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MTIA 2009 - Healthstory Project Overview Dictation To Clinical Data


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Over view of the Healthstory Project for the Medical Transcription Industry Association (MTIA)

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MTIA 2009 - Healthstory Project Overview Dictation To Clinical Data

  1. 1. Welcome! The Health Story Project Dictation to Clinical Data: Automating the Production of Structured and Encoded Documents Kim Stavrinaki s MTIA Conference, April 2009 Kim Stavrinakis MHA,RT, Sr. Manager, GE Healthcare Nick van Terheyden, MD, Chief Medical Officer, M*Modal
  2. 2. Presentation Overview  Background: The Current Situation  Enabling the EMR with the Missing Link  A User Experience (GE/RISL)  The Health Story Project  Conclusion
  3. 3. Background The Current Situation
  4. 4. Problems Facing Clinicians According to an American College of Physician Executives survey, 6 in 10 physicians have considered leaving the profession due to: burnout  low morale/depression  loss of autonomy  low reimbursement rates  patient overload  bureaucratic red tape  loss of respect, and  medical liability environment  Complexity and workload is crippling physicians and hindering their ability to deliver high quality care
  5. 5. Electronic Health Record Universe Critical to the success of EHRs is to reconcile two opposing needs Enterprise need for  structured and coded information capture Physician’s practical  need for a fast and easy method for creating clinical notes.
  6. 6. The Current Situation – Structured  Tedious manual process  Time-consuming  Documentation lacks expressiveness of natural language  Lack of Flexibility  Poor user interface  Cost Fails to Meet Individual Physician Time vs.  Benefit Test Cultural resistance   Oblivious to HIM Requirements Direct Data Entry:  Incomplete and Inadequate Semantic Structured and encoded information. Standards
  7. 7. “Although completing such templates may help physicians survive a report-card review, it directs them to ask restrictive questions rather than engaging in a narrative-based, open-ended dialogue.” Pamela Hartzband, M.D., and Jerome Groopman, M.D. n engl j med 358;16 april 17, 2008
  8. 8. The Current Situation  Transcription can be expensive  Subject to longer turn-around times  Clinical data lost, because documents are neither structured nor encoded  Majority of attested information is only in the document  Contains the detail and comprehensive scope of patient information  Support human decision making  Reimbursement is based on narrative documentation  Retains current workflow, favored by physicians  Interoperable Dictation:  Under utilized source of data for EMR Fast and easy, expressive.
  9. 9. The Current Situation  High cost of documentation Cost of ownership and physician time vs. transcription cost   60% of the data lost to the EHR  Care process inefficiencies and impact on quality
  10. 10. Enabling the EMR The Missing Link in Information Capture in Healthcare
  11. 11. Data Entry Time  The average physician spends 33 seconds dictating an establish office visit  92% of all office visits are established  If the average physician sees 40 patients a day, total dictation time of 30 minutes plus time to search for the data.  Using a traditional EHR application, the same number of patients would require 140 minutes of data entry time.  Physicians are not willing to spend an additional 90 minutes per day for data entry. (40 X 92% x 33 seconds) + (40 x 8% x 125) = < 30 minutes per day Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group
  12. 12. Crossing the Chasm… What if you could continue to use narrative and dictation and at the same time increase usage of the EMR and make more records available for the health information exchange?
  13. 13. Health Story Project Vision  Comprehensive electronic clinical records that tell a patient’s complete health story  All of the clinical information required for good patient care  administration  reporting and  research   will be readily available electronically, including information from narrative documents
  14. 14. Goals  Bridge the gap between narrative documents and structured data  Encourage proliferation of information for the EHR
  15. 15. Based on HL7 CDA Clinical Document Architecture Requirements  Human readable document Must be presentable as a document  Rendered version covers clinical information intended by the  author  Can contain machine-processable data  Cross platform and application independent  Can be transformed with style sheets
  16. 16. Adoption  Incremental adoption overcomes the “not me first” dilemma  Not dependent on recipient’s ability to receive or process  Reverse adoption (can encode headers of existing documents)  Non-proprietary  Readable with any browser
  17. 17. Encoding  Does not preclude “once and done” concept  Compatible with Speech Understanding/Recognition  Can be facilitated by Natural Language Processing  Leverage existing relationships with transcriptionists/editors/knowledge based workers  Potential for automated coding (billing)  Supports data abstraction/research
  18. 18. Accessible Clinical Data
  19. 19. User Experience GE/RISL The Missing Link in Information Capture in Healthcare Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare
  20. 20. Clinical Document Architecture Why CDA? Precision Reporting Radiology Imaging of Lakeland Florida
  21. 21. Why CDA?  Radiology results is key tool in providing diagnosis  Results need to be: concise  consistent representing the highest quality  precipitate alerts before the report is distributed   Radiology Information System rich in data  eliminates redundancy  streamlines workflow   CDA benefits standard for clinical communication  foundation for structuring data 
  22. 22. Precision Reporting Building a reporting tool that leverages standards for structuring data that  drives patient care Screen  drives outcomes for best shot of practices report  drives research for better patient with halo care and outcomes Utilizing data at each point of care that culminates in rich information for the radiologist
  23. 23. Key Workflows  Self Editing real time – read, proof, sign each exam  batch mode - read multiple exams then sign via signature queue  VR edits  Option to send to Medical Editor during reporting process   Batch Option – dynamic combinations of workflow based on confidence models user based thresholds that determines how report is  returned/reviewed to signature queue preliminary/draft to signature queue  transcriptionist then preliminary to signature queue   Transcriptionist – Medical Editor workflow
  24. 24. Results Reporting Workflow Data Center Dictation Report in Edit Mode using conversational local capture tool – speaking can either type to correct or voice commands When dictation is Report is returned Dictating the complete and ready for edits Procedure EOL is pushed
  25. 25. Results Reporting Workflow 2 Data Center After final sign the report is Edit Mode using local capture tool – processed in voice in selection the NLP engine between brackets for learning Voice in options for brackets, sign report, add via voice more dictation in the sections, then sign
  26. 26. Results Reporting Batch Mode Report goes to Dictating the Medical Editor or When Procedure signature queue, dictation is Radiologist moves complete on to next exam
  27. 27. Understanding Diagnostic Reporting Values Benefits Attributes Means (Why?) Does (How?) Is (What?) • Enables easy Radiologist • Easy to create reports using a • Multiple modes of workflow adoption by adjusting to your variety of workflow models around dictation workflow • Focus time on findings and • Speedy process • Pre-configured document models results • Capture a competitive advantage • No re-dictate existing information • Compliance alerts over other RAD groups • Increase revenue with more • Easily identify items to be • Pre-populated patient information reports / day confirmed or corrected; Deliver reports to referring MDs faster Source: GE analysis
  28. 28. Radiology Imaging of Lakeland Florida Radiology & Imaging Specialists (RIS)  physician-owned  twenty board-certified radiologists  many sub-specialized  live since November 12, 2008
  29. 29. “You didn’t change the radiologists’ work, and that is what made it easy on me.” David Marichal, CIO, Radiology and Imaging Spec. of Lakeland, FL
  30. 30. Results VOC: flexibility is key  • full-time rads: 70% Medical Editor workflow/30% self-edit • part-time rads can use it in batch digital dictation mode rads love not having to dictate accession #,  name, signs/symptoms, etc… quality of the engine is very good  self-edit for stat exams has reduced # of calls  from the hospital
  31. 31. Conversational Documentation … transformation of dictation directly into structured clinical documents while encoding data depending on the care givers and organizations needs EHR
  32. 32. Meaningful Clinical Documents Meaningful Clinical Documents are a blend between free form text and fully structured documentation that represent the thought process, and  capture the clinical facts 
  33. 33. How it Works
  34. 34. The Health Story Project and Meaningful Clinical Documents The Missing Link in Information Capture in Healthcare Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare
  35. 35. Meaningful Clinical Documents vs. Text  Structured and encoded clinical content enables… pre-signature alerts,  decision support,  best documentation practices,  multiple output formats,  multi-media reporting,  data mining   Implements HL7 CDA4CDT standard compliant document types  Increases quality of documentation
  36. 36. Health Story Document Types Implementation Guides Completed  History & Physical  Consultation  Operative Report  DICOM Imaging Reports Upcoming  Discharge Summary w/IHE  Billing and Reimbursement Requirements  Progress Notes  .PDF work with Adobe
  37. 37. Project Members Founders Promoters Original Benefactors: Participants
  38. 38. Conclusion
  39. 39. Crossing the Chasm…Babel Must Go  Medical text “typed” from dictation has “no meaning” black marks on a page…  info must be tagged as discrete data  elements in order to assign meaning  Clinical documentation uses wide variety of terms with same meaning…. and terms that sound the same that have  different meanings….. authors have a wide variety of styles, accents,  methods of dictation…
  40. 40. Health Story…  Captures meaningful clinical documents  Is the bridge between free form narrative and expressive notes, and  fully structured clinical data   Improves the quality of clinical documentation  Generates semantically interoperable clinical data that will solve the fundamental challenges with EMRs - allowing clinical  decision support, alerts, decision support, data mining enable interoperability, reporting, patient safety initiatives, PQRI  (pay for performance), PSI (patient safety indicators) and improve billing data capture
  41. 41. Impact  Allows providers to maintain preferred workflow and documentation methods  Increases the value and usability of narrative documents (dictation/trans, SRT)  Accelerates the implementation of interoperable electronic health records  Allows reuse of information
  42. 42. Getting Involved  Join the Health Story Project   Participate in HL7 Structured Document work group  Participate in HL7 ballots  Encourage implementation EHR vendor adoption  provider preference  transcription RFPs 
  43. 43. Membership Options and Benefits
  44. 44. Q&A Kim Stavrinakis Sr. Manager, Product Definition, GE Healthcare
  45. 45. Where You Can Find Me Nick van Terheyden, MD, CMO, M*Modal Twitter Technorati RSSSpeech Understanding MyBlogLog LinkedIn Plaxo FaceBook Digg Delicious E-Mail GrandCentral (301) 355-0877