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Pathway to Meaningful Use:

Unlocking Valuable Information in

Unstructured Documents

Kim Stavrinaki

s

Liora Alschuler Co-Founder, Health Story Project CEO, Lantana Consulting Group

HIMSS Virtual Briefing Wednesday, March 14, 2012

11:15 a.m. ET

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Goals of Today’s Session

Highlight the vision and goals of the Health Story

Project

Provide perspective on why HL7 CDA is ideally

suited to be a Meaningful Use content standard

Review the Health Story use case in the HIMSS

Interoperability Showcase

Demonstrate how Nuance Healthcare solutions

can unlock valuable information in unstructured

documents

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Health Story Presenter

Liora Alschuler

CEO, Lantana Consulting Group

Health Story Co Founder, Executive Committee

Co-Editor, HL7 Clinical Document Architecture

liora.alschuler@lantanagroup.com

Led project that produced design of first XML-based exchange

specification for healthcare

Co-editor of HL7 CDA, Continuity of Care Document (CCD), and

many HL7 guides that leverage CCD templates

Founding member of Health Story and leads technical strategy and

development

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Meaningful Use

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Meaningful Use

meaningful use: thanks for the fax

Meaningful Use: Certifiable!

MEANINGFUL USE: Return on Investment

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THE CHALLENGE

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A physician’s practical

need for fast and easy

(30 sec) methods of creating

clinical documentation

The enterprise need for

structured and coded

information capture to support

meaningful use

The Health Story Challenge

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Narrative

Text

HL7 CDA Structured Documents

Coded Discrete Data Elements

EHR Repository

HIM Applications

Clinical Applications

SNOMED CT

Disease, DF-00000

Metabolic Disease, D6-00000

Disorder of glucose metabolism, D6-50100

Diabetes Mellitus, DB-61000

Type 1, DB-61010

Insulin dependant type IA, DB-61020

Neonatal, DB75110

Carpenter Syndrome, DB-02324

Disorder of carbohydrate metabolism, D6-50000

Health Story: Incremental Approach

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Meaningful Use ≈ Data Reuse over the Full Health Story

patient care

billing/claims adjudication

research

quality reporting

clinical decision support

outcomes analysis

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THE SOLUTION

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Health Story Project

Non profit, industry alliance

Founded 2007

Associate Charter

Agreement: HL7

Sponsored HL7 standards for

common clinical documents (8!)

Member organizations provide

direction

www.healthstory.com

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Guides for 8 Common Documents

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HOW IT WORKS

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HL7 Clinical Document Architecture

Normative HL7 standard since 2000

Widely implemented

Provides a gentle on-ramp to information

exchange

Abstract/generic specification covers all

document/note/report types

Meets use cases with constraints expressed as

“templates”

Based on HL7 CDA Standard

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Health Story Defines CDA Templates

Templates are reusable building blocks

Templates that are particularly relevant for CDA:

1. Constrain the document sections based on the type of

document (section-level templates)

2. Constrain the entries within document sections (entry-level

templates)

<section>

<!-- template for Infection details section -->

<templateId root="2.16.840.1.113883.10.20.5.5.6"/>

<code codeSystem="2.16.840.1.113883.6.1"

codeSystemName="LOINC" code="51898-5"

displayName="Risk Factors"/>

...

</section>

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HL7 Continuity of Care Document

CCD also based on CDA

Health Story Relationship to HL7 CCD

Health Story reuses CCD templates

CCD Problem Observation (2.16.840.1.113883.10.20.1.28)

CCD Procedure Activities (2.16.840.1.113883.10.20.1.29)

CCD Medication Activities (2.16.840.1.113883.10.20.1.24)

CDC’s National Healthcare Safety Network

reuses CCD templates

CCD Reaction template (2.16.840.1.113883.10.20.1.54)

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Clinical Document Standards Consolidation

0. HL7 Continuity of Care Document

1. HL7 History and Physical

2. HL7 Consult Note

3. HL7 Discharge Summary

4. HL7 Diagnostic Imaging Report

5. HITSP/C32 - Summary Documents Using

HL7 CCD

6. HL7 Operative Note

7. HL7 Procedure Note

8. HL7 Unstructured Documents

9. HL7 Progress Notes

10. HITSP/C84 Consult and History & Physical

Note Document

11. HITSP/C48 Encounter Document constructs

12. HITSP/C62 Scanned document

“Consolidated CDA” HL7 Implementation

Guide

Health Story supported guides in blue

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Creating Discrete Entries

Methods for acquiring codes from notes:

1. Computer-assisted coding (CAC)

2. Natural language processing (NLP)

3. Data capture templates

4. Mobile and smartphone technology

Applying standard HL7 CDA markup makes the

discrete entries usable within an EHR and for the

meaningful use program

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Example: Discharge Summary

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Health Story: Incremental Approach

Benefit Value

Retains patient story Maintains primary role of documentation to clearly

describe and communicate what is going on with

patient.

Preserves physician

time for clinical care

Makes efficient use of physician time by enabling

choice of documentation methods and fosters EMR

acceptance

Supports meaningful

use

Interoperability: implements HL7 CDA document

standards for electronic exchange of clinical

information

Enables data reuse Structured narrative enables better outcomes

reporting, data mining, and decision support

Collaborative approach Developed by broad array of providers, vendors and IT

organizations; Balloted process through HL7 supports

harmonization

Better documentation Supports better coding, DRG optimization

= better reimbursement

Demonstrating

Consolidated

CDA on the

floor at

HIMSS12

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Health Story Telling: HIMSS12

Integration Platform

Dictating MD Transcriptionist Abstractor

Voice capture

Voice to text

Enrich Standard format

Telephone

PDR

Smart phone

Transcription

Speech recognition

NLP

DRT

CAC

CDA

ICD, CPT…

HL7 V2

HIE

MRM

EMR

Billing

Analytics

Quality

People

Platforms

Applications

H

e

a

l

t

h

S

t

o

r

y

Meaningful Use Clinical Document Ecosystem

Clerk

Imaging

Desktop appliances

Scan-to-CDA

OCR

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Aldo Leopold(1887 –1948) Author, scientist, ecologist, forester, and environmentalist, professor at the

University of Wisconsin; wrote A Sand County Almanac (1949), which has sold over two million copies

“The key to intelligent tinkering is to keep all the parts.”

All the parts, HIMSS 2012:

History & Physical

Progress Note

Unstructured Documents

Referral Request

Consult Note (Referral Response)

Lab Report

CCD Summary

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WHERE TO START

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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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Actionable Next Steps

1. Providers:

Is your documentation vendor set

up to deliver CDA documents? If

no, when?

Is your EHR vendor set up to

receive CDA documents? If no,

when?

2. Vendors: Check out the

requirements here:

www.healthstory.com

3. Join the Project!

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Contact Information

Liora Alschuler

CEO, Lantana Consulting Group

Health Story Co Founder, Executive Committee

Co-Editor, HL7 Clinical Document Architecture

liora.alschuler@lantanagroup.com

Led project that produced design of first XML-based exchange

specification for healthcare

Co-editor of HL7 CDA, Continuity of Care Document (CCD), and

many HL7 guides that leverage CCD templates

Founding member of Health Story and leads technical strategy and

development