AMIA’s 2011 Annual Health Policy Conference
considered the future of clinical data capture, content and
documentation with its challenges and opportunities.
Because of the importance of high quality clinical
documentation and data in supporting patient care, and
given current initiatives encouraging the adoption of
electronic health records (EHRs), it is crucial to
understand how documentation and data capture
processes and policies may be affected by “going
electronic.”
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
AMIA’s 6thAnnual Policy Meeting (AMIA
working definitions)
Clinical documentation [and data capture] refers to
findings, observations, assessments, and care plans that are
recorded in an individual's health record. It may include
data entered using various methods, such as computer
entry, document scanning, voice dictation, and automated
acquisition from devices.
An individual’s health record is the repository of clinical
information recorded about that person. The record has
many functions.
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
AMIA’s 6thAnnual Policy Meeting 2011 Meeting
Assumptions
Need to transform the way we capture data and document clinical care
New technological and technical advances for clinical data capture
and documentation
New and diverse data sources, health technologies and devices for data
acquisition, collection and reporting, treatment support, and
information dissemination
Blurring of lines between devices and applications intended primarily
for use by providers, and those intended for patients
Dynamic environmental factors, trends and issues impacting clinical
data capture and documentation
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
AMIA’s 6thAnnual Policy Meeting AMIA Guiding
Principles
Clinical data capture and documentation:
1. Be clinically driven and patient-centric –reflecting an individual’s longitudinal
and lifetime health status
2. Be efficient –enhancing overall provider efficiency, effectiveness and productivity
3. Be accurate, reliable, valid and complete –enabling high quality care
4. Support multiple uses –including quality and performance measurement and
improvement, population health, policymaking, research, education, and
payment
5. Enable team collaboration and clinical decision making –including the patient
as a member of the team
6. Reflect input from multiple sources –including nuanced medical discourse,
structured items and data captured in other systems and devices
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
Journal of American Medical Informatics Association: The Future State
of Clinical Data Capture and Documentation: a report from AMIA’s
2011 Policy Meeting Caitlin M Cusack, George Hripcsak, Meryl
Bloomrosen, S Trent Rosenbloom, Charlotte A Weaver, Adam Wright,
David K Vawdrey, Jim Walker, Lena Mamykina
Research Agenda Recommendations
• DHHS should fund the development of innovative automated
documentation tools, including data input methods that
accommodate entry by various methods such as dictation with or
without voice recognition, digital handwriting, and document
scanning with or without optical character recognition.
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
Journal of American Medical Informatics Association 2013: The wave
has finally broken: now what? (Simborg)
Barriers to achieving the promise of improved quality and reduced
cost remain, as well as some unintended negative consequences.
• Poor usability of user interfaces: Both anecdotal and formal survey
data continue to indicate that physician unhappiness with EHRs
remains a problem. A HIMSS task force has described ‘usability’ as
‘possibly the most important factor hindering widespread adoption
of EMRs’
• Distrust of EHR-produced encounter notes: EHR vendors
incorporate a number of tools in their products to speed up the
process of recording a clinical encounter. These include problem
templates, copy forward, and ‘singleclick’ entry of review of
systems and physical examination components.
Department of Veterans Affairs
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i5021 Technology-Enabling Digital Documentation
Project Wiki Site
http://vacloud.us/groups/5021/
Contact Information
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Jorge A. Ferrer M.D., M.B.A
Medical Informaticist
VHA OIA Health Informatics
E mail: jorge.ferrer@va.gov
Department of Veterans Affairs
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