Transcript Illinois PDF/H Pilot - Association for Information and

Optimal Healthcare Management Through Technology
Illinois PDF Healthcare Pilot
September 13, 2008
Rick Benoit
Chair PDF/Healthcare Workgroup
Stasia Kahn, MD
Co-Founder, Fox Prairie Medical Group
Vice President, Northern Illinois Physicians
For Connectivity
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
What is PDF Healthcare?
• A “Best Practices Guide” describing attributes of the
Portable Document Format (PDF) to facilitate the
capture, exchange, preservation and protection of
healthcare information
– Share data easily between healthcare institutions
– Ease the transition into digital health records for
information exchange and sharing
– Bridge the gap between healthcare providers and
consumers
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
What it is NOT…
•
•
•
•
•
•
Another PDF format…
Another PDF creation tool…
Another PDF product…
Another PHR offering…
Another proprietary solution…
Another PDF standard…
Advancing Healthcare
PDF
Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
PDF Healthcare’s Mission
PDF
– provides a trusted and universal means by which healthcare data is
captured, exchanged, preserved and protected
– facilitates the use of digital healthcare content of various platforms and
devices
– encourages and supports healthcare patients / consumers to control and
account for their own and family health records
Therefore, through the development, deployment and evolution of the PDF
Healthcare Guides, the following will be realized:
– PDF supports the migration of multiple record types to a universal PDFbased container
– PDF promotes and accelerates the adoption of an electronic healthcare
record
– PDF provides efficiencies potentially resulting in:
• Error reductions
• Elimination of redundancies
• Improvements in workflow processes
• Improvements in patient care delivery and communication
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
PDF Healthcare’s Objective
• Objective
– To develop a secure, electronic container that can store
and transmit relevant healthcare information, including
but not limited to personal documents, clinical notes,
lab reports, electronic forms, scanned images,
photographs, digital X-rays, and ECGs, important for
maintaining and improving one’s health.
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Why PDF Healthcare?
• PDF is powerful and flexible
• PDF focuses on the specific needs of the
healthcare market
• Interoperability and portability
– PDF is based on open, published specifications
• The PDF Healthcare Best Practices Guide has
been developed and will be maintained by an
external committee with healthcare industry
knowledge
• PDF Readers are ubiquitous, easy to access
and use as well as being a trusted document
container
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Objectives - 2008
• Identify, document, distribute, and publish
multiple use cases to physicians and consumers
• Explore and develop a strategy for including the
HL7 CDA / CCD document format
• Gather feedback from users and identify needs
for version 2 of the BPG and IG
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Dak Systems Consulting
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Additional Information
For more information please email:
[email protected]
To join the working group please contact:
Betsy Fanning - [email protected]
To purchase and download the Best Practice Guide:
http://www.aiim.org/product.asp?ID=1675
To download the Implementation Guide and Toolkits:
http://www.aiim.org/pdfh/ig
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Initial PDF Healthcare Offering
• Best Practices Guide
– Describes the attributes of the Portable Document
Format (PDF) that are relevant to facilitate the capture,
exchange, preservation and protection of healthcare
information
• Implementation Guide / Use Cases
– Supplemental information that provides examples of
interoperability with existing healthcare standards such
as ASTM’s Continuity of Care Record (CCR)
– Future use cases could include Health Level 7’s Clinical
Document Architecture (CDA) as well as other, new,
emerging standards
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Why did we Implement PDF/H?
• An ambulatory EMR is a data repository which is
a subset of a longitudinal health record
• Except in a completely closed healthcare
system, a longitudinal EMR includes imported
documents and images
• Imported data cannot be captured by the
discrete data fields delineated by the CCR
• Consulting providers are used to dealing with
narrative documents rather than summary data
displayed by the CCR
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Overview of Data Flow Patterns in
Ambulatory Healthcare Settings
• Raw data is
transformed
into clinical
output
during an
in-person
medical
encounter
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Exporting Summary Care
information From an EMR
• Healthcare
Delivery
Organization
creates and
exports
summary
care
information
from an EMR
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Continuity of Care Record Pilot in
Illinois
• June 8 2005 ASTM CCR successfully balloted
• September 2005- June 2007 14 CCRs exchanged
• February 2008 PDF/H successfully balloted ASTM and
AIIM
• December 2007- September 2008 22 PDF/Healthcares
exchanged and 1 CCR
• Receiving physicians were representatives of small,
medium and large academic and private groups.
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Summary PDF/H Pilot
Feedback
•
•
•
•
•
11 PDF/Hs and 1 CCR uploaded to the portal
1 failure- PDF/Healthcare not accessed 2 more failures
1 imported directly into EMR
10 Viewed online by the provider
5 Providers printed the document themselves
2 had someone else print
Those that were working in a digital office were interested in being
able to download the PDF/H into their system
One that was paper based was interested in saving the file to an
office computer
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Lessons Learned
• If at all possible call the receiving physician ahead of time (a week or
more ideally)
• Confirm the email address of either the administrator or physician
who will be accessing the portal
• Confirm the provider who is seeing the patient
• Spam filters may block the notification emails
Solution: Implement a return receipt for notification emails or a
decision support feature that notifies the sender that the PDF/H
or CCR has not been viewed by the recipient within a specified
period of time
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Lessons Learned
• When referring to an institution that screens patients prior to making
appointments, it may be difficult to find a physician willing to view the
PDF/H
• The receiving providers may not have a complete view of the
rendered CCR due to margin issues
Solution: Change the margins of the style sheet
• If the image is saved in nonstandard image format such as PCX the
recipient will have to save the attachment and find an application to
view it
Solution: Scan all documents into EMR using a widely available
format such as TIF,BMP
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Lessons Learned
• Standard style sheet proved to be confusing to the
recipients with delivery of multiple discrete lab results
• Solution: Modify CCR style sheet to better group the results
• EMR PDF viewers have varying ability to view
attachments to the PDF
• Providers saving the PDF in their EMR need to save
attachments separately if viewer will not allow access
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Provider Feedback
• Incorporate a Narrative Note explaining
the purpose of the referral
• Attach the most recent Office Encounter
• Be more concise to avoid excessive
scrolling
• Simplify the procedure to access the
PDF/H
• Attach MRI Image
• Limit Administrative Burden on Provider
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Limiting Administrative Burden
• For practice groups where a physician prefers not to
view PDF/H directly, use a generic log in
• Consulting provider field would be generic for the entire
practice
• Health Information Management Specialist would be
responsible for delivering the content of the PDF/H to the
appropriate physician
• Disadvantage to this approach is that the physician no
longer chooses what to import from the PDF package
• Beware of using generic log in office with multiple sites
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Technology Next Steps
• Render images and text documents into the PDF
document so they can be viewed without concerns for
file type
• Implement XFA form technology to allow for creation of
different views of CCR data
• Allow transmission of PDF to patients via portal for
importing into PHR
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Expansion of the Technology
• Import CCR/CCD data as structured data into recipient
EMR
• Allow for the exchange of PHR data into EMRs
• Implement PDF/H at hospital discharge
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Expansion of the Technology
Import CCR/CCD data as structured data
 This is dependent on EMR vendors addressing the data integrity
issues of
• Identifying the creator and sources of data
• Tracking the creator and sources of data
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Obstacles for Discrete Data Import

It is important to identify and differentiate whether a diagnosis or
medication entry originated from a healthcare provider, which healthcare
provider, or patient
 Fraud and errors in medications and diagnosis could be perpetuated
 Patients have not been educated to code data in a structured format. Personal
Health Record past medical history and medication entries allows for
unstructured data
 Entries from patients should not be used for billing purposes or take the place of
a dialogue between a healthcare provider and patient
 A patient could be labeled or treated inappropriately because of their own
misunderstanding of the nuiances of coding structured data
 Providers vary in their familiarity with structured data pertaining to other medical
specialties
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Tracking the Creator and Sources of Data
•
•
Currently EMR systems will tag all data entered through the EMR as to the
data by user ID
EMR vendors would need to be required to identify the creator and the
source of all structured data as coming in from an external source
EMR vendors would need to be required to tag the originator of all
structured data fields
EMR vendors would need to be required to have tracking mechanisms
in place to allow data sources to flow across disparate electronic
health records systems
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Expansion of the Technology
Allow for the exchange of PHR data into EMRs
This is dependent on the following:
• Engaging Consumers in using Personal Health Records
• Limiting the IT burden on providers who agree to accept
asynchronous PDF/Hs from patients
• Defining Informed Consent
• Compensating Physicians who exchange data with their
patients electronically
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Next steps
 Additional Use Cases of PDF/Healthcare
being explored in Illinois
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Next steps
NIPFC regional data sharing pilot at Hospital
Discharge
• PDF/Healthcare implemented in Legacy
Hospital Information Systems
• Limited data set CCR to be implemented allowing for
Medication and Problem list reconciliation
• Patient will receive a paper version with the goal of
exporting the electronic file to primary care providers
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Next steps
Fox Prairie Medical Group/Healthstring Pilot
•
•
•
•
Prepopulate PHR for patients with one or more chronic diseases
Export PDF/Healthcare files to patient portal
Import files into Healthstring PHR
Healthstring nurse coaches will facilitate transfer of the
technology to the patient’s home environment
• Initial exchange EMR to PHR but the long term goal is to allow
for PHR to EMR exchange
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Stay Tuned
www.niphysiciansforconnectivity.org
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity
Optimal Healthcare Management Through Technology
Questions?
Contact Information:
Dr. Stasia Kahn
Vice President,Northern Illinois Physicians For Connectivity
[email protected]
Vik Sheshadri PhD,Vice President eMedapps
[email protected]
Advancing Healthcare
Information Exchange
Northern Illinois Physicians For Connectivity