Department of Veterans Affairs 2012 VAi2 Innovation: i5021 Jorge A. Ferrer M.D., M.B.A.

Department of Veterans Affairs

2012 VAi2 Innovation: i5021 https://vacloud.us/groups/5021/

Jorge A. Ferrer M.D., M.B.A | Medical Informatician | Veterans Health Administration OIA HI KBS | E mail: [email protected]

Adjunct Assistant Professor UTHealth School of Biomedical Informatics

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Study: Physician Perceptions of Two Electronic Medical

Records (EMRs): VistA (VA) and GE Centricity Lisa

Grabenbauer, University of Nebraska Medical Center 2009.

oResearch Objective: Examine physicians’ perspective on the

objective benefits and limitations of current EMR

o Conclusions: Current EMR frustrates physician collection of

data to improve patient care with cumbersome interfaces and

processes

o Recommendations:

o EMR must provide seamless and flexible interfaces across

system boundaries, for data input as well as data

retrieval

o EMR should facilitate patient and team interactions, not

inhibit them


Problem StatementThe 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. oThe 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.

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Project Goals and Design Principles

Objective: Fundamentally improve clinical documentation at the point of service

First Principles:o Tell the patient’s storyo Fill in knowledge gapso Minimize the intrusiveness of information technology

in the exam room and points of careo Let the workflow process drive the technology – not

the other way around

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Veterans Health Administration Strategic Plan FY 2013 – 2018oVHA Goals and Objectives: Provide Veterans Personalized, Proactive, Patient-Driven Health Care.oa. VA Health Care Delivery ob. Communicationoc. Awareness & Understanding od. Access to Information & Resources oe. Quality & Equity of. 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.og. 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.

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AMIA’s Invitational Health Policy Meetings

o2006: Toward a National Framework for the Secondary Use of Health Data o2007: Advancing the Framework: Use of Health Datao2008: Informatics, Evidence-based Care, and Research; Implications for National Policyo2009: Anticipating and Addressing Unintended Consequences of HIT and Policy o2010: Future of Health IT Innovation and Informaticso2011: Future State of Clinical Data Capture and Documentation

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AMIA’s 6thAnnual Policy Meeting The Future State of Clinical Data Capture and DocumentationDecember 6-7, 2011, Washington, D.C.

oAMIA’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.”

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AMIA’s 6thAnnual Policy Meeting (AMIA working definitions)

oClinical 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.

oAn individual’s health record is the repository of clinical information recorded about that person. The record has many functions.

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AMIA’s 6thAnnual Policy Meeting The Future State of Clinical Data Capture and Documentation December 6-7, 2011, Washington, D.C.

Time spent on documentationo21% of time documenting

o Annals Emergency Medicine. 1998;31:87-91o21% of time documenting

o Annals Family Medicine. 2005;3(6):488-493o1.4 hour/day

o Journal Clinical Oncology. 2002;20(24):4722-4726oUp from 0.3 hours/day in 1976

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Department of Veterans Affairs 10


AMIA’s 6thAnnual Policy Meeting 2011 Meeting AssumptionsoNeed to transform the way we capture data and document clinical careoNew technological and technical advances for clinical data capture and documentationoNew and diverse data sources, health technologies and devices for data acquisition, collection and reporting, treatment support, and information dissemination oBlurring of lines between devices and applications intended primarily for use by providers, and those intended for patientsoDynamic environmental factors, trends and issues impacting clinical data capture and documentation

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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 status2. Be efficient –enhancing overall provider efficiency, effectiveness and productivity3. Be accurate, reliable, valid and complete –enabling high quality care4. 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 team6. Reflect input from multiple sources –including nuanced medical discourse, structured items and data captured in other systems and devices

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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

oResearch Agenda Recommendationso 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.

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Journal of American Medical Informatics Association 2013: The wave has finally broken: now what? (Simborg)oBarriers to achieving the promise of improved quality and reduced cost remain, as well as some unintended negative consequences.

o 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’

o 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.

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Department of Veterans Affairs 2012 VAi2 Innovation: i5021 Jorge A. Ferrer M.D., M.B.A.

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