Transcript CS27.2 - e-Health Conference

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A CDR as an Integral Part of an SHR Solution:
An Alberta Netcare SHR Case Study
e-Health - May 27, 2013
gordon point informatics
www.gpinformatics.com
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Faculty/Presenter Disclosure
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Presenter: Louise Brown, MBA, CMC, Certified CDA Specialist
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Relationships with commercial interests:
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Grants/Research Support: Nothing to disclose
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Speakers Bureau/Honoraria: Nothing to disclose
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Consulting Fees: Nothing to disclose
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Other: Nothing to disclose
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Outline
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Presentation Objectives
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Background to the Alberta Netcare SHR Project
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Clinical Documents vs. Messaging Paradigms
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CDA Specific Considerations

Downfalls of One Dimensional SHR Architectures
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Conclusions
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Background & Objectives
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Potential overlap of data in Event-driven SHR Repositories and
Clinical Document Repositories
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So what should drive the decisions regarding the use of clinical
documents and CDRs or messaging-based workflow for SHR?
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Provide some guidance and basic rules of thumb - Alberta
Netcare SHR Project
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Alberta Netcare Shared Health Record
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SHR - a copy of subsets of clinical information captured in POS
applications
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Focuses on data appropriate for sharing
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E.g. basic encounter information, referrals, encounter summaries, clinical
observations, problems/conditions/diagnosis, care plans, care protocols,
and health status indicators.
Primary Goals of the Alberta Netcare SHR:
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Sharing clinical information between EMRs and the Alberta Netcare EHR
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Eliminate the need for printing and scanning to move clinical information
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Alberta Netcare Shared Health Record
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SHR Release 1 - encounters and transcribed clinical reports.
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Release 2 – Care Compositions, Immunization, Alerts and Screenings
Release 3 - ‘EMR to EMR’ with an initial support to the CDM programs
Release 4 – Patient Health Portal (PHP)
The SHR solution is a hybrid of clinical documents and core
messaging.
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Leverages the existing transcribed reports and transforms them to
standardized Clinical Document Architecture (CDA) documents
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Captures SHR workflow for encounter-based data using core HL7v3
messaging (based on R02.04.03).
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CLINICAL DOCUMENTS VS. CORE
MESSAGING
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What are Clinical Documents?
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Electronic documentation of clinical observations and
services (e.g. Discharge Summaries, Clinical Notes)
“Static snapshots” - post occurrence
Contain data “as it was” when
originally created
Can be captured in many
electronic formats
Can be exchanged using many
methods
Often stored in CDRs
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Common Use Cases
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Access/portability/exchange
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Integration
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Access distributed information through common metadata
Transcription systems
Re-use/derivative data
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Summaries, reports
Transcribed clinical reports
have been part of the Netcare
solution for many years.
~ 90% of DI reports are available through
Netcare and/or through active EMR integration.
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Messaging in Contrast…
Messages are generally used to support an ongoing
transaction-based process often in a real-time fashion.
 Convey status information and updates related to one
dynamic business object.
 Sending and Receiving system responsibilities
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SHR Encounter Messaging
Encounter Interactions
handled with HL7v3
Messaging
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Rule of Thumb
More Interactive and tightly coupled communication
process = messaging paradigm (e.g. Encounters
workflow)
More Passive and loosely coupled communication
process = document paradigm (e.g. Discharge
Summaries, Procedure Reports)
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IM/IT Enabled Business Services
Access
(wait times
information and
management)
Chronic Disease
Management
(patient profile and
population
dashboard)
Registries
Public Health
Surveillance
(reporting and
outbreak
management)
Shared
Health
Record
SHR within the Alberta Netcare EHR
Clinical Events
Repository
Repositories
Client
Drug
Lab
Diagnostic
Imaging
Text
Reports
Other – e.g.
Imm/
ARIs;Scree
nings; Oher
CDA
documents
Clinical
(Event);
CCPs
Provider
Shaded = Planning or Early Stages
Health Regions/Board
Delivery Site
Registries
(EMPI)
Clinical
Data
EHR
Log /
Sys
Term
Index Audit
Alrts. Svcs.
Data Access Services (LRS)
Clinical Document
Repositories
Netcare
Patient Portal
Provider
PACS
Service
Recipient
IAM
Provincial Health Information Exchange
(pHIE)
Eclipsys
EPIC
Meditech Clinical Information
System / Enterprise
Medical Record
Integration
Hubs
Provider
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Other services
Wait Times Mgmt Public Health
Other
users
Physician/
Provider
Pharmacy System PACS / RIS
Public Health
Provider
Pharmacist
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Radiologist
Lab System Phys EMR
Lab Clinician
Physician/
Provider
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CLINICAL DOCUMENT ARCHITECTURE
SPECIFIC CONSIDERATIONS
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HL7 CDA vs. Messaging
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Specific to CDA documents:
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CDA is similar to core HL7 messaging in that:
 Based on HL7v3 Reference Information model
 Capable of sending discrete data and coded values
 Capable of sending narratives and notes
 Capable of sending images (e.g. JPG, BMP)
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BUT
 Core messaging can accommodate many status changes as
part of workflow whereas CDA is not designed for this
 CDA documents are human readable (when rendered in a
browser) and can easily be stored as a persistent ‘object’
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CDA Implementation Considerations
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CDA hierarchy basic to
complex structures:
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Level 1 – Header + ‘Blob’(e.g.
jpeg)
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Level 2 – Header + Narrative
Sections
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Level 3 – Header + Narrative
Sections + Structured Entries
(computer processible
components)
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Examples of Levels 2 & 3
Narrative Block
Structured Entries
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Interoperability Trade-Offs
Alberta SHR Transcribed
Reports are transformed
to CDA Level 1
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DOWNFALLS OF ONE DIMENSIONAL EHR
ARCHITECTURES
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Downfalls of One Dimensional SHR Architectures
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Only a Clinical Document Repository
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Doesn’t adequately address real-time workflow
requirements
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Requires a transport mechanism (often messaging)
Only messaging
SHR Clinical Documents
are transported in basic
HL7v3 Messages
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Doesn’t adequately address the need for
authenticated documents captured as snapshots at a
point in time
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May not adequately address technical limitations
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The Alberta Netcare SHR Solution
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Clinical requirements for “snapshots” of clinical
documents
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Clinical Requirements for event-driven workflow
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Maximizes existing technical capabilities
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Thank You!
[email protected]
QUESTIONS?
18-Jul-15
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