17. EHR Decision Support
A computer-generated
suggestion about care for
an individual patient
me
18. The secret sauce of the
HIT chicken soup
photo via Robert Couse-Baker
19. photo via nosha
e rain forest canopy is a
seamless web through which
arboreal creatures efficiently
move to reach the edible
fruits without any attention
to the individual trees.
McDonald et al. Canopy Computing: using the Web in Clinical Practice. JAMA. 1998;280(15):1325-1329.
30. If an observation is a question
and the observation value is
an answer…
LOINC provides codes for
questions
Other vocabularies provide
codes for the answers
31. How fast does my
patient usually walk?
41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
32. Standardized Assessments in LOINC
Vreeman DJ, McDonald CJ, Huff SM. Representing patient assessments in LOINC®. AMIA Annu Symp Proc. 2010;832-836. PMID: 21347095.
Vreeman DJ, McDonald CJ, Huff SM. LOINC® - a universal catalog of individual clinical observations and uniform representation of enumerated collections. Int
J Funct Inform Personal Med. 2010;3(4):273-291.
36. An ICF-based Template
Escorpizo R et al. Creating an interface between the International Classification of Functioning, Disability and Health and physical therapist practice.
Phys Ther. 2010 Jul;90(7):1053-63. PMID: 20448104
could be coded
with LOINC
ICF Intervention
Targets
38. photo via Ed Yourdon
41957-2:Walking speed 24 hour mean
Walking speed: 1 m/s
64098-7:Distance walked in 6 minutes
6 min walk distance: 600m
Fall risk: Mod
NNN-N:More than 2 falls in last 1Y
ICF: walking short distances
d4500.1 “mild difficulty with walking short distances with the
use of assistive devices that are available to the person in
their current environment”
39. photo via Menage a Moi
b2804 “Radiating pain in a segment or region”
Classifying measures:
• Upper limb tension tests
• Spurling’s tests
• Distraction test
Imaging
24937-5:Cervical spine MRI W & WO Contrast IV
LOINC codes TBD
40. Now we have a powerful
set of coded data that
computers can operate on
and exchange between
independent systems in
an understandable way.
41. ICF-powered EHRs
Get patient reported
data before the clinical
encounter, with logic to
help drive evaluation
Rauch A et al. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability
and Health during multidisciplinary patient management. Phys Ther. 2010 Jul;90(7):1039-52. PMID: 20508027
42. ICF-powered EHRs
Computerized
reminders to clinicians
for following ICF-based
intervention guidelines
Rauch A et al. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability
and Health during multidisciplinary patient management. Phys Ther. 2010 Jul;90(7):1039-52. PMID: 20508027
43. ICF-powered EHRs
Rauch A et al. Using a case report of a patient with spinal cord injury to illustrate the application of the International Classification of Functioning, Disability
and Health during multidisciplinary patient management. Phys Ther. 2010 Jul;90(7):1039-52. PMID: 20508027
45. By incorporating vocabulary
standards into our clinical
information systems we can:
leverage the EHR’s potent
capabilities
and
move closer towards the
healthcare system we dream of