Electronic Medical Records – Building Encounter FormsErika OrrickGE Healthcare

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“By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”President Bush, 2004 State of the Union

What are EMR systems and why is this significant?

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What is an EMR system?

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Encounter forms generate chart data

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What is rapidly increasing adoption of EMR systems?

One recent reform pushing adoption of EMR systems has been Medicare’s (and many private insurers’) “pay-for-performance” initiatives. It is much easier to prepare needed reports using electronic systems. (e.g. HbA1C for diabetes)

This reform is one thing pushing EMR systems into smaller, less tech-savvy clinics than they were previously found.

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EMR systems also can enable data availability

RHIOs (Regional Health Information Organizations) are forming to encourage patient data exchange.

EMR systems allow easy patient contact for drug recalls, etc.

Why is this an end-user software engineering problem?

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Encounter forms in clinical workflows

Centricity® EMR is shipped with a default set of encounter forms, but many providers/clinics are used to working in a certain way and want to customize the forms to match them. There are a several third party vendors who sell additional forms and customization services for our EMR product.

Forms enable quick entry of information in a manner that will ensure accurate coding for insurance/Medicare filing.

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Default output of an encounter form

History of Present Illness

Chief Complaint: chest pain

Location: Substernal

Quality: Burning

Severity: moderate

Duration: 3 days

Timing: constant

Radiation: none

Exacerbating factors: eating

Relieving factors: antacids

Associated with: weekly staff meetings

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Provider-preferred output of the form

“This patient presents with a 3 day history of substernal chest pain. He describes it as moderately burning in character. Michael also describes the pain as constant without radiation. The patient states that eating exacerbates the pain, and that antacid provides relief from the pain. Pain is often associated with weekly staff meetings.”

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MEL (Medical Expression Language) to generate natural language output

{CFMT(DOCUMENT.TEMP_305780818_1_891658, "", "This patient presents with a ", "")}{

cond

case DOCUMENT.TEMP_305780819_1_891659 == "minutes" return " minute"

case DOCUMENT.TEMP_305780819_1_891659 == "hours" return " hour"

case DOCUMENT.TEMP_305780819_1_891659 == "days" return " day"

case DOCUMENT.TEMP_305780819_1_891659 == "months" return " month"

else ""

endcond}{CFMT(OBSNOW("HPI location"), "", " history of ", "", "")}{cfmt(OBSNOW("Chief Cmplnt"), "", " ", "", ". ")}

This snippet of code produces only the first sentence of the previous paragraph:

“This patient presents with a 3 day history of substernal chest pain.”

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The current Encounter Form Editor

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Single item edit detail in the EFE

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Debugging: MEL Trace--------------------------------------------------------------

-- Starting MELTrace on 07/26/2005 2:19 PM for WSID 600

--------------------------------------------------------------

execute>Attach Symbols Begin

execute>Attach Symbols End

>{/****VARIABLES FOR MEL BUILT-IN SYMBOLS USED IN FORM****/\par }

execute>end

results>NULL

>{/****START OF FORM TRANSLATION BODY****/\par }

execute>end

results>NULL

>{/****START OF FORM TRANSLATION BODY****/\par }

execute>end

results>NULL

>{/****START OF FORM TRANSLATION BODY****/\par }

execute>end

results>NULL

>{/****START OF FORM TRANSLATION BODY****/\par }

execute>end

results>NULL

>{/****START OF FORM TRANSLATION BODY****/\par }

execute>end

results>NULL

>{/****VARIABLES FOR MEL BUILT-IN SYMBOLS USED IN FORM****/\par }

execute>end

results>NULL

>{/****START OF FORM TRANSLATION BODY****/\par }

execute>end

results>NULL

…

….

execute>call VAL("6")

results>6

execute>6 <= 5.50

results>FALSE

execute>if FALSE

results>FALSE

execute>Document.TEMP_CCC_HPI_FORM_OPENED

results>"OPENED"

execute>"OPENED" == ""

results>FALSE

execute>Document.TEMP_CCC_A_P_FORM_OPENED

results>"OPENED"

execute>"OPENED" == ""

results>FALSE

execute>FALSE AND FALSE

results>FALSE

execute>Document.TEMP_CCC_PED_A_P_FORM_OPENED

results>"OPENED"

execute>"OPENED" == ""

results>FALSE

execute>FALSE AND FALSE

results>FALSE

… (and so on)

Problem Summary

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How do allow end users to construct encounter forms more easily?

How do we make this customization tool more accessible to less technical users?

How do we encourage the use of standards so one clinic can have a consistent interface in spite of using forms constructed by GE Healthcare, by a third-party vendor, and in house?

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Erika Orrick

erika.orrick@ge.com

http://www.gehealthcare.com