Using Standards to Get to Meaningful
Use: Exchange Basic Records and
Meet Early Requirements
Kim
Bob Dolin, MD, FACP, FACMI
Principal, Semantically Yours, LLC
Stavrinaki
Chair, Health Level Seven
s
Liora Alschuler
Principal, Alschuler Associates, LLC
Thursday, June 10, 2010
HIMSS Virtual Conference & Expo
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Meaningful Use?
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Meaningful Use!
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Session Overview
 Health Story interoperability strategy
 How Health Story leads to meaningful use
 What this means for you
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HEALTH STORY
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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Meaningful Use ≈ Data Reuse
“If you can not
measure it,
you can not
improve it.”
Lord Kelvin (1824-1907)
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The 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
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Health Story Members
Founding Members
Promoters
Contributors
Participants
Aprima Software | Scribe Healthcare Technologies
All Type | Arrendale Associates | Dictation Services Group
Healthline, Inc. | MD-IT | New England Medical Transcription
Sten-Tel, Inc. | Broward Sheridan Technical Center
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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: 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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HL7 Clinical Document Architecture
 Health Story specifications
are based on HL7 CDA
 CDA is “just right”
 Single standard for entire
EHR is too broad
 Multiple standards and/or
messages for each EHR
function may be too difficult to
implement
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HL7 Clinical Document Architecture
Other benefits of CDA:
 Normative HL7 standard since 2000
 Widely implemented
 Provides a gentle on-ramp to information
exchange
 Provides mechanism for inserting evidencebased medicine directly into the process of
care
 Top down strategy lets you implement once
and reuse many times for new scenarios
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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



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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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

… and more …
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Today’s Workflow
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Growing Use of Clinician EMR Interaction
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Evolving Dictation/Transcription
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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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Health Story  Meaningful Use
Meaningful Health Story Interoperability Strategy
Use

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
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Incrementalism Works for the Internet
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Why Health Story?
HL7 Implementation
Guide for CDA R2:
Procedure Note
Sample: Endoscopy Report
Judy Logan
Associate Professor
Oregon Health & Science University
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WHAT THIS MEANS
FOR YOU
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Actionable Next Steps
Is your system
capable of producing
an HL7 CDA
document?
Requirements:
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Actionable Next Steps
 Get involved in Health
Story
 Lead the industry
 Weigh in on development
priorities
 Project is interested in
tracking and highlighting
implementations
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In Summary
A physician’s practical
need for fast and easy
methods for creating
clinical documentation
Computer image courtesy of M*Modal
The enterprise need for
structured and coded
information capture to
support meaningful use
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Contact Information
Bob Dolin, MD
Liora Alschuler
Semantically Yours, LLC
Alschuler Associates, LLC
bobdolin@gmail.com
liora@alschulerassociates.com
Joy Kuhl
Health Story Project
joy@optimalaccords.com
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Q&A
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