Single Presentation Layer: Design Directions for iehr Graphical User Interface

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1 Single Presentation Layer: Design Directions for iehr Graphical User Interface CAPT Michael Weiner, MC, USN DoD/VA Interagency Program Office Dr. Jonathan Nebeker Veterans Health Administration, Office of Informatics & Analytics DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Michael Weiner, CAPT, MC, USN: Has no real or apparent conflicts of interest to report Dr. Jonathan Nebeker: Has no real or apparent conflicts of interest to report Acknowledgements Funding from AHRQ R18-HS and VA Salt Lake City Geriatrics Research and Education Center Intellectual contributions from Charlene Weir, PhD, RN DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. 2

3 Learning Objectives 1. Discuss the advantages to the provider of having a presentation layer that remains constant even as legacy applications are replaced by modernized components 2. Describes the responsibilities of the single presentation layer 3. Explains the functions of the presentation layer DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 3

4 VA/DoD Data Sharing Health* *As of Jan 2012 DoD Data on Shared Patients Current View able Data Outpatient pharmacy data, laboratory and radiology results Inpatient laboratory and radiology results Discharge summaries (58* DoD sites = 100% of inpatient beds) Inpatient consultations, operative reports, history and physical reports, transfer summary notes, initial evaluation notes, procedure notes, evaluation and management notes, preoperative evaluation notes, and post-operative evaluation and management notes (58* DoD sites - available to all DoD providers and VA providers enterprise wide) Allergy data and problem list data Theater clinical data: Theater inpatient notes, outpatient encounters, and ancillary clinical data Ambulatory encounters, procedures, and vital signs Family, social, and other history, and questionnaires Current Computable Data (limited VA sites) enables drug-drug and drug allergy safety checks and alerts Pharmacy data Medication allergy data * Walter Reed AMC & Bethesda NNMC merged to form WRNMMC in Sept Data on Separated Service Members Outpatient pharmacy data, lab and radiology results Inpatient laboratory and radiology results Allergy data Consult reports Admission, disposition, transfer data Standard ambulatory data record elements (including diagnosis and treating physician) Pre-/post-deployment health assessments Post-deployment health reassessments Data on OIF/OEF Polytrauma Patients Radiology images Scanned medical records Two-way, on-demand view of health data available in real-time Bidirectional Health Information Exchange Live data flow beginning 2004; data from 1989 forward Viewable data exchange between all DoD and VA medical facilities as of July 2007 One-way, monthly transfer of health data Federal Health Information Exchange Live data flow beginning 2002; data from 1989 forward Health data on more than 5.8 million Service members One-way transfer of health data initiated at time of decision to transfer patient Live data flow beginning March 2007 From Walter Reed National Military Medical Center in Bethesda and Brooke AMC VA All VA Medical Facilities 4.3 million correlated patients, including 1.9 million patients not in FHIE repository 148,140 average weekly FHIE/BHIE queries 1 st qtr FY 2012 Computable pharmacy and allergy exchange on more than 1,338, million lab results 15.0 million radiology reports 95.7 million pharmacy records 113 million standard ambulatory data records 5.2 million consultation reports 3.3 million deployment-related health assessments on more than 1.5 million individuals 5 VA Polytrauma Centers (Tampa, Richmond, Minneapolis, Palo Alto, San Antonio) Radiology images for more than 470 patients Scanned records for more than 570 patients 4

5 IPO Mission Established by the National Defense Authorization Act for Fiscal Year 2008 (NDAA FY08) and Public Law stipulates the IPO: To act as the single point of accountability for the Department of Defense and the Department of Veterans Affairs in the rapid development and implementation of electronic health record systems or capabilities To accelerate the exchange of health care information between the DoD and VA in order to support the delivery of health care by both Departments. DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 5

6 iehr To Be Architecture Common DoD-VA Requirements: HL7 EHR-S Functional Model with DoD and VA vetted Extensions (SV-4) Common DoD-VA Integrated Health Business Reference Model (OV-5) Common DoD-VA To Be Process Flow Model (OV-6C) Presentation (Common GUI) Battlefield Car e DoD Unique Pediatr ic s Phar mac y Applications and Services Common (Joint) Applications & Services Per sonal Health Rec or d Labor ator y Blood Mgmt Nur sing Home VA Unique Long Ter m Car e Militar y Readiness Obstetr ic s Disability Evaluation Inpatient Or der s Mgmt Emer genc y Dept Care Doc ument Mgmt Rehabilitative Car e Tr ansient Outr eac h Enr oute Car e Veter inar y Dental Care Consult & Refer r al Mgmt Immunization Oper ating Room Mgmt Oc c upational Health (VA) Common Interface Standards Common Services Broker (includes Enterprise Service Bus (ESB) and Infrastructure Services) Common Interface Standards Common Data Centers Common Information Interoperability Framework (CIIF) Common Information Model, Common Terminology Model, Information Exchange Specifications, Translation Service Common Data Standards: SNOMED CT and Extensions, LOINC and RxNorm DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. 6 Common DoD-VA Measures of Effectiveness, Measures of Performance and Key Performance Parameters Joint DoD/VA DoD Only VA Only 6

7 Presentation Layer GUI is the EHR for users It guides thought and work Why is EHR so hard to use? Why can t we find information we need? Why are there so many clicks? DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 7

8 EHRs are Data Centric Building blocks of EHR are data domains Meds, Labs, Rad, Notes, Diagnoses, etc. Designed without regard to cognition: e.g., gives CDS after decision Results in bad thought and work flow DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. 8

9 EHR Function Proposed HL7 Functional Requirements v2 >200 pages of requirements Store data Present data Is this what clinicians do: read and enter data? DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 9

10 Transition Move from data centric work areas to function centric work areas Get to a place where we Understand Plan Execute DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 10

11 Proposed Presentation Layer Clinician Home Page DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. * The health record above contains sample test data used for demonstration purposes 11

12 Proposed Presentation Layer- Patient Summary Page DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. * The health record above contains sample test data used for demonstration purposes 12

13 What users want from EHR Help get work done Help understand what is going on Help plan interventions Help execute interventions How many interfaces have tabs or workspaces optimized for each of these functions? DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 13

14 Evolution of GUI Design DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. 14

15 Care Coordination is Target (For inpatient and outpatient settings) DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS. 15

16 Design Principles Support thought flow Support work flow Information-rich environment Provocation Move away from focus on data as per HL7 Functional Model Move toward focus on function of interfaces DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 16

17 Evidence-Based Design What is in primary work area Goals Model of patient (what is going on) Common Ground (what you and others are doing) Abilities in primary work area Manipulate information: grouping, hiding/emphasizing, zooming, panning, etc. Plan: Temporary ideas, what if simulations Execute Plan: communication, reminders, task lists etc. DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 17

18 Key Features Expose goals Display relationships Task management in context of plan Pervasive support for communication Focus on cognitive support in context Interactive, Integrated Interfaces DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 18

19 Context Nebeker DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS

20 Questions? DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of 20

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