1September, 2005 What IHE Delivers

Connecting Health Information Connecting Health Information Technology Standards to the Technology Standards to the

Point-of-Care: The IHE MethodPoint-of-Care: The IHE Method

Audrey E. Dickerson RN MSAudrey E. Dickerson RN MS

Manager Standards Initiatives, HIMSSManager Standards Initiatives, HIMSS

ISO/TC 215 Health Informatics SecretaryISO/TC 215 Health Informatics Secretary

Marcia Veenstra RN, MSNMarcia Veenstra RN, MSN

Consortium Practice ManagerConsortium Practice Manager

CPM Resource CenterCPM Resource Center

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Digital Age of InformationDigital Age of Information

In the digital age there is a fundamental In the digital age there is a fundamental difference in the generation, distribution difference in the generation, distribution and consumption of data, information, and and consumption of data, information, and knowledgeknowledge

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ObjectivesObjectives

Differentiate quality nursing care from Differentiate quality nursing care from non-quality carenon-quality care

Recognize currently nurses do not have Recognize currently nurses do not have cross enterprise nor intra-enterprise cross enterprise nor intra-enterprise interoperability documentation as part of interoperability documentation as part of their electronic workflowtheir electronic workflow

Discover how nursing could have Discover how nursing could have interoperable documentationinteroperable documentation

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What is Nursing Care?What is Nursing Care?

Treating the human response toTreating the human response to::

Illness and diseaseIllness and diseaseMedical care and treatmentMedical care and treatmentSurgery and recoverySurgery and recoveryMedicinal products such as medications Medicinal products such as medications

and other products that can be and other products that can be prescribed for illness and diseaseprescribed for illness and disease

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Nursing DocumentionNursing Documention

Health AssessmentHealth Assessment Vital signs and measurements, including PainVital signs and measurements, including Pain Heart and lung sounds and other body soundsHeart and lung sounds and other body sounds Internal and external patient fluid managementInternal and external patient fluid management Activities of daily livingActivities of daily living

Educate the patient and familyEducate the patient and family Disease, medication and treatment managementDisease, medication and treatment management Life style changes and disease preventionLife style changes and disease prevention Safety in health and illnessSafety in health and illness Pain managementPain management

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Why Standardized Terminology?Why Standardized Terminology?

Describes all aspects of nursing careDescribes all aspects of nursing care Reflects the knowledge and skills that are essential to Reflects the knowledge and skills that are essential to

nursing practice in a semantic waynursing practice in a semantic way

Provides consistent conceptsProvides consistent concepts Describe assessments, interventions and outcomes of their Describe assessments, interventions and outcomes of their

actionsactions

Facilitates critical thinkingFacilitates critical thinking at the point of care at the point of care

Provides a reduction of errorProvides a reduction of error by providing alerts by providing alerts for critical observations and interventionsfor critical observations and interventions

Evaluates the impactEvaluates the impact of nursing care of nursing care

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An established initiative improving the An established initiative improving the quality, safety, efficiency, and effectiveness quality, safety, efficiency, and effectiveness of care by agreeing on standardized ways of care by agreeing on standardized ways

to implement existing standards, and to implement existing standards, and inventing the processes for making it inventing the processes for making it

happen.happen.

http://www.ihe.net

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Patient Care Coordination ProfilesPatient Care Coordination Profiles

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The PlanThe Plan

GoalGoal: Move nursing data between care : Move nursing data between care settings across timesettings across time

Year 1Year 1: Move data from ambulatory care : Move data from ambulatory care into acute care and back to ambulatory into acute care and back to ambulatory care electronically without regard for care electronically without regard for vendor application.vendor application.

Year 2Year 2: Move data from ambulatory care to : Move data from ambulatory care to acute care, though all acute care, in acute care, though all acute care, in hospital care transfers and back to hospital care transfers and back to ambulatory care without regard for vendor ambulatory care without regard for vendor application.application.

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Three Use Case’sThree Use Case’s

A diabetic nursing home patient is transferring A diabetic nursing home patient is transferring from the LTC environment to an in-patient from the LTC environment to an in-patient acute care hospital based on deteriorating acute care hospital based on deteriorating functional status assessments. functional status assessments.

A normally active, older adult in an assisted A normally active, older adult in an assisted living community has an accidental fall living community has an accidental fall requiring admission to an acute care facility.requiring admission to an acute care facility.

A recently widowed 75 year old woman is A recently widowed 75 year old woman is admitted to an adult inpatient floor of a admitted to an adult inpatient floor of a behavior health hospital for depression post behavior health hospital for depression post suicide attemptsuicide attempt

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Hand Off/Transfer of Care: Use Case # 1Hand Off/Transfer of Care: Use Case # 1

Daily Assessment & call to providerDaily Assessment & call to provider

Hand off to TransportHand off to Transport

Assessment in the TransportAssessment in the Transport

Hand off Transport to Acute CareHand off Transport to Acute Care

Assessment on admission to Acute care/Med-Surg Assessment on admission to Acute care/Med-Surg UnitUnit

Daily Assessments on UnitDaily Assessments on Unit

Hand off and Assessment to TransportHand off and Assessment to Transport

Hand off to LTC Hand off to LTC

Daily AssessmentDaily Assessment

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Scale CharacteristicsScale CharacteristicsQualities reviewed in scalesQualities reviewed in scales

Scales chosen are evidence-based with strong reliability Scales chosen are evidence-based with strong reliability and validity.and validity.

Widely accepted cross-enterprise or Widely accepted cross-enterprise or required/recommended by accrediting agenciesrequired/recommended by accrediting agencies

Content ScalesContent Scales

Numeric Rating Scale (NRS-11) for PainNumeric Rating Scale (NRS-11) for Pain

Braden Scale for Predicting Pressure Sore RiskBraden Scale for Predicting Pressure Sore Risk©©

Geriatric Depression Scale (GDS)Geriatric Depression Scale (GDS)

Minimum Data Set – Section GMinimum Data Set – Section G

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MDS section GMDS section GPhysical Functional and Structural ProblemsPhysical Functional and Structural Problems

Activities of Daily Living self performance Activities of Daily Living self performance

Activities of Daily Living (ADL) support providedActivities of Daily Living (ADL) support provided

Test for balanceTest for balance

Limitation for Range of MotionLimitation for Range of Motion

Modes of locomotionModes of locomotion

Modes of transferModes of transfer

Task SegmentationTask Segmentation

Rehabilitation potentialRehabilitation potential

Change in ADL functionChange in ADL function

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Geriatric Depression ScaleGeriatric Depression Scale

Subjective Questions: Subjective Questions: (Examples listed)(Examples listed)

Are you basically satisfied with life?Are you basically satisfied with life? Do you feel that your life is empty?Do you feel that your life is empty? Do you often get bored?Do you often get bored? Are you hopeful about the future?Are you hopeful about the future? Do you often feel helpless?Do you often feel helpless?

Yes / No answers that may have a number score Yes / No answers that may have a number score

Numbers are totaled Numbers are totaled

Totals are used to find where the patient is in a Totals are used to find where the patient is in a range, Normal, Mild or Severe Depressionrange, Normal, Mild or Severe Depression

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Braden Scale for Predicting Pressure Sore RiskBraden Scale for Predicting Pressure Sore Risk

Vertical Axis:Vertical Axis: Sensory Sensory

perceptionperception MoistureMoisture Activity Activity MobilityMobility NutritionNutrition Friction and ShearFriction and Shear

Horizontal AxisHorizontal Axis Very limited (x2), Very moist, Very limited (x2), Very moist,

chairfastchairfast, , very probably very probably inadequate, potential probleminadequate, potential problem

Slightly limited (x2), Slightly limited (x2), occasionally moist, walks occasionally moist, walks occasionally, adequate, no occasionally, adequate, no apparent problemapparent problem

No impairmentNo impairment Completely, constantly, Completely, constantly,

bedfast, very poor, problembedfast, very poor, problem

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Numeric Rating Scale for PainNumeric Rating Scale for Pain

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Standards for Technical UseStandards for Technical UseIHE Integration Profiles (XDS-MS)IHE Integration Profiles (XDS-MS)

Continuity of Care Record (CCR)Continuity of Care Record (CCR)

Continuity of Care Document (CCD)Continuity of Care Document (CCD)

Clinical Document Architecture (CDA)Clinical Document Architecture (CDA)

HL7 Care Record SummaryHL7 Care Record Summary

Logical Observation Identifiers Names and Codes (LOINC)Logical Observation Identifiers Names and Codes (LOINC)

Systematized Nomenclature of Medicine Clinical Terms Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT)(SNOMED-CT)

BPPH consents BPPH consents

In context of Continuity of Care Document, the In context of Continuity of Care Document, the functional status is the patient’s status at the time functional status is the patient’s status at the time the document was created. Medical Summary or the document was created. Medical Summary or XPHR Extract will contain FSA if available.XPHR Extract will contain FSA if available.

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Standard Building Blocks forNarrative and Tabular Health Documents

A healthcare “document” is a composite of structured and coded health information, both narrative and tabular, that describes acts, observations and services for the purpose of exchange

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Templates from CCRTemplates from CCR Templates fromTemplates fromIHE Content Modules & HL7 Implementation GuidesIHE Content Modules & HL7 Implementation Guides

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Template content from CCRTemplate content from CCR

CDA: foundation standard enabling the definition of templates for a broad range of healthcare documents

CCD: collection of templates, including CCR that represent the core data elements for healthcare summary documents

Building on the Foundation

A CCD based Document A CDA based document compatible with CCD

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Interoperability OutcomesInteroperability Outcomes

Early intervention minimizes complications and reduces length Early intervention minimizes complications and reduces length of stay. of stay.

Ensure all pertinent data will be available immediately prior/at the Ensure all pertinent data will be available immediately prior/at the time of transfer without concern about lost data.time of transfer without concern about lost data.

Complete clinical information promotes safety, adequate after-Complete clinical information promotes safety, adequate after-care, improved outcomes and patient satisfaction.care, improved outcomes and patient satisfaction.

Receipt of data prior to transfer allows receiving facility to plan Receipt of data prior to transfer allows receiving facility to plan for appropriate staffing resources based on patient acuity, and for appropriate staffing resources based on patient acuity, and early critical thinking for admitting nurse. (Resource early critical thinking for admitting nurse. (Resource maximization)maximization)

Continuity of interdisciplinary plan of care promotes early Continuity of interdisciplinary plan of care promotes early discharge and increased patient satisfaction.discharge and increased patient satisfaction.

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Advancing the Agenda for Patient CareAdvancing the Agenda for Patient Care

Understand and embrace this initiativeUnderstand and embrace this initiative

Get involved with Profile developmentGet involved with Profile development

Respond to public comment opportunitiesRespond to public comment opportunities

Attend educational workshopsAttend educational workshops

Attend the HIMSS08 Interoperability ShowcaseAttend the HIMSS08 Interoperability Showcase

Include IHE Integration Profiles in your RFP’sInclude IHE Integration Profiles in your RFP’s

Participate in IHE CommitteesParticipate in IHE Committees

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How YOU canHow YOU can participateparticipate

IHE Needs Nurses! Even if you could IHE Needs Nurses! Even if you could participate part of the time, IHE would be participate part of the time, IHE would be HAPPY!HAPPY!

Please contact:Please contact: Joyce Sensmeier Joyce Sensmeier jsensmeier@himss.orgjsensmeier@himss.org Audrey Dickerson Audrey Dickerson adickerson@himss.orgadickerson@himss.org Marcia Veenstra Marcia Veenstra marciaveenstra@cpmrc.commarciaveenstra@cpmrc.com

23September, 2005 What IHE Delivers

Questions ??