Mobilizing Data for Pressure Ulcer Prevention Challenge Webinar
1. Mobilizing Data for Pressure Ulcer
Prevention Challenge Webinar
January 23, 2013
Sponsored by the ONC
Slide #0
2. Agenda
• Welcome & Vision
Judy Murphy RN, FACMI, FAAN, Deputy National Coordinator
Policy & Programs ONC
• Project History & Background
Ann O’Brien RN, MSN Kaiser Permanente
• Mobile Apps as a Strategy for Quality &
Interoperability
Tim Cromwell RN, PhD, Veterans Health Administration
• Model Development Process
Susan A. Matney RN, MSN, FAAN 3M Health Info Systems
• Terminology Resources for App Developers
Jay Lyle PhD Terminologist
• Challenge Details & Evaluation Criteria
Hemali Thakkar, Challenger Manager – Health 2.0 1
3. Health IT:
Helping to Drive the 3-Part Aim
Better healthcare
IOM 6 domains of quality: Safety, Effectiveness, Patient-
Centeredness, Timeliness, Efficiency, and Equity.
Better health
Keeping patients well; Increasing the health of populations:
focus on preventive care.
Reduced costs
Lowering the total cost of care while improving quality.
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Health Information Technology
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4. Patient-Centric health care
and health record
• Develop a standard, mobile bedside pressure
ulcer assessment tool
• Promote the integration of nursing assessment
into common information models
• Lay the groundwork for exchange of nursing
assessment data for:
individual patient centric care
cross-patient aggregation for analysis
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5. Objectives for
Mobile App Challenge
• Provide an opportunity for mobile application
developers to partner with clinicians to transform
care
• Describe a future vision where patient-centered data
informs the development of information models and
results in interoperability and improved care
• Invite participation in the vision of mobilizing data to
support patient centered care and evidence based
practice
• Describe the resources for developers to meet the
objectives of the mobile challenge
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6. The Prototype for
Mobilizing Data
• As many as 3 million patients are treated in U.S. health
care facilities each year for pressure ulcers
• Annual cost of pressure ulcers is $3.2 billion
• 60,000 patients die annually from pressure ulcer
complications
• Most pressure ulcers are preventable.
• Per standards of care, patients are assessed for pressure
ulcer risk on admission and at prescribed intervals
• Quality data for pressure ulcers are already collected but
reported in a variety of ways.
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7. Current State
• Patients receive from care in different healthcare organizations and
their data does not move with them because it is bound within the
proprietary software.
• Data is stored in a way that is difficult to share and compare data
across patients or episodes of care.
• Clinicians do not have the comprehensive view of the single
patient’s history and cannot track data over time.
• There are not consistent models for collecting and storing data
which limits opportunities for comparison and data mining for
quality outcomes.
• As a country, we are unable to automate evidence based practice
and personalize care beyond the borders of a single health system.
• It is “organization-centric care” not patient-centered care.
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8. Background & Overview
• KP-VA Collaborative in 2010 defined an
information model driven by nursing practice to
enable:
– Data capture
– Data re-use
– Data sharing within and outside organizations.
– Measurement and extraction of data for meaningful EHR
use to support quality, safety, efficiency and decision
support.
• The American Nurses Association sponsored
Tipping Point collaborative meetings with
professional nursing leaders
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9. Mobile App Challenge
• The aim of this challenge is to create a free mobile app
(for iPhone, Android, or both) that will free information
from data silos and promote the development and
implementation of common information models.
• The goal is to combine reference and authoritative
terminologies that free documented observations to
move between and among various information systems
and organizations.
• Encouraging the use of emerging and existing
standards, this challenge will demonstrate the value of
common models and terminologies to achieve
improved information exchange.
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10. Model Development Process
• VA/KP started Mind Map and Model
• Interfaced with SDOs – LOINC, SNOMED CT, HL7
• LOINC nursing subcommittee accepted the project
– recruited nursing informatics leaders
– harmonized skin/wound assessment from six
institutions
• Part of the model taken up by HL7 patient care
committee and Pressure Ulcer Risk DAM created
– Enhanced with interventions
– Vetted through wound care experts
– Balloted and approved
• SNOMED CT and LOINC content requested
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11. Skin Inspection Class
class Skin Inspection Detail
«enumeration»
«enumeration» Pressure Ulcer Risk Assessment Item Skin Condition
Skin Moistness
Skin Inspection
dry
normal extremely dry
- skin color :Skin Color
moist normal
- skin moistness :Skin Moistness
diaphoretic friable
- skin temperature :Skin Temperature
clammy
- skin turgor :Skin Turgor
«enumeration» «enumeration»
Skin Temperature Skin Color
«enumeration»
cool Skin Turgor normal for ethnic group
warm (normal) ashen
cold good elasticity (normal)
cyanotic
hot poor, decreased elasticity
flushed
tenting = not found
jaundiced
mottled
pale
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12. Terminology Coding
Type Text Terminology Code FSN
Question Skin Moisture LOINC 39129-2 Moisture:Type:PT:Skin:Nom::
Value Diaphoretic SNOMED CT 52613005 excessive sweating (finding)
Value Moist SNOMED CT 16514006 moist skin (finding)
Value Clammy SNOMED CT 102598000 clammy skin (finding)
Question Skin Temperature LOINC 44968-6 Temperature:Type:PT:Skin:Ord:Palp:
Value Consistent With Body Temperature SNOMED CT 297977002 Skin normal temperature (finding)
Value Warm SNOMED CT 102599008 warm skin (finding)
Value Cool SNOMED CT 427733005 cool skin (finding)
Question Skin Turgor LOINC 39109-4 Turgor:Imp:PT:Skin:Nom::
Value Good Elasticity (normal) SNOMED CT 297956000 skin turgor normal (finding)
Value Decreased Elasticity (Poor) SNOMED CT 425244000 decreased skin turgor (finding)
Value Tenting SNOMED CT 297957009 stretched skin (finding)
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13. Model Navigation:
www.fhims.org
• Requirements are in Challenge text
• Relationships and further details are in the UML
model
• UML model is analysis level, not design level
• UML model supports interoperability, not
application design
• UML model contains material not relevant to
Challenge (Interventions package)
• UML model does specify terminology identifiers
(also in spreadsheet)
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14. Model Scope
Office of the National Coordinator for
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Health Information Technology 13
15. Evaluation Criteria
• Innovation
• Design and usability, including user friendliness and
attractiveness of the interface
• Use of National Pressure Ulcer Advisory Panel (NPUAP)
guidance to improve pressure ulcer prevention and care
• Ease of integration with PHR/EHR interface
• Application of the HL7 Pressure Ulcer Prevention Domain
Analysis Model (DAM)
• Application of the LOINC® Nursing Subcommittee and the
International Health Terminology Standards Development
Organization (IHTSDO) Nursing Special Interest Group (SIG)
terminology and candidate models
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16. Timeline
• Submission Period Began: December 5, 2012
• Submission Period Ends: April 29, 2013
• Evaluation Process Begins: May 3, 2013
• Evaluation Process Ends: May 16, 2013
• Winners Notified: May 24, 2013
• Winners Announced: Conf TBD, in May-June, 2013
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17. Prizes
First Place: $60,000
Second Place: $15,000
Third Place: $5,000
recognition, publicity, credibility and reach!
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