Over view of the Healthstory Project for the Medical Transcription Industry Association (MTIA)

1. Welcome!
The Health Story Project
Dictation to Clinical Data: Automating the Production of
Structured and Encoded Documents
Kim Stavrinaki
s
MTIA Conference, April 2009
Kim Stavrinakis MHA,RT, Sr. Manager, GE Healthcare
Nick van Terheyden, MD, Chief Medical Officer, M*Modal
www.healthstory.com

2. Presentation Overview
 Background: The Current Situation
 Enabling the EMR with the Missing Link
 A User Experience (GE/RISL)
 The Health Story Project
 Conclusion
www.healthstory.com

3. Background
The Current Situation
www.healthstory.com

4. Problems Facing Clinicians
According to an American College of Physician Executives survey, 6
in 10 physicians have considered leaving the profession due to:
burnout

low morale/depression

loss of autonomy

low reimbursement rates

patient overload

bureaucratic red tape

loss of respect, and

medical liability environment

Complexity and workload is crippling physicians and
hindering their ability to deliver high quality care
www.healthstory.com

5. Electronic Health Record Universe
Critical to the success
of EHRs is to reconcile
two opposing needs
Enterprise need for

structured and coded
information capture
Physician’s practical

need for a fast and easy
method for creating
clinical notes.
www.healthstory.com

6. The Current Situation – Structured
 Tedious manual process
 Time-consuming
 Documentation lacks expressiveness
of natural language
 Lack of Flexibility
 Poor user interface
 Cost
Fails to Meet Individual Physician Time vs.

Benefit Test
Cultural resistance

 Oblivious to HIM Requirements
Direct Data Entry:
 Incomplete and Inadequate Semantic Structured and
encoded information.
Standards
www.healthstory.com

7. “Although completing such templates may help
physicians survive a report-card review, it directs
them to ask restrictive questions rather than
engaging in a narrative-based, open-ended
dialogue.”
Pamela Hartzband, M.D., and Jerome Groopman, M.D.
n engl j med 358;16 april 17, 2008
www.healthstory.com

8. The Current Situation
 Transcription can be expensive
 Subject to longer turn-around times
 Clinical data lost, because documents
are neither structured nor encoded
 Majority of attested information is only
in the document
 Contains the detail and
comprehensive scope of patient
information
 Support human decision making
 Reimbursement is based on narrative
documentation
 Retains current workflow, favored by
physicians
 Interoperable Dictation:
 Under utilized source of data for EMR Fast and easy,
expressive.
www.healthstory.com

9. The Current Situation
 High cost of documentation
Cost of ownership and physician time vs. transcription cost

 60% of the data lost to the EHR
 Care process inefficiencies and impact on quality
www.healthstory.com

10. Enabling the EMR
The Missing Link in
Information Capture in Healthcare
www.healthstory.com

11. Data Entry Time
 The average physician spends 33 seconds dictating an
establish office visit
 92% of all office visits are established
 If the average physician sees 40 patients a day, total
dictation time of 30 minutes plus time to search for the
data.
 Using a traditional EHR application, the same number of
patients would require 140 minutes of data entry time.
 Physicians are not willing to spend an additional 90
minutes per day for data entry.
(40 X 92% x 33 seconds) + (40 x 8% x 125) = < 30 minutes per day
www.healthstory.com
Data and Chart courtesy Mark R. Anderson, FHIMSS, CPHIMS, CEO, AC Group

12. Crossing the Chasm…
What if you could continue to use
narrative and dictation and at the same
time increase usage of the EMR and
make more records available for the
health information exchange?
www.healthstory.com

13. Health Story Project Vision
 Comprehensive electronic clinical records that
tell a patient’s complete health story
 All of the clinical information required for
good patient care

administration

reporting and

research

 will be readily available electronically, including
information from narrative documents
www.healthstory.com

14. Goals
 Bridge the gap between narrative documents
and structured data
 Encourage proliferation of information for the
EHR
www.healthstory.com

15. Based on HL7 CDA
Clinical Document Architecture Requirements
 Human readable document
Must be presentable as a document

Rendered version covers clinical information intended by the

author
 Can contain machine-processable data
 Cross platform and application independent
 Can be transformed with style sheets
www.healthstory.com

16. Adoption
 Incremental adoption overcomes the “not me
first” dilemma
 Not dependent on recipient’s ability to receive or
process
 Reverse adoption (can encode headers of
existing documents)
 Non-proprietary
 Readable with any browser
www.healthstory.com

17. Encoding
 Does not preclude “once and done” concept
 Compatible with Speech
Understanding/Recognition
 Can be facilitated by Natural Language
Processing
 Leverage existing relationships with
transcriptionists/editors/knowledge based
workers
 Potential for automated coding (billing)
 Supports data abstraction/research
www.healthstory.com

18. Accessible Clinical Data
www.healthstory.com

19. User Experience
GE/RISL
The Missing Link in
Information Capture in Healthcare
Kim Stavrinakis
Sr. Manager, Product Definition, GE Healthcare
www.healthstory.com

20. Clinical Document Architecture
Why CDA?
Precision
Reporting
Radiology Imaging
of Lakeland Florida
www.healthstory.com

21. Why CDA?
 Radiology results is key tool in providing diagnosis
 Results need to be:
concise

consistent representing the highest quality

precipitate alerts before the report is distributed

 Radiology Information System
rich in data

eliminates redundancy

streamlines workflow

 CDA benefits
standard for clinical communication

foundation for structuring data

www.healthstory.com

22. Precision Reporting
Building a reporting tool that
leverages standards for
structuring data that
 drives patient care
Screen  drives outcomes for best
shot of practices
report  drives research for better patient
with halo care and outcomes
Utilizing data at each point of care that
culminates in rich information for the radiologist
www.healthstory.com

23. Key Workflows
 Self Editing
real time – read, proof, sign each exam

batch mode - read multiple exams then sign via signature queue

VR edits

Option to send to Medical Editor during reporting process

 Batch Option – dynamic combinations of
workflow based on confidence models
user based thresholds that determines how report is

returned/reviewed to signature queue
preliminary/draft to signature queue

transcriptionist then preliminary to signature queue

 Transcriptionist – Medical Editor workflow
www.healthstory.com

24. Results Reporting Workflow
Data Center
Dictation Report in
Edit Mode using
conversational
local capture tool –
speaking
can either type to
correct or voice
commands
When dictation is
Report is returned
Dictating the complete and
ready for edits
Procedure EOL is pushed
www.healthstory.com

25. Results Reporting Workflow 2
Data Center
After final sign
the report is
Edit Mode using
local capture tool –
processed in
voice in selection
the NLP engine
between brackets
for learning
Voice in options
for
brackets, sign
report, add via
voice more
dictation in the
sections, then
sign
www.healthstory.com

26. Results Reporting Batch Mode
Report goes to
Dictating the Medical Editor or
When
Procedure signature queue,
dictation is
Radiologist moves
complete
on to next exam
www.healthstory.com

27. Understanding Diagnostic Reporting
Values Benefits Attributes
Means (Why?) Does (How?) Is (What?)
• Enables easy Radiologist • Easy to create reports using a • Multiple modes of workflow
adoption by adjusting to your variety of workflow models around dictation
workflow
• Focus time on findings and • Speedy process • Pre-configured document models
results
• Capture a competitive advantage • No re-dictate existing information • Compliance alerts
over other RAD groups
• Increase revenue with more • Easily identify items to be • Pre-populated patient information
reports / day confirmed or corrected; Deliver
reports to referring MDs faster
Source: GE analysis www.healthstory.com

28. Radiology Imaging of Lakeland Florida
Radiology & Imaging Specialists (RIS)
 physician-owned
 twenty board-certified radiologists
 many sub-specialized
 live since November 12, 2008
www.healthstory.com

29. “You didn’t change the radiologists’ work,
and that is what made it easy on me.”
David Marichal, CIO, Radiology and Imaging
Spec. of Lakeland, FL
www.healthstory.com

30. Results
VOC:
flexibility is key

• full-time rads: 70% Medical Editor workflow/30% self-edit
• part-time rads can use it in batch digital dictation mode
rads love not having to dictate accession #,

name, signs/symptoms, etc…
quality of the engine is very good

self-edit for stat exams has reduced # of calls

from the hospital
www.healthstory.com

31. Conversational Documentation
… transformation of dictation directly into
structured clinical documents while encoding
data depending on the care givers and
organizations needs
EHR
www.healthstory.com

32. Meaningful Clinical Documents
Meaningful Clinical Documents are a blend between
free form text and fully structured documentation that
represent the thought process, and

capture the clinical facts

www.healthstory.com

33. How it Works
www.healthstory.com

34. The Health Story Project and
Meaningful Clinical Documents
The Missing Link in
Information Capture in Healthcare
Kim Stavrinakis
Sr. Manager, Product Definition, GE Healthcare
www.healthstory.com

35. Meaningful Clinical Documents vs. Text
 Structured and encoded clinical content enables…
pre-signature alerts,

decision support,

best documentation practices,

multiple output formats,

multi-media reporting,

data mining

 Implements HL7 CDA4CDT standard compliant
document types
 Increases quality of documentation
www.healthstory.com

36. Health Story Document Types
Implementation Guides
Completed
 History & Physical
 Consultation
 Operative Report
 DICOM Imaging Reports
Upcoming
 Discharge Summary w/IHE
 Billing and Reimbursement Requirements
 Progress Notes
 .PDF work with Adobe
www.healthstory.com

37. Project Members
Founders
Promoters
Original Benefactors:
Participants
www.healthstory.com

38. Conclusion
www.healthstory.com

39. Crossing the Chasm…Babel Must Go
 Medical text “typed” from dictation
has “no meaning”
black marks on a page…

info must be tagged as discrete data

elements in order to assign meaning
 Clinical documentation uses wide variety
of terms with same meaning….
and terms that sound the same that have

different meanings…..
authors have a wide variety of styles, accents,

methods of dictation…
www.healthstory.com

40. Health Story…
 Captures meaningful clinical documents
 Is the bridge between
free form narrative and expressive notes, and

fully structured clinical data

 Improves the quality of clinical documentation
 Generates semantically interoperable clinical
data that will
solve the fundamental challenges with EMRs - allowing clinical

decision support, alerts, decision support, data mining
enable interoperability, reporting, patient safety initiatives, PQRI

(pay for performance), PSI (patient safety indicators) and improve
billing data capture
www.healthstory.com

41. Impact
 Allows providers to maintain preferred workflow
and documentation methods
 Increases the value and usability of narrative
documents (dictation/trans, SRT)
 Accelerates the implementation of interoperable
electronic health records
 Allows reuse of information
www.healthstory.com

42. Getting Involved
 Join the Health Story Project
www.healthstory.com

 Participate in HL7 Structured Document
work group
 Participate in HL7 ballots
 Encourage implementation
EHR vendor adoption

provider preference

transcription RFPs

www.healthstory.com

43. Membership Options and Benefits
www.healthstory.com

44. Q&A
Kim Stavrinakis
Sr. Manager, Product Definition, GE Healthcare
www.healthstory.com

45. Where You Can Find Me
Nick van Terheyden, MD, CMO, M*Modal
Twitter http://twitter.com/drnic1
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FaceBook http://profile.to/drnick
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E-Mail nvt@mmodal.com
GrandCentral (301) 355-0877
www.healthstory.com