Managing the Flood of Codes: maintaining patient problem lists in the era of Meaningful Use and ICD10
Abstract
In a medical record, the problem list is a centralized place where healthcare providers can summarize key clinical information about patients. While problem-oriented medical records have been promulgated since Larry Weed described them in 1968, recent advances in health information technologies, evolution in clinical workflows and the emergence of several federal programs have elevated the importance of up to date problem lists. However, each of these forces have also added requirements to how problem lists are structured, formatted and used. For example, current federal programs encourage healthcare providers using electronic health record systems to document problem lists using either SNOMED CT or ICD-9, while federal reimbursement practices are migrating towards ICD-10. None of these problem list standards have been demonstrated to be usable for direct problem list entry. Busy healthcare providers have found it challenging to maintain patient problem lists that accommodate these requirements while also performing other necessary tasks, such as electronic prescribing and test ordering. In this presentation, we will discuss the state of science around creating and maintaining structured problem lists that accommodate numerous external requirements, and demonstrate examples of tools that put this science into practice.
Description and Outline of the Proposed Presentation:
The presentation will include didactic materials, a live demonstration of two different approaches to problem list creation and maintenance, and time for discussion. The presentation will:
- Review research covering the use of terminologies in the clinical user interface, highlighting the desired attributes of an interface terminology.
- Discuss the existing interface terminologies and terminology subsets in wide use for problem list documentation, including the SNOMED Core Subset, the VA/KP SNOMED subset and the Intelligent Medical Objects interface terminology. Discussants will also review other interface terminologies used in more local settings, such as those used in their own institutions.
- Discuss requirements for problem list documentation in the era of Meaningful Use and ICD 10.
- Using real-world electronic medical record systems, demonstrate examples of difficult and time-consuming workflows that involve multiple information-based clinical tasks, including prescription-writing, ordering tests while assigning medical necessity-based codes, updating a problem list and performing clinical documentation.
- Demonstrate real-world solutions to complex and redundant information-based clinical workflows.
- Discuss emerging methods to facilitate or predict problem encoding in a structured problem list using available data from patient medical records and institutional patterns of clinical practice, including lessons learned from the eMerge network and from MAPLE. [add refs]
- Allow time for discussion.
Presenters Include:
S. Trent Rosenbloom, MD, MPH, is Associate Professor of Biomedical Informatics with secondary appointments in Medicine, Pediatrics and the School of Nursing at Vanderbilt University. He is a board certified Internist and Pediatrician who is a nationally recognized investigator in the field of health information technology evaluation. His work has focused on studying how healthcare providers interact with health information technologies when documenting patient care and when making clinical decisions. Dr. Rosenbloom was the recipient of the annual competitive AMIA New Investigator Award in 2009. Dr. Rosenbloom is an expert in developing, maintaining and evaluating interface terminologies for clinical documentation and for problem list development, and has spearheaded efforts to implement a structured and coded problem list and to provide terminology services, including SNOMED CT and ICD-10, to healthcare providers at Vanderbilt University Medical Center.
Edward K. Shultz, MD, MS, is Associate Professor of Biomedical Informatics, Associate Professor of Pathology and Director of Technology Integration at Vanderbilt University Medical Center. In those capacities he defines an informatics technical architecture that will scale up to support our evolving enterprise, for directing technical support for the server and application development infrastructure and for enterprise level decision support databases. He provides a bridge between the basic research activities within the Department and the units that support operational systems in the hospital, clinics, and affiliated sites. Among the many efforts Dr. Shultz currently leads work integrating multiple EHR-based applications that create, maintain and use structured patient problems to drive downstream clinical processes. Chief among these efforts is a tool that will integrate problem selection with e-Prescribing, test ordering, ICD selection and clinical documentation.
Adam Wright, PhD, is an Associate Research Scientist in the Division of General Medicine at Brigham and Women’s Hospital, Boston, MA. Dr. Wright was the recipient of the annual competitive AMIA New Investigator Award in 2010. Dr. Wright currently leads a variety of interrelated research projects, all in the area of clinical decision support. Notable among these projects is his work developing state of the art tools to provide targeted decision support for healthcare providers creating and maintaining problem lists in electronic medical records. Dr. Wright has designed and validated novel algorithms for identifying and documenting patient problems, using data mining techniques to infer relationships between medical record data such as medications and lab results, and problems. In addition, Dr. Wright has developed tools that provide problem-specific information with tailored evidence-based suggestions.
Conference Themes Covered:
This presentation will cover several themes from the AMIA 2012 symposium, including:
- Clinical Informatics (i.e., the design, development, and implementation of state-of-the-art clinical systems);
- Clinical Workflow and Human Factors (i.e., use that revolves around usability, workflow);
- Data Interoperability and Information Exchange (i.e., implement various clinical data integration … including use of … vocabularies);
- Achieving Meaningful Use (i.e., promote the successful and effective development…toward “meaningful use”);
- Terminology and Standards Ontologies (i.e., use of various application-specific and general purpose clinical terminologies).
Specific Educational Goals:
Those attending this presentation will:
- review the burden of medical record tasks healthcare providers encounter while providing clinical care and simultaneously accommodating coding and billing requirements;
- learn which tasks can complement each other to make overall work more efficient;
- learn what methods have and have not been demonstrated to assist healthcare providers create, maintain and use structured, coded problem lists.
Who Should Attend:
- Healthcare team members using electronic medical records and patient portals. This group may include healthcare providers, students, medical assistants, medical receptionists, research personnel, and patients.
- Healthcare administrators interested in meeting criteria for Meaningful Use and ICD10 usage, including those implementing quality improvement initiatives.
- Clinical informaticians interested in learning about problem list creation and documentation, clinical terminologies and clinical workflow challenges.