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Mobilizing Data for Pressure Ulcer Prevention Challenge Webinar

January 23, 2013

Sponsored by the ONC

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• 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

Agenda

Health Information Technology

IOM 6 domains of quality: Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, and Equity.

Better healthcare

Keeping patients well; Increasing the health of populations: focus on preventive care.

Better health

Lowering the total cost of care while improving quality.

Reduced costs

$

Health IT: Helping to Drive the 3-Part Aim

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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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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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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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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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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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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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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 9

Skin Inspection Class

class Skin Inspection Detail

Pressure Ulcer Risk Assessment Item

Skin Inspection

- skin color :Skin Color

- skin moistness :Skin Moistness

- skin temperature :Skin Temperature

- skin turgor :Skin Turgor

«enumeration»

Skin Color

normal for ethnic group

ashen

cyanotic

flushed

jaundiced

mottled

pale

«enumeration»

Skin Turgor

good elasticity (normal)

poor, decreased elasticity

tenting = not found

«enumeration»

Skin Temperature

cool

warm (normal)

cold

hot

«enumeration»

Skin Moistness

normal

moist

diaphoretic

clammy

«enumeration»

Skin Condition

dry

extremely dry

normal

friable

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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) 11

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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Model Scope

Office of the National Coordinator for Health Information Technology

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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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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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Prizes

First Place: $60,000

Second Place: $15,000

Third Place: $5,000

recognition, publicity, credibility and reach!

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Questions?

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bit.ly/UlcerChallenge

Contact Hemali: hemali@health2con.com

www.health2challenge.com