Modernizing Patient Records
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This is a presentation I delivered at AIIM 2010 in Philadelphia. It presents a holistic look at the make up of a patient record and the challenges in moving to a digital environment.
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Modernizing Patient Records
- 1. Can it rally happen? Presented by: Bob Larrivee AIIM Director/Industry Advisor Digital Patient Records:
- 2. January 12, 2009 President Obama announces digital health records for all within 5 years August 19, 2009 HHS announces “Information Breach” regulations 36+ Breaches listed by HHS as of 03/2010 Affecting 500+ individuals The Mandate
- 3. Many in the Electronic Health Records (EHR) space Over 70 vendors listed in a single site Includes: GE Healthcare Advanced Data Systems Cerner Corporation McKesson Source: http://www.ehr-software.net/comparison.htm The Players
- 4. Medical History and demographics Medications, immunizations and allergies Lab results and radiological images Insurance Coverage and claims Financial Billing Information Patient Requests Living Will What is a Patient Record?
- 5. Nirvana
- 6. Acceptance of electronic information Healthcare Physicians Hospitals Labs Insurance Claims Billings Pharmaceutical Prescriptions Global Adoption
- 7. Reality
- 8. Multi-faceted Environment Healthcare Insurance Pharmaceutical Legal Process Issue Hand-offs On-ramps and off-ramps Healthcare - Extended
- 9. Standardization Functionality – ensuring that the systems can support the activities and perform the functions for which they are intended Security – ensuring that systems can protect and maintain the confidentiality of data entrusted to them Interoperability – ensuring systems implement the recognized standards and can exchange information and work with other systems. The Challenge
- 10. Dynamic integration of content From this To this 10
- 11. Hand-offs Should be clean Well defined Automated On-Ramps and Off-Ramps Information and Records Entering a process Handled in the process Exiting a process Note: The end of one process begins the next Process
- 12. ISO 18308 Requirements for an Electronic Health Record Reference Architecture Electronic Health Records(EHR)- HL7 EHR – S Functional Model (HER-S FM) EHR – Interoperability Model (EHR/IM) Personal Health Record Systems Functional Model (PHR-S FM) Digital Imaging and Communications in Medicine (DICOM) More…. Existing Work and Standards
- 13. Office of the National Coordinator for Health Information Technology and the Centers for Medicare & Medicaid Services Defined “meaningful use” of EHR Solutions Improving quality, safety, efficiency, care coordination, population and public health; Reducing health disparities; Engaging patients and their families; and, Ensuring adequate privacy and security protections for personal health information Certification Commission for Health Information Technology Updated Certification Programs Progress
- 14. The issue is large Extends beyond healthcare alone Standards need to be adopted and adhered to Process within and beyond an organization must be designed and documented Looking Ahead
- 15. A Lesson from ECM ECM can be the umbrella Leverage Content Management Interoperability Services (CMIS) Standard A common web services interface to support uniform access across different content repositories Leverage ERM Standards Leverage BPM Best Practices
- 16. We are getting there but there is a lot of work ahead Standards need to be set and adopted EHR should be part of your ECM Environment Included as a content/records source Strong and seamless processes are key Identify the on and off ramps of patient records Digital Patient records can and is becoming a reality Look at it holistically My Opinion
- 17. Bob Larrivee – Director and Industry Advisor – AIIM Email – blarrivee@aiim.org Twitter - @BobLarrivee Visit: AIIM.ORG InformationZen.org AIIM Knowledge Center AIIMCommunities.org Thank you
Notas do Editor
- Modernizing Patient Records: Will it really work?Thinking about process and how healthcare providers interact with the insurance industry is one of the areas where I get stuck. As an example, my family Physician has made the move to digital records already. He saw and understood the benefit early on. Where it falls flat for him is the majority of insurers and benefits administration firms he deals with require that he send hard copy rather than digital records for processing, partially defeating the purpose of going digital. Secondly, there appears to be no standard as yet for hospitals, clinics and practitioners to correspond and exchange information. Within the ECM world, we have dealt with this for many years and the time is now that things are changing with the emerging Content Management Interoperability Standard (CMIS). Looking at this historically, and the scenario I faced with my own records, I have no choice but to wonder if the efforts for patient records while admirable and much needed will fall short. We need to move in this direction and I fully support it but I also feel we need to step back and look at the bigger picture. How long has it taken our industry to work out a standard and how long will it take for the healthcare system? I know that standards develop over time but is there a way to leverage what has been done already even if it is not specific to an industry like healthcare and wouldn’t it make sense to begin there? I am not hearing a lot about this.In order for this effort to be effective in healthcare there needs to be:A set of universally accepted interoperability standards established for information and content of all types and formatsConsideration for the on and off ramps of information within a processA plan as to how other entities like the insurance and benefit claims segments will interact with healthcare providers so they too will be part of the solution and not be seen as part of the problemNow I know I have not covered everything but the point I am trying to make is that the opportunity is here today for the ECM and Healthcare communities to come together and work toward the common goal of managing information and content regardless of format and type. The objective of universal access to patient records in a secure environment is nothing new nor is it out of reach. What remains to be seen is how this transition is approached, planned and executed.What say you on this topic? I look forward to hearing from you and remember, AIIM provides the training you need to jump start your information management projects. www.aiim.org/trainingBob Larrivee – AIIM
- Modernizing Patient Records: Will it really work?January 12, 2009President Obama announces digital health records for all within 5 yearsAugust 19, 2009HHS announces “Information Breach” regulationsAs I have said in the past, I think the efforts by our current administration and President Obama is highly commendable. I think the suggestion and action to move our healthcare system into a digital state is long overdue but I just can’t help feeling that making patient records digital is not going far enough.
- In an ideal world, the patient would not need to be concerned about how records are handled and if the provider can access his/her information.Regardless of where you go, each entity in the healthcare arena could access your information as needed and when needed.
- As an example, my family Physician has made the move to digital records already. He saw and understood the benefit early on. Where it falls flat for him is in the handoff and more specifically with the Insurance industry. The majority of insurers and benefits administration firms he deals with require that he send hard copy rather than digital records for processing, partially defeating the purpose of going digital.
- The reality of this today is that there are major disconnects.This is such an important issue that Microsoft and even Google with Google Health are creating areas where you can upload and store your personal health information, making it accessible to you and/or medical staff as needed.In this case, you are the responsible steward of your own information and this trend is getting clearer as labs and other facilitators of healthcare services no provide you with your records and a message they will destroy their copy within so many days.
- This progress is a wonderful thing and I am excited to see it coming into focus but from a holistic perspective, I am thinking about process and how healthcare providers interact with the pharma and insurance industries as one of the areas where I get stuck. As an example, my family Physician has made the move to digital records already. He saw and understood the benefit early on. Where it falls flat for him is in the handoff and more specifically with the Insurance industry. The majority of insurers and benefits administration firms he deals with require that he send hard copy rather than digital records for processing, partially defeating the purpose of going digital.
- There appears to be no fully accepted standard as yet for hospitals, clinics and practitioners to correspond and exchange information. Recently, I was injured in a fall. I went to a local hospital for treatment and was given electronic files of the x-rays and diagnosis to take back for the follow-up visit with my Physician. Knowing my Physician had transitioned to the digital age; I had high hopes and was excited that this was really happening. My excitement soon came back to reality when I presented the CD to my Physician who looked at it and determined he could not import the information to his system. Not compatible, not surprising.There is agreement however that the 3 main areas of focus need to be functionality, security and interoperability.
- In the case of User 1 on the left, the IA has not been developed strategically, if at all. The individual functional components exist as silos and can be repeated, that is to say functions such as authoring/capture, document management and portals can occur multiple times in multiple standalone applications. As a result, User 1 is burdened with being the point of integration. User 1 must learn and interface with several search tools, process interfaces and content/records management tools, for example. From a content delivery perspective, this means that User 1 must take on the burden of not only locating and assembling all relevant content, but in arranging and organising them to provide the level of insight cutting across all resources to support his current business issue.User 2, on the other hand, has the benefit of a well-defined and orchestrated IA, including a well-defined content delivery strategy that dynamically assembles various pieces of content based on a particular business need. As a result, User 2 accesses content within the context of a business processes as a single cross-organizational resource, simplifying access, eliminating frustration and increasing productivity and effectiveness.
- Consideration for the on and off ramps of information within a processA plan as to how other entities like the insurance and benefit claims segments will interact with healthcare providers so they too will be part of the solution and not be seen as part of the problem
- There are some works in progress and standards available in this space likeISO 18308Requirements for an Electronic Health Record Reference ArchitectureElectronic Health Records(EHR)- HL7EHR – S Functional Model (HER-S FM)EHR – Interoperability Model (EHR/IM)Personal Health Record Systems Functional Model (PHR-S FM)Digital Imaging and Communications in Medicine (DICOM)More….But the problem is that not all vendors or facilities adhere to them, so therefore we must conclude that they are not fully adopted standards.
- Examples of meaningful use objectives:Implement drug/allergy checkMaintain active medication/allergy listRecord and chart changes in vital signsIncorporate clinical lab-test results into EHR as structured dataCheck insurance eligibility electronically Provide patients with an electronic copy of their discharge instructions and procedures at time of discharge, upon request This last bullet is of particular interest to me…
- CMIS stands for “Content Management Interoperability Services,” and is an ECM interoperability standard developed and supported by the who’s who in ECM, including Microsoft, IBM, EMC, Oracle, Alfresco, Day Software and Open Text. Initial release of the standard occurred in late 2008.The purpose of the specification is to define a common Web services interface that will allow developers to build applications that can talk uniformly to many different content repositories – the task that the early web services and Service-Oriented Architecture movements have been explicitly hinting at for close to a decade.What separates CMIS from previous attempts is that it is not tied down with the baggage or overhead of a “heavy-handed” approach, such as SOA, which we will define in more detail on the following slide.The “Standards-oriented suite” approach does NOT assume that there is a well-defined architecture in place BEFORE attempting to tackle cross-repository integration. Instead, the CMIS standard is targeted at the commonalities across repositories rather than separate, specific integration with EACH repository in a one-at-a-time manner. Simply put, CMIS is aimed at simplifying to a common set of expected interface or integration points that are SPECIFIC to ECM environments.There have been previous attempts at such a standard, and the mere rise of a new standard is no reason to assume that it will be successful, nor that it will cure all ills. However, given the other trends in the ECM market which are pushing for broader adoption, at a wider variety of price points and capabilities, the timing is right for a “real” standard to assist organisations bridging BCS offerings versus the larger and more specialised deployment of ECM that they may have already put in place.The death of any standard is the lack of awareness and demand for the adoption of a standard. Keep an eye on CMIS and how any solutions you are examining work with this standard. If you are a buyer of ECM solutions, make sure that your contacts within your suppliers of your choice understand your interest in making this or any other standard a working reality.