Welcome!
Health Story Project Update
Wednesday, April 21, 2010
1:00-2:00 PM central
If you are on the call, please press your unique audio pin.
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The Health Story Project
 Vision: Comprehensive electronic clinical
records that tell a patient’s complete health
story.
 Goal: All of the clinical information required
for good patient care, administration,
reporting and research are readily available
electronically, including information from
narrative documents.
 www.healthstory.com
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Webinar Purpose
 Participants speak knowledgeably about the
project and status
 Decision makers equipped with information
needed to evaluate participation
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Agenda
1:00-1:25 PM
 Project Overview and Update

Joy Kuhl, Optimal Accords and Mark Ivie, M*Modal
 Technical Strategy Update

Liora Alschuler, Alschuler Associates
1:25-1:45 PM
 New Guide for Unstructured Documents

Peter Bedell, Fujitsu and Therasa Bell, Osmosyz
 New Guide for Procedure Notes

Judy Logan, Oregon Health & Science University
1:45-2:00 PM
 Dialogue
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Ground Rules
 Place phone on mute
 Avoid hold
 Submit comments and questions via web tool
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Introductions
Joy Kuhl
Health Story Project
joy@optimalaccords.com
Theresa Bell
Osmosyz
tbell@inofile.com
Mark Ivie
M*Modal
mark.ivie@mmodal.com
Peter Bedell
Fujitsu
pbedell@us.fujitsu.com
Liora Alschuler
Alschuler Associates
liora@alschulerassociates.com
Judy Logan
Oregon Health & Science
University
loganju@ohsu.edu
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Mark Ivie, M*Modal
OVERVIEW AND UPDATE
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Background: Why Health Story?
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
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Computer image courtesy of M*Modal
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The Health Story Project
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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: Guiding Principles
1. Inclusive and open process
2. Leverage current technology investments
3. Enable broad stakeholder engagement
4. Provide a glide path for incremental interoperability
5. Minimize disruption to clinician workflow
6. Base strategy on existing standards
7. Use proven technology
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Health Story Members
Founding Members
Promoters
Contributors
Participants
Aprima Software | Scribe Healthcare Technologies
All Type | Broward Sheridan Technical Center
Dictation Services Group | Healthline, Inc.
MD-IT | New England Medical Transcription | Sten-Tel, Inc.
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Health Story Projects
HL7 Implementation Guides
Completed
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History & Physical
Consultation
Operative Report
DICOM Imaging Reports
Discharge Summary (in publication)
Procedure Note (in reconciliation)
Unstructured Documents (in reconciliation)
Upcoming
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 Progress Notes
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Adoption Strategy
 Health Leven Seven (HL7) collaborates
with Health Story on development and ballot
of technical implementation guides
 Medical transcription companies support
creation, delivery and enrichment
 EHR vendors systems send, receive, display
and integrate
 Health providers select the approach and
receive vendor support for standards-based
document creation, management and enrichment
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Liora Alschuler, Alschuler Associates
INTEROPERABILITY
STRATEGY
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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.”
David Blumenthal, MD
National Coordinator for HIT
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Meaningful Use ≈ Data Reuse
patient care
clinical
decision
support
billing/claims
adjudication
quality reporting
outcomes
analysis
research
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“The key to
intelligent
tinkering is to
keep all the
parts.”
Aldo Leopold
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Based on HL7 CDA
Clinical Document Architecture supports:
 Human readable document
 Machine-processable data (e.g. discrete
reportable transcription)
 Cross platform and application independent
Health Story Approach
 Standardize through ANSI SDO (HL7 ballot)
Minimum
Optimum
• CDA header
• Standard section codes
• Broad industry agreement on
clinical content
• Reuse of entry-level templates
• “Templated CDA”
 Support Meaningful Use
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Health Story Documents
Blend between free form text and fully structured
documentation that
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represent the thought process, and
capture the clinical facts
Health Story makes “discrete reportable transcription” work
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Minimal Document for Exchange
<recordTarget>
<patientRole>
...
<patient>
<name>
<given>Adam</given>
<family>Everyman</family>
</name>
</patient>
</patientRole>
</recordTarget>
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Optimum Level: Today
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.2.8"/>
<code codeSystem="2.16.840.1.113883.6.1"
codeSystemName="LOINC"
code="46239-0"
displayName="REASON FOR VISIT"/>
<title>REASON FOR VISIT/CHIEF COMPLAINT</title>
<text>
<paragraph>Stomach ache.</paragraph>
</text>
</section>
</component>
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Achievable: Tomorrow
<entry typeCode="DRIV">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.1.33"/>
<!-- Social history observation template -->
<id extension="123456789" root="2.16.840.1.113883.19"/>
<code codeSystem="2.16.840.1.113883.6.96"
codeSystemName=”SNOMED”
code="230056004"
displayName="Cigarette smoking"/>
<statusCode code="completed"/>
<effectiveTime>
<low value="1972"/>
<high value="2000"/>
</effectiveTime>
<value xsi:type="ST">1 pack per day</value>
</observation>
</entry>
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Incremental Interoperability
EHR
Repository
Clinical
Applications
HIM
Applications
Coded Discrete
Data Elements
HL7 CDA Structured
Documents
Narrative
Text
SNOMED CT
Disease, DF00000
Metabolic Disease, D600000
Disorder of carbohydrate
metabolism, D6-50000
Disorder of glucose metabolism,
D6-50100
Diabetes Mellitus, DB61000
Neonatal,
DB75110
Type 1, DB61010
Carpenter Syndrome,
DB-02324
Insulin dependant type IA,
DB-61020
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Impact
 Allows providers to choose preferred
workflow and documentation methods
 Provides on-ramp to EMR system adoption
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pre-populate EMR with structured documents
integrate legacy documents
 Increases the value and usability of narrative
documents
 Allows intelligent and meaningful re-use of
information
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Successes
 Members generating Health Story/HL7
compliant CDA today: GE Medical,
MedQuist, M*Modal
 Many members planning to generate
standards-based documents within next year
 Health Story/HL7 H&P and Consult
recommended by HITSP
 On CCHIT HIE Roadmap
 Included in HIMSS EHR Adoption Model
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Therasa Bell, Osmosyz and Peter Bedell, Fujitsu
NEW GUIDE FOR
UNSTRUCTURED DOCUMENTS
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Judy Logan, Oregon Health & Science University
NEW GUIDE FOR
PROCEDURE NOTES
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Joy Kuhl, Health Story Project
IN SUMMARY
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The Health Story Project
 Five Year Goals
1.
Strengthen Operations
2.
Establish Brand Awareness
3.
Maintain Strong Coalition
4.
Increase Market Demand
5.
Sustain Technical Specification Development
6.
Earn National Endorsement
7.
Foster Widespread Adoption
8.
Declare Success
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Get Involved
 Consider the Health Story pathway
 Share the story
 Join the project
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Where You Can Find Us
Health Story Presentation
Illinois Health Information Mgmt Association
Thursday, April 22, 2010
Peoria, Illinois
www.ilhima.org
Health Story Technology Workshop
MTIA Conference
Thursday, April 29, 2010
Daytona Beach, Florida
www.mtia.com
$395, $295/members
Special Offer: Non members can use workshop cost toward membership
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Actionable Next Steps
Is your system
capable of
producing an HL7
CDA document?
Requirements:
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WE WANT TO HEAR FROM YOU
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Presenters
Joy Kuhl
Health Story Project
joy@optimalaccords.com
Theresa Bell
Osmosyz
tbell@inofile.com
Mark Ivie
M*Modal
mark.ivie@mmodal.com
Peter Bedell
Fujitsu
pbedell@us.fujitsu.com
Liora Alschuler
Alschuler Associates
liora@alschulerassociates.com
Judy Logan
Oregon Health & Science
University
loganju@ohsu.edu
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APPENDIX
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Supports Meaningful Use
Meaningful Health Story Interoperability Strategy
Use
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Delivers common clinical documents to the point of care
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Standardizing document types and sections today makes it easier
to agree on data elements tomorrow
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Incrementally adding key data elements into narrative is attractive
to clinicians
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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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CDA is the basis for ...
 Consult Note
 Continuity of Care Document
 Diagnostic Imaging Report
 Discharge Summary
 Healthcare-associated Infections,
Public Health Case Reports
 History and Physical
 Operative Note
 Personal Health Monitoring
 Plan-2-Plan Personal Health
Record
 HITSP/C28 Emergency Care
Summary
 HITSP/C32 - Summary Documents
Using HL7 CCD
 HITSP/C38 - Patient Level Quality
Data Document Using IHE
Medical Summary (XDS-MS)
 HITSP/C48 Encounter Document
constructs
 HITSP/C84 Consult and History &
Physical Note Document
 HITSP/C78 Immunization Document
 Procedure Note
 HITSP/C74 PHRM
 Quality Reporting Document
 HITSP/C62 Scanned document
 Minimum Data Set
 Unstructured Documents
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… and more …
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