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Possibilities and Implications of ICF-powered
Health Information Technology
Assistant Research Professor, Indiana University School of Medicine Research Scientist, Regenstrief Institute, Inc
CSM 2012 – The ICF and PT 10 Years Later
02.10.2012 © 2012 dvreeman@regenstrief.org
Daniel J. Vreeman, PT, DPT, MSc
photo via Sadie Hernandez
The Future Great Scott!
Complete, longitudinal information that follows the consumer
Care that is value-based and coordinated across settings
photos via meddygarnet and brykmantra
Health decisions made with information tools that assist and guide
Have you considered…
Results Fewer errors, waste, variations Consumer-centered care Lower spending
Meanwhile, back on planet Earth…
Patients move faster and further than their health information
Growing Recognition
1960’s • 1st studies of
computers in healthcare
1991 • IOM says
EHR’s are essential
2003 • HHS promotes
widespread use of HIT
2004 • Pres. Bush
makes HIT a top national priority
2004+ • Flurry of
federal activity
2009 • ARRA has $20
billion for HIT adoption
Evidence for Health IT
92% of 154 studies
e "rst priority in realizing the bene"ts of health IT is to achieve nationwide adoption of EHRs and widespread information exchange.
“
3 Ways EHRs can Help Accelerate that Vision Data reuse Decision support Canopy computing
practice management, quality reporting, accreditation, public health, research…
Collect once. Use many.
EHR Decision Support A computer-generated suggestion about care for an individual patient
me
The secret sauce of the HIT chicken soup
photo via Robert Couse-Baker
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.
Indiana Network For Patient Care A Unified Patient Record
How does all this relate to ICF?
Fundamental challenge: local systems have idiosyncratic ways of identifying similar concepts
Vocabulary standards provide the linuga franca.
Standards ^
Functional Status
ICF: categories of function LOINC: assessments (observations)
We all know about ICF…
Logical
Observation
Identifiers
Names and
Codes A universal code system that facilitates exchange,
pooling, and processing of results
15,500+ users in 145 countries
MEASUREMENTS
US
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
How fast does my patient usually walk? 41959-8:Walking speed:Vel:1W^mean:^Patient:Qn:Calculated
photo via Ed Yourdon
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.
Warning: Long road ahead.
Getting Back to the Future Moving towards semantic interoperability
Might start with templates
photo via Marcin Wichary
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
Some Advantages ICF worldview Same labels and meaning
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”
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
Now we have a powerful set of coded data that
computers can operate on and exchange between
independent systems in an understandable way.
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
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
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
Key Lesson of Today
photo via IMLS DCC
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
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