Monday, October 18, 2010
Health Reform Timeline
Implementation Timeline
The implementation timeline is an interactive tool designed to explain how and when the provisions of the health reform law will be implemented over the next several years.
Timeline @ KFF
The implementation timeline is an interactive tool designed to explain how and when the provisions of the health reform law will be implemented over the next several years.
Timeline @ KFF
The EHR Life Cycle: HIM's Role in the Metamorphosis From Paper
This is a good overview on some of the challenges of implementing EMR solution.
The EHR Life Cycle: HIM's Role in the Metamorphosis From Paper
The EHR Life Cycle: HIM's Role in the Metamorphosis From Paper
Sunday, October 17, 2010
Meaningful Use
The Definition of Meaningful Use Requirements
The requirements of meaningful use to qualify for incentive payments was released on July 13, 2010. The final rule definitively outlines all the specifics of Stage 1 meaningful use and clinical quality measure reporting to receive the incentive payments in 2011 and 2012.
The Recovery Act specifies three main components of Meaningful Use:
The use of a certified EHR in a meaningful manner (e.g.: e-Prescribing);
The use of certified EHR technology for electronic exchange of health information to improve quality of health care; and
The use of certified EHR technology to submit clinical quality and other measures.
The definition of meaningful use harmonizes criteria across CMS programs as much as possible and coordinate with existing CMS quality initiatives. It also closely links to the certification standards criteria in development by the Office of the National Coordinator (ONC) and provides a platform for a staged implementation over time.
Specifics of Stage 1 Meaningful Use (2011 and 2012)
Meaningful use includes both a core set and a menu set of objectives that are specific for eligible professionals and hospitals. For Eligible Professionals, there are a total of 25 meaningful use objectives. 20 of the objectives must be completed to qualify for an incentive payment. 15 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives. For Hospitals, there are a total of 24 meaningful use objectives. 14 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives.
The definition of meaningful use includes reporting of clinical quality measures. See the link titled "Meaningful Use Clinical Quality Measures" in the Links Inside CMS section below to learn more about these specifications for eligible professionals and hospitals. More information on the final rule and fact sheets regarding meaningful use are available below.
To realize improved health care quality, efficiency and patient safety, the criteria for meaningful use will be staged in three steps over the course of the next five years. Stage 1 sets the baseline for electronic data capture and information sharing. Stage 2 (est. 2013) and Stage 3 (est. 2015) will continue to expand on this baseline and be developed through future rule making.
Incentive Program
Core and Menu Set
The requirements of meaningful use to qualify for incentive payments was released on July 13, 2010. The final rule definitively outlines all the specifics of Stage 1 meaningful use and clinical quality measure reporting to receive the incentive payments in 2011 and 2012.
The Recovery Act specifies three main components of Meaningful Use:
The use of a certified EHR in a meaningful manner (e.g.: e-Prescribing);
The use of certified EHR technology for electronic exchange of health information to improve quality of health care; and
The use of certified EHR technology to submit clinical quality and other measures.
The definition of meaningful use harmonizes criteria across CMS programs as much as possible and coordinate with existing CMS quality initiatives. It also closely links to the certification standards criteria in development by the Office of the National Coordinator (ONC) and provides a platform for a staged implementation over time.
Specifics of Stage 1 Meaningful Use (2011 and 2012)
Meaningful use includes both a core set and a menu set of objectives that are specific for eligible professionals and hospitals. For Eligible Professionals, there are a total of 25 meaningful use objectives. 20 of the objectives must be completed to qualify for an incentive payment. 15 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives. For Hospitals, there are a total of 24 meaningful use objectives. 14 are core objectives that are required, and the remaining 5 objectives may be chosen from the list of 10 menu set objectives.
The definition of meaningful use includes reporting of clinical quality measures. See the link titled "Meaningful Use Clinical Quality Measures" in the Links Inside CMS section below to learn more about these specifications for eligible professionals and hospitals. More information on the final rule and fact sheets regarding meaningful use are available below.
To realize improved health care quality, efficiency and patient safety, the criteria for meaningful use will be staged in three steps over the course of the next five years. Stage 1 sets the baseline for electronic data capture and information sharing. Stage 2 (est. 2013) and Stage 3 (est. 2015) will continue to expand on this baseline and be developed through future rule making.
Incentive Program
Core and Menu Set
Tuesday, October 5, 2010
Revisiting HL7
The term HL7 may be used in a number of contexts and it may be worthwhile to know a little about it. I have tried to cull information from various places and put it down in a few brief passages.
HL7 is represents "global standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services." It also stands for the (HL7) group that is a Designated Standards Maintenance Organization comprised of healthcare providers, software vendors and consultants.
The initial Version 2 of HL7 was message based and built more or less in an ad hoc manner.HL7 V2.x focused mainly on the "syntax" (structure and layout) for communication between systems.
The Version 3 is model-based built upon the Reference Information Model (RIM)
Version 3 is object-oriented (meaning that it combines data structures with functions to create re-usable objects).RIM is a unique representation of the health care domain set of information and data. RIM represents the semantic and lexical connections between the information carried in the fields of HL7 messages. RIM provides the basis for creating HIS application architecture and persistence layers. There is a RIM implementation based on Java that is available.
HL7 version 3 specifications37 for RIM include:
- Nouns--things that are being communicated
- Adjectives--descriptors and relationships of the nouns
- Verbs--actions being requested or communicated
- semantics of the communication--the actual meaning of a message
- syntax for communication--the structure and layout of the communication
- A channel to carry the communication
On a technical level, RIM is a collection of:
- Subject areas
- Classes--a template which defines the variables and methods for a particular type of object, example: patient class. Core RIM classes are Entity, Role, Participation, Act, Act-Relationship and Role-Link.
- Attributes--qualities of a class, for instance patient class would have name, date of birth, sex, address, etc.39
- Use cases--a way in which a system can be used, described as a step-by-step sequence of actions, along with the system's response and certain other information
- Actors--patients, medical and health professionals, and anyone else involved in a health care event
- Trigger events, example: follow-up clinical visit by a patient
Interactions
For clinical content needs, the HL7 vocabulary tables refer to external terminology sources like SNOMED, ICD10.
Detailed RIM tutorials @ are here
EHR, itself being a repository if information, does not have a standard. But HL7 drafted a functional model for EHR systems. The model helps create functional profiles. The profiles are listed below
Direct Care Profile
- Care Management
- Clinical Decision Support
- Operations Management and Communication
Supportive Profile
- Clinical Support
- Measurement, Analysis, Reporting, Research
- Administrative and Financial
Information Infrastructure Profile
- EHR Security
- EHR Information and Records Management
- Unique Identity, Registry and Directory services
- Support for HIT standards
- Interoperability
- Manage Business Rules
- Workflows
In total there are about 125 functions each with a function name, function statement, description and rationale for inclusion.
The clinical domains include
– Laboratory, Radiology, Nursing, Surgery, Pharmacy, Dietary
Administrative domains include…
– Registration, Billing, Scheduling, Medical records, Staff demographics
– Authorization and permissions
In an effort to create a Healthcare Business Process Reference Model, we can use the HL7 Healthcare Development Framework's practices. One practice that interested me in particular is the Domain Analysis. The diagram below gives the structure of accomplishing a typical domain analysis.
In summary, there is much to be leveraged from HL7 artifacts but finding what is relevant in an ocean of artifacts is a challenge :-).
HL7 is represents "global standards for the exchange, management and integration of data that supports clinical patient care and the management, delivery and evaluation of healthcare services." It also stands for the (HL7) group that is a Designated Standards Maintenance Organization comprised of healthcare providers, software vendors and consultants.
The initial Version 2 of HL7 was message based and built more or less in an ad hoc manner.HL7 V2.x focused mainly on the "syntax" (structure and layout) for communication between systems.
The Version 3 is model-based built upon the Reference Information Model (RIM)
Version 3 is object-oriented (meaning that it combines data structures with functions to create re-usable objects).RIM is a unique representation of the health care domain set of information and data. RIM represents the semantic and lexical connections between the information carried in the fields of HL7 messages. RIM provides the basis for creating HIS application architecture and persistence layers. There is a RIM implementation based on Java that is available.
HL7 version 3 specifications37 for RIM include:
- Nouns--things that are being communicated
- Adjectives--descriptors and relationships of the nouns
- Verbs--actions being requested or communicated
- semantics of the communication--the actual meaning of a message
- syntax for communication--the structure and layout of the communication
- A channel to carry the communication
On a technical level, RIM is a collection of:
- Subject areas
- Classes--a template which defines the variables and methods for a particular type of object, example: patient class. Core RIM classes are Entity, Role, Participation, Act, Act-Relationship and Role-Link.
- Attributes--qualities of a class, for instance patient class would have name, date of birth, sex, address, etc.39
- Use cases--a way in which a system can be used, described as a step-by-step sequence of actions, along with the system's response and certain other information
- Actors--patients, medical and health professionals, and anyone else involved in a health care event
- Trigger events, example: follow-up clinical visit by a patient
Interactions
For clinical content needs, the HL7 vocabulary tables refer to external terminology sources like SNOMED, ICD10.
Detailed RIM tutorials @ are here
EHR, itself being a repository if information, does not have a standard. But HL7 drafted a functional model for EHR systems. The model helps create functional profiles. The profiles are listed below
Direct Care Profile
- Care Management
- Clinical Decision Support
- Operations Management and Communication
Supportive Profile
- Clinical Support
- Measurement, Analysis, Reporting, Research
- Administrative and Financial
Information Infrastructure Profile
- EHR Security
- EHR Information and Records Management
- Unique Identity, Registry and Directory services
- Support for HIT standards
- Interoperability
- Manage Business Rules
- Workflows
In total there are about 125 functions each with a function name, function statement, description and rationale for inclusion.
The clinical domains include
– Laboratory, Radiology, Nursing, Surgery, Pharmacy, Dietary
Administrative domains include…
– Registration, Billing, Scheduling, Medical records, Staff demographics
– Authorization and permissions
In an effort to create a Healthcare Business Process Reference Model, we can use the HL7 Healthcare Development Framework's practices. One practice that interested me in particular is the Domain Analysis. The diagram below gives the structure of accomplishing a typical domain analysis.
In summary, there is much to be leveraged from HL7 artifacts but finding what is relevant in an ocean of artifacts is a challenge :-).
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