1. www.healthstory.com Welcome! Health Story Project Update Wednesday, April 21, 2010 1:00-2:00 PM central If you are on the call, please press your unique audio pin.

2. 2 www.healthstory.com The Health Story Project  Vision: Comprehensive electronic clinical records that tell a patient’s complete health story.  Goal: All of the clinical information required for good patient care, administration, reporting and research are readily available electronically, including information from narrative documents.  www.healthstory.com www.healthstory.com

3. 3 Webinar Purpose  Participants speak knowledgeably about the project and status  Decision makers equipped with information needed to evaluate participation

4. 4 www.healthstory.com Agenda 1:00-1:25 PM  Project Overview and Update  Joy Kuhl, Optimal Accords and Mark Ivie, M*Modal  Technical Strategy Update  Liora Alschuler, Alschuler Associates 1:25-1:45 PM  New Guide for Unstructured Documents  Peter Bedell, Fujitsu and Therasa Bell, Osmosyz  New Guide for Procedure Notes  Judy Logan, Oregon Health & Science University 1:45-2:00 PM  Dialogue

5. 5 www.healthstory.com Ground Rules  Place phone on mute  Avoid hold  Submit comments and questions via web tool

6. 6 www.healthstory.com Introductions Joy Kuhl Health Story Project joy@optimalaccords.com Theresa Bell Osmosyz tbell@inofile.com Mark Ivie M*Modal mark.ivie@mmodal.com Peter Bedell Fujitsu pbedell@us.fujitsu.com Liora Alschuler Alschuler Associates liora@alschulerassociates.com Judy Logan Oregon Health & Science University loganju@ohsu.edu

7. 7 www.healthstory.com OVERVIEW AND UPDATE Mark Ivie, M*Modal

8. 8 www.healthstory.com A physician’s practical need for fast and easy methods for creating clinical documentation The enterprise need for structured and coded information capture to support meaningful use Background: Why Health Story? Computer image courtesy of M*Modal

9. 9 www.healthstory.com The Health Story Project  Non profit  Industry alliance  Founded 2007  Associate Charter Agreement: HL7  Sponsor HL7 standards for flow of information between narrative and EMR systems  Member organizations provide direction

10. 10 www.healthstory.com Health Story: Guiding Principles 7. Use proven technology 6. Base strategy on existing standards 5. Minimize disruption to clinician workflow 4. Provide a glide path for incremental interoperability 3. Enable broad stakeholder engagement 2. Leverage current technology investments 1. Inclusive and open process

11. 11 www.healthstory.com Health Story Members Founding Members Participants All Type | Broward Sheridan Technical Center Dictation Services Group | Healthline, Inc. MD-IT | New England Medical Transcription | Sten-Tel, Inc. Contributors Aprima Software | Scribe Healthcare Technologies Promoters

12. 12 www.healthstory.com Health Story Projects HL7 Implementation Guides Completed  History & Physical  Consultation  Operative Report  DICOM Imaging Reports  Discharge Summary (in publication)  Procedure Note (in reconciliation)  Unstructured Documents (in reconciliation) Upcoming  Progress Notes www.healthstory.com

13. 13 www.healthstory.com Adoption Strategy  Health Leven Seven (HL7) collaborates with Health Story on development and ballot of technical implementation guides  Medical transcription companies support creation, delivery and enrichment  EHR vendors systems send, receive, display and integrate  Health providers select the approach and receive vendor support for standards-based document creation, management and enrichment

14. 14 www.healthstory.com INTEROPERABILITY STRATEGY Liora Alschuler, Alschuler Associates

15. 15 www.healthstory.com What is Meaningful Use? “Meaningful use, in the long-term, is when EHRs are used by health care providers to improve patient care, safety and quality.” David Blumenthal, MD National Coordinator for HIT

16. 16 www.healthstory.com Meaningful Use ≈ Data Reuse patient care billing/claims adjudication research quality reporting clinical decision support outcomes analysis

17. 17 www.healthstory.com “The key to intelligent tinkering is to keep all the parts.” Aldo Leopold

18. 18 www.healthstory.com Based on HL7 CDA Clinical Document Architecture supports:  Human readable document  Machine-processable data (e.g. discrete reportable transcription)  Cross platform and application independent Health Story Approach  Standardize through ANSI SDO (HL7 ballot)  Support Meaningful Use MinimumOptimum CDA header Standard section codes Broad industry agreement on clinical content Reuse of entry-level templates “Templated CDA”

19. 19 www.healthstory.com Health Story Documents Blend between free form text and fully structured documentation that  represent the thought process, and  capture the clinical facts  Health Story makes “discrete reportable transcription” work

20. 20 www.healthstory.com Minimal Document for Exchange... Adam Everyman

21. 21 www.healthstory.com Optimum Level: Today <code codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" code="46239-0" displayName="REASON FOR VISIT"/> REASON FOR VISIT/CHIEF COMPLAINT Stomach ache.

22. 22 www.healthstory.com Achievable: Tomorrow <code codeSystem="2.16.840.1.113883.6.96" codeSystemName=”SNOMED” code="230056004" displayName="Cigarette smoking"/> 1 pack per day

23. 23 www.healthstory.com 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 Incremental Interoperability

24. 24 www.healthstory.com Impact  Allows providers to choose preferred workflow and documentation methods  Provides on-ramp to EMR system adoption  pre-populate EMR with structured documents  integrate legacy documents  Increases the value and usability of narrative documents  Allows intelligent and meaningful re-use of information

25. 25 www.healthstory.com Successes  Members generating Health Story/HL7 compliant CDA today: GE Medical, MedQuist, M*Modal  Many members planning to generate standards-based documents within next year  Health Story/HL7 H&P and Consult recommended by HITSP  On CCHIT HIE Roadmap  Included in HIMSS EHR Adoption Model

26. 26 www.healthstory.com NEW GUIDE FOR UNSTRUCTURED DOCUMENTS Therasa Bell, Osmosyz and Peter Bedell, Fujitsu

27. 27 www.healthstory.com NEW GUIDE FOR PROCEDURE NOTES Judy Logan, Oregon Health & Science University

28. 28 www.healthstory.com IN SUMMARY Joy Kuhl, Health Story Project

29. 29 www.healthstory.com The Health Story Project  Five Year Goals 1. Strengthen Operations 2. Establish Brand Awareness 3. Maintain Strong Coalition 4. Increase Market Demand 5. Sustain Technical Specification Development 6. Earn National Endorsement 7. Foster Widespread Adoption 8. Declare Success

30. 30 www.healthstory.com Get Involved  Consider the Health Story pathway  Share the story  Join the project

31. 31 www.healthstory.com Where You Can Find Us Health Story Presentation Illinois Health Information Mgmt Association Thursday, April 22, 2010 Peoria, Illinois www.ilhima.org Health Story Technology Workshop MTIA Conference Thursday, April 29, 2010 Daytona Beach, Florida www.mtia.com $395, $295/members Special Offer: Non members can use workshop cost toward membership

32. 32 www.healthstory.com Actionable Next Steps Is your system capable of producing an HL7 CDA document? Requirements:

33. 33 www.healthstory.com WE WANT TO HEAR FROM YOU

34. 34 www.healthstory.com Presenters Joy Kuhl Health Story Project joy@optimalaccords.com Theresa Bell Osmosyz tbell@inofile.com Mark Ivie M*Modal mark.ivie@mmodal.com Peter Bedell Fujitsu pbedell@us.fujitsu.com Liora Alschuler Alschuler Associates liora@alschulerassociates.com Judy Logan Oregon Health & Science University loganju@ohsu.edu

35. 35 www.healthstory.com APPENDIX

36. 36 www.healthstory.com Supports Meaningful Use Meaningful Use Health Story Interoperability Strategy Delivers common clinical documents to the point of care Standardizing document types and sections today makes it easier to agree on data elements tomorrow Incrementally adding key data elements into narrative is attractive to clinicians Partial structuring facilitates natural language processing Health Story’s path to Meaningful Use  Hit the ground running with basic CDA, to meet the needs of front line clinicians  Incrementally layer discrete data elements into CDA documents

37. 37 www.healthstory.com CDA is the basis for...  Consult Note  Continuity of Care Document  Diagnostic Imaging Report  Discharge Summary  Healthcare-associated Infections, Public Health Case Reports  History and Physical  Operative Note  Personal Health Monitoring  Plan-2-Plan Personal Health Record  Procedure Note  Quality Reporting Document  Minimum Data Set  Unstructured Documents  … and more …  HITSP/C28 Emergency Care Summary  HITSP/C32 - Summary Documents Using HL7 CCD  HITSP/C38 - Patient Level Quality Data Document Using IHE Medical Summary (XDS-MS)  HITSP/C48 Encounter Document constructs  HITSP/C84 Consult and History & Physical Note Document  HITSP/C78 Immunization Document  HITSP/C74 PHRM  HITSP/C62 Scanned document