Electronic Medical Records

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Electronic Medical Records Building Encounter
Forms

• Erika Orrick
• GE Healthcare

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• By computerizing health records, we can avoid
  dangerous medical mistakes, reduce costs, and
  improve care.President Bush, 2004 State of the
  Union

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What are EMR systems and why is this significant?
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What is an EMR system?
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Encounter forms generate chart data
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What is rapidly increasing adoption of EMR
systems?

• One recent reform pushing adoption of EMR systems
  has been Medicares (and many private insurers)
  pay-for-performance initiatives. It is much
  easier to prepare needed reports using electronic
  systems. (e.g. HbA1C for diabetes)
• This reform is one thing pushing EMR systems into
  smaller, less tech-savvy clinics than they were
  previously found.

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EMR systems also can enable data availability

• RHIOs (Regional Health Information Organizations)
  are forming to encourage patient data exchange.
• EMR systems allow easy patient contact for drug
  recalls, etc.

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Why is this an end-user software engineering
problem?
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Encounter forms in clinical workflows

• Centricity EMR is shipped with a default set of
  encounter forms, but many providers/clinics are
  used to working in a certain way and want to
  customize the forms to match them. There are a
  several third party vendors who sell additional
  forms and customization services for our EMR
  product.
• Forms enable quick entry of information in a
  manner that will ensure accurate coding for
  insurance/Medicare filing.

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Default output of an encounter form

• History of Present Illness
• Chief Complaint chest pain
• Location Substernal
• Quality Burning
• Severity moderate
• Duration 3 days
• Timing constant
• Radiation none
• Exacerbating factors eating
• Relieving factors antacids
• Associated with weekly staff meetings

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Provider-preferred output of the form

• This patient presents with a 3 day history of
  substernal chest pain. He describes it as
  moderately burning in character. Michael also
  describes the pain as constant without radiation.
  The patient states that eating exacerbates the
  pain, and that antacid provides relief from the
  pain. Pain is often associated with weekly staff
  meetings.

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MEL (Medical Expression Language) to generate
natural language output

• CFMT(DOCUMENT.TEMP_305780818_1_891658, "", "This
  patient presents with a ", "")
• cond
• case DOCUMENT.TEMP_305780819_1_891659
  "minutes" return " minute"
• case DOCUMENT.TEMP_305780819_1_891659 "hours"
  return " hour"
• case DOCUMENT.TEMP_305780819_1_891659 "days"
  return " day"
• case DOCUMENT.TEMP_305780819_1_891659 "months"
  return " month"
• else ""
• endcondCFMT(OBSNOW("HPI location"), "", "
  history of ", "", "")cfmt(OBSNOW("Chief
  Cmplnt"), "", " ", "", ". ")
• This snippet of code produces only the first
  sentence of the previous paragraph
• This patient presents with a 3 day history of
  substernal chest pain.

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The current Encounter Form Editor
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Single item edit detail in the EFE
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Debugging MEL Trace

• --------------------------------------------------
  ------------
• -- Starting MELTrace on 07/26/2005 219 PM for
  WSID 600
• --------------------------------------------------
  ------------
• executegtAttach Symbols Begin
• executegtAttach Symbols End
• gt/VARIABLES FOR MEL BUILT-IN SYMBOLS USED IN
  FORM/\par
• executegtend
• resultsgtNULL
• gt/START OF FORM TRANSLATION BODY/\par
• executegtend
• resultsgtNULL
• gt/START OF FORM TRANSLATION BODY/\par
• executegtend
• resultsgtNULL
• gt/START OF FORM TRANSLATION BODY/\par
• executegtend
• resultsgtNULL
• gt/START OF FORM TRANSLATION BODY/\par
• executegtend

. executegtcall VAL("6") resultsgt6 executegt6 lt
5.50 resultsgtFALSE executegtif FALSE resultsgtFALSE
executegtDocument.TEMP_CCC_HPI_FORM_OPENED result
sgt"OPENED" executegt"OPENED" "" resultsgtFALSE
executegtDocument.TEMP_CCC_A_P_FORM_OPENED results
gt"OPENED" executegt"OPENED" "" resultsgtFALSE
executegtFALSE AND FALSE resultsgtFALSE
executegtDocument.TEMP_CCC_PED_A_P_FORM_OPENED res
ultsgt"OPENED" executegt"OPENED"
"" resultsgtFALSE executegtFALSE AND
FALSE resultsgtFALSE (and so on)
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Problem Summary
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How do allow end users to construct encounter
forms more easily?

• How do we make this customization tool more
  accessible to less technical users?
• How do we encourage the use of standards so one
  clinic can have a consistent interface in spite
  of using forms constructed by GE Healthcare, by a
  third-party vendor, and in house?

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• Erika Orrick
• erika.orrick_at_ge.com
• http//www.gehealthcare.com