bridging the gaps with closed loop clinical …€¦ · loop clinical documentation aaron brauser...

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BRIDGING THE GAPS WITH CLOSED‐

Collaborative Intelligence for Health – © 2016 MModal IP LLC, All rights reserved. – Confidential Information

LOOP CLINICAL DOCUMENTATION

Aaron Brauser

Evolution of Medical Record• In 1752 AD:

Si l lid t d d f b ti– Single consolidated record of observations– Noted the care and treatment provided– Helped to improve care with historical story– Communication for healthcare workers

• Today:


– Quality of care– Population Management– Reimbursements– Research

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Financial Impacts of Documentation


* United States Government Accountability Office. “Data on Application and Coverage Denials.” March, 2011

Other Impacts


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The Perfect Documentation Storm

CDI


CDI Demands

The Documentation DilemmaMRN: 000000DOS: 09/11/2009

CHIEF COMPLAINT:Patient is a 25 year old woman complaining of feeling frequentlyPatient is a 25 year old woman complaining of feeling frequentlyfatigued. She reported also occasional dizziness, sleepingdifficulties and morning headaches.

OBJECTIVE:Recent bout with the flu.

PHYSICAL EXAMINATION:Vital signs are normal with a blood pressure of 120/80, pulse 62,temperature 98.6 degrees, weight 108 pounds.

ASSESSMENT: Although flu symptoms were in remission, patient has not fullyrecovered yet.

PLAN:Place patient on Biaxin for the next two weeks. The patient willcall us if there is no improvement, any worsened or new symptoms.


EMR Direct Data EntryStructured and encoded information

• Enables MU, decision support and direct billing• But can result in lower documentation quality (overly structured templates, cut & paste,… )

• May negatively affect physician productivity, patient detail and overall care

Narrative DocumentationUnstructured notes

• Very expressive – tells the patient “story”• More meaningful & useful to physicians• But difficult to reuse in order to drive systems for

patient care, reimbursement and population reporting

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John Lennon’s Elbow

“EMR progress notes are like music from John Lennon’s elbow. They are created by individuals with great talent, the results are awful, and nobody seems to mind.”


Robert E. Hirschtick, MD

Source: John Lennon’s ElbowJAMA 2012, 308 (5); 463-464

Innovation in Technologies…Why not Helthcare?


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JAMA 2012; 307 (23): 2497‐2498

Computer Assisted Physician Documentation (CAPD)


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Data used by abstractors are often found in dictated reports or free form progress notes not

The Other Challenge

dictated reports or free form progress notes, not as structured data in the electronic health record. And it has been the experience of our members that without making the entire record structured, discrete data or having mature text recognition software in place, one cannot extract all the data needed on every patient to create accurate quality


needed on every patient to create accurate quality metrics.”

--College of Healthcare Information Management Executives (CHIME)*

New Opportunity for Finding & Organizing Data

What we already know about our

patients.

DiscreteDataFields

What we could know about our

patients.

NarrativeReports

Natural Language Understanding (NLU) applied to clinical documentation, coding, text data mining, and clinical decision support will provide significant and lasting strategic & financial benefits.

Facilitate quality care delivery

Feed information from previous care encounters

Change care pathway through patient


Change care pathway through patient involvement

Promote accurate and timely clinician documentation

Reduce administrative costs through efficiencies12

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Dissecting Natural Language Understanding…

D b t di i ?Do you remember sentence diagramming?

Subject ObjectVerb

Collaborative Intelligence for Health – © 2016 MModal IP LLC, All rights reserved. – Confidential Information13

Preposition

PrepositionObject

How does the computer know what the words mean?

• Subject: Heart attack

• Verb: treated

• Subject: 22298006 (SNOMED-CT Myocardial infarction)

• Verb: treated

“Heart attack treated with Bayer.”

Must get translated to this:


• Preposition: with

• Preposition Object: Bayer

• Preposition: with

• Preposition Object: 1191 (RxNorm Aspirin)

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NLU Savings Lives... AAA Example

• What is the real AAA patient population? p p p– 37% of patients identified did not have AAA on their

problem list – AAA is known as a “ticking time bomb” and “the widow

maker” because it can grow without anyone knowing • If it ruptures it is deadly. • If it is repaired before rupture mortality rate significantly

decreases

• Identify aneurysm size to drive care protocols -– Patients with AAA >5cm, referred to vascular surgery

for immediate repair– Patients with AAA 3-5cm, brought in for follow-up


Patients with AAA 3 5cm, brought in for follow up exam

– Patient with AAA <3cm, had diagnosis added to problem list so can be tracked and followed up with by PCP

NLU Information Model

Evidence

Concept Instance

Condition


M*Modal ValueSets

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Automating CDI Workflows


Thank you


Aaron Brauser

bridging the gaps with closed loop clinical …€¦ · loop clinical documentation aaron brauser...

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