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National Committee on Vital Health Statistics

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The G-CPR effort is a collaboration of Veterans Administration, Department of ... Definition of the Computer-based Patient Record; ... – PowerPoint PPT presentation

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Title: National Committee on Vital Health Statistics


1
National Committee on Vital Health Statistics
  • Briefing by
  • Government Computer-based Patient Record (G-CPR)
    Partnership
  • March 4, 1998

2
G-CPR Conceptual Model
Each Partner -CDR -Apps
Shared Requirements -Technical -Functional -Progr
ammatic
3
Government Computer-based Patient Record G-CPR
  • The G-CPR effort is a collaboration of Veterans
    Administration, Department of Defense, Indian
    Health Services, and Louisiana State University
    Medical Center.
  • The G-CPR Partnership formed to develop
    approaches to appropriate sharing of information
    to manage care of shared populations of patients
  • Partners will jointly define business and
    technical characteristics for data sharing, and
    will look to the private sector for solutions.

4
Partnerships Purpose
  • Define the technical and functional requirements
    for the development of a worldwide Government
    Computer-based Patient Record (G-CPR)

5
G-CPR Vision
  • Improve public and individual health status by
    sharing clinical information

6
G-CPR Goals
  • Create a collaborative partnership to
    appropriately share clinical information via a
    comprehensive, lifelong medical record
  • Where no standards exist, the partnership will
    seek to advance the development, establishment,
    and adherence to standards

7
G-CPR Business Characteristics (1 of 3)
  • Provide clinical information to care providers
    across the continuum of care
  • Support a mullet-disciplinary team approach to
    care delivery
  • Provide simple and complex clinical decision
    support that can be available at the point of
    care
  • Support population management
  • (preventive and disease states)

8
G-CPR Business Characteristics (2 of 3)
  • Enable patient-centric care, including shared
    decision-making between care provider and patient
  • Provide a seamless path to obtaining medical
    knowledge and reference material when needed by
    the caregiver
  • Document care in a coded, structured manner to
    support outcomes measurement and implementation
    of clinical logic

9
G-CPR Business Characteristics (3 of 3)
  • Provide solutions that are unobtrusive to the
    patient and provider relationship
  • Support flexible means of entry and retrieval of
    data by authorized care givers/users and medical
    devices across all partners healthcare settings,
    independent of platforms
  • Support multiple migration paths and different
    timelines among the partners

10
G-CPR Technical Characteristics (1 of 2)
  • Provide common technology tools for integration,
    possible solutions may include
  • Lexicon
  • Elements of a clinical data repository
  • A uniform clinical information model
  • Event points
  • Browser enabling
  • Authentication and security
  • Data exploration tools
  • Patient and provider identifiers
  • Communication protocols, and
  • Other standards

11
G-CPR Technical Characteristics (2 of 2)
  • Incorporate standards-based information sharing
    within a partner selected standards set
  • Adhere to vendor-independent, open systems
    architecture
  • Provide services to integrate selected products
    into the partners IM/IT environment

12
Standards Organization Participation
  • One or more of the partners are represented on
    the following standards development organizations
  • Health Level 7 (HL7)
  • National Library of Medicine
  • Health Care Finance Administration (HCFA)
  • SNOMED III
  • ANSI
  • U.S. Federal Drug Administration - National Drug
    Codes (NDC)
  • Logical Observation Indentifiers, Names and Codes
    (LOINC)
  • ASC X12N
  • DICOM
  • CORBAmed

13
Major Users and Functions of the CPR
  • Primary users Physicians, Nurses, and other
    direct Patient Care Providers
  • Access to information from multiple sources and
    multiple care delivery sites
  • Provides point-of-care clinical decision support
  • Supports clinician workflow through integrated
    patient records, guidelines, critical paths,
    treatment plans, with access to knowledge and
    reference databases.
  • Secondary users Case managers, Medical Records
    personnel, and Quality Assurance Officers
  • Supports the collection of outcomes data
  • Supports the collection of information for
    population-based longitudinal studies
  • Enables improved reporting capability for
    utilization management and measurement of
    performance against quality assurance indicators.

14
What is the distinction between EMR and other
related topics?
There are numerous terms in use to discuss the
opportunities to a automate patient-related
health data. We concur with the following
definitions EMR Electronic Medical Record A
location or device for keeping track of patient
care events - Institute of Medicine. An
electronic form of the current paper record.
Often the first generation approach to delivering
an automated clinical record. CPR
Computer-based Patient Record The computer-based
patient record is electronically maintained
information about an individuals lifetime health
status and health care. - Computer-based
Patient Record Institute The CPR is the
consolidation of clinical data associated with
the care of a patient across a period of time,
geography, and providers. CPRS Computer-based
Patient Record System The CPRS includes the
transaction-based feeder systems and technical
infrastructure required to support secure and
confidential collection, assess, transmission,
display and exploration of the CPR data.
Additionally, the CPRS incorporates clinical
decision support and access to external knowledge
databases in a secure environment. (Examples
VA - VISTA, DoD - CHCSII, LSUMC-SMS, IHS-VISTA.
15
Capabilities being successfully provided by
providers, payers, vendors and standards
organizations?
  • Providers - Focus is primarily on information
    management with emphasis on clinical decision
    support. Many of the CPR initiatives are several
    years old and provide case study information on
    lessons learned.
  • Examples Intermountain Health Care, Regenstrief
  • Payers - Focus is primarily on information
    management delivered to providers rather than
    patients.
  • Examples Kaiser - Ohio
  • Vendors - Focus is primarily on information
    access and delivery tools for clinical
    decision-makers across multiple episodes of care.
  • Standards - Health Level 7 is the predominant
    messaging standard. The challenge and critical
    success factor is the requirement to develop
    standards which address coding of data and the
    core set of data elements.

16
Impediments
  • Differing definitions of computer-based patient
    records
  • Complexity, length and cost of implementation
  • Lack of a common data model
  • Lack of a comprehensive Clinical Lexicon
  • Balancing confidentiality with secure and
    appropriate access
  • Complex algorithms for developing rules-based
    decision support systems
  • Limited advances in voice and hand-writing
    recognition
  • Unfriendly user interface and data collection
    mechanisms
  • Data ownership issues
  • Lack of clear, universal and enforceable
    confidentiality policies.

17
Recommendations to Address Impediments
  • The impediments previously described fall into
    two categories - Universal and Site Specific. We
    believe NCVHS should focus on the following
    Universal impediments
  • Definition of the Computer-based Patient Record
  • Data set to be developed in conjunction with
    G-CPR partnership
  • Advancing the development of Clinical Lexicon
    standards
  • Advancing the development of Unique patient
    identifiers
  • Policies regarding data ownership
  • Advancing strategies for balancing security and
    confidentiality.

18
Recommendations for NCVHS
  • Expedite definition and approval of data
    standards
  • Unique patient identifier
  • Collaborate with the G-CPR partnership in
    developing an initial minimum data set
  • Include vendor community to outline
    capabilities/approaches
  • Encourage consumer involvement to determine
    expectations and concerns through mechanisms
    beyond the Public Register (Surveys, public
    debate forums, Web-site discussion rooms, etc.)
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