Archive for the ‘Electronic Health Records’ Category
The NLM exhibit booth at the 2013 Annual Meeting of the Medical Library Association in Boston featured theater presentations to bring users up-to-date on several NLM products and services. The presentation recordings are captioned and accessible from the NLM Distance Education Program Resources page. The presentations include:
Note: To listen to the voice recordings and view the captions you may need the latest version of Flash® Player (download for free from the Adobe Web site). To zoom in to detailed screens, use the scroll button. For more information, go to the NLM Technical Bulletin page.
Research funded by the National Library of Medicine provides new insight into why patients stop taking drugs that lower their cholesterol, and what happens when patients try those drugs, known as statins, a second time. Researchers found that more than 90% of patients who stopped taking statins because of an adverse reaction could tolerate the medication when tried again. The study is published in the April 2, 2013, issue of the Annals of Internal Medicine.
NLM grantee Alexander Turchin MD, MS, of Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School, notes that statins are commonly stopped even though their benefits are well documented. He and colleagues wanted to better understand why statins are discontinued and whether adverse reactions play a role. They conducted a retrospective study, analyzing clinical data in an electronic medical record (EMR) system. Researchers examined structured data as well as the narrative electronic notes of health providers. Those notes frequently are the only place in an EMR where adverse reactions to medications are documented. Using the NLM grant, researchers developed natural language processing software and scoured more than 5 million notes, on more than 107,000 patients, recorded over nearly a decade. The software generated data on a scale that could not have been done manually. Researchers say the next step would be to conduct a clinical trial to determine if outcomes are improved when statins are tried again, after an adverse event.
The National Library of Medicine, part of the National Institutes of Health, conducts and funds research in biomedical informatics, which involves applying computers and communications technology to the field of health. This research was supported by NLM’s Division of Extramural Programs grant RC1-LM010460. This was an NIH Challenge Grant, supported by NLM with funds from the American Recovery and Reinvestment Act. For additional information, visit the Brigham and Women’s Hospital News Release.
The National Library of Medicine (NLM) Value Set Authority Center (VSAC), in collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), has published the annual update for the 2014 Eligible Hospital Clinical Quality Measure (CQM) Value Sets. The update includes revised value sets to address deleted and remapped codes in the latest terminology versions, as well as new codes for addressing CQM logic corrections and clarifications. The NLM update of the VSAC coincides with the CMS posting of the official updated 2014 Eligible Hospital CQMs.
The value sets provide lists of the numerical values and individual names from standard vocabularies used to define the clinical concepts (e.g. diabetes, clinical visit) used in the CQMs. The content of the VSAC will gradually expand to incorporate value sets for other use cases, as well as for new measures and updates to existing measures. The VSAC offers a Downloadable Resource Table (DRT), accessible from the “Download” tab on the VSAC Web page, that provides prepackaged downloads for the most recently updated and released 2014 CQM Value Sets, as well as to previously released versions. Access to the Value Set Authority Center requires a free Unified Medical Language System® Metathesaurus License. NLM also provides the Data Element Catalog that identifies data element names (value set names) required for capture in Electronic Health Record (EHR) technology, certified under the 2014 Edition of the ONC Standards and Certification Criteria.
The following resources are available to help health care providers and vendors navigate the 2014 CQMs:
A new database developed by the Agency for Healthcare Research and Quality (AHRQ), with support from the Centers for Medicare and Medicaid Services (CMS), can help software developers create better Electronic Health Records (EHRs) for the care of children. The children’s EHR format establishes a blueprint for EHRs to better meet the needs of health care providers and pediatric patients by combining best practices in clinical care, information technology, and insights from experts in children’s health. Since few EHRs have been created with children’s needs in mind, gaps in functionality, data elements, and other areas tend to occur. The format guides EHR developers in understanding the requirements for functionality, data standards, usability and interoperability of an EHR system to more optimally support the provision of health care to children, especially those enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). The format is readily accessible and adoptable by EHR developers for use during product development or enhancement.
The children’s EHR format was authorized by the 2009 Children’s Health Insurance Program Reauthorization Act (CHIPRA). The format includes a minimum set of data elements and applicable data standards that can be used as a blueprint for EHR developers seeking to create a product that can capture the types of health care components most relevant for children. Child-specific data elements and functionality recommendations are sorted into topic areas that include prenatal and newborn screening tests, immunizations, growth data, information for children with special health care needs and child abuse reporting. The EHR format provides guidance on structures that permit interoperable exchange of data, including data collected in school-based, primary, and inpatient care settings. The format is compatible with other EHR standards and facilitates quality measurement and improvement through the collection of clinical quality data.
In addition to providing guidance to developers, the format can provide guidance for EHR system purchasers and policy makers. For example, policy makers and purchasers can use the requirements when assessing functionality of EHRs. More information about the children’s EHR format is available on the AHRQ website.
The Agency for Healthcare Research and Quality (AHRQ) and the Electronic Data Methods (EDM) Forum have announced the official launch of eGEMs (Generating Evidence and Methods to improve patient outcomes). eGEMs is a new peer-reviewed, open access journal designed to curate a knowledge base of emerging lessons learned, focusing on using electronic clinical data to advance research and quality improvement, with the overall goal of improving patient and community outcomes. Authors are welcome to submit papers, images, or other media focused on the four themes of data methods, informatics, governance, and the learning health system. Submissions are published upon acceptance.
Under a recent agreement with the American Medical Association (AMA), the National Library of Medicine (NLM) will be including the AMA’s Current Procedural Terminology (CPT) codes for molecular pathology tests in the National Institutes of Health’s Genetic Testing Registry (GTR). GTR is operated by NLM’s National Center for Biotechnology Information (NCBI), and provides a resource for comprehensive information about genetic tests. The database provides a central location for voluntary submission of test information by providers. Content includes the test’s purpose, methodology, validity, evidence of the test’s usefulness, and laboratory contacts and credentials.
Under the new agreement, AMA’s CPT codes for molecular pathology tests will be integrated into GTR. The AMA-created codes describe the latest advances in genetic testing and molecular diagnostic services for reporting and tracking purposes. AMA’s new, more detailed CPT codes for molecular pathology became effective in 2012. Inclusion of the CPT codes in GTR further enhances the database’s interoperability with electronic medical records and laboratory information management systems. GTR also incorporates SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms), an extensive clinical terminology produced by the International Health Terminology Standards Development Organisation (IHTSDO), and LOINC (Logical Observation Identifiers Names and Codes), produced by the Regenstrief Institute, which provides standardized terms and codes for identifying laboratory and clinical observations. NLM is the US Member of the IHTSDO and provides support for the development and free US-wide use of both SNOMED CT and LOINC. CPT, SNOMED CT, and LOINC are required standards in the certification criteria for electronic health record products issued by the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services.
The National Library of Medicine, in collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), has launched the NLM Value Set Authority Center (VSAC). The VSAC provides downloadable access to all official versions of vocabulary value sets contained in the 2014 Clinical Quality Measures. The value sets provide lists of the numerical values and individual names from standard vocabularies used to define the clinical concepts, e.g., diabetes or clinical visit, used in the quality measures. The content of the VSAC will gradually expand to incorporate value sets for other use cases, as well as for new measures and updates to existing measures. Access to the Value Set Authority Center requires a free Unified Medical Language System Metathesaurus License. NLM also provides the Data Element Catalog that identifies data element names (value set names) required for capture in Electronic Health Record (EHR) technology, certified under the 2014 Edition of the ONC Standards and Certification Criteria.
The Guide for Reading Eligible Professional and Eligible Hospital 2014 eCQMs, published by CMS, provides guidance for understanding and using the electronically specified eligible professional (EP) and eligible hospital (EH) clinical quality measures (“eMeasures”). CMS has also provided the following release notes with updated program requirements related to the eCQMs, and global changes incorporated across all measures, as well as specific changes to the measures retained in the 2014 eCQMs; Clinical Quality Measures for CMS’s 2014 EHR Incentive Program for Eligible Professionals and Clinical Quality Measures for CMS’s 2014 EHR Incentive Program for Eligible Hospitals. CMS has also published the 2014 Clinical Quality Measures Tipsheet, which includes an overview of the CQMs, including the number of measures eligible professionals (EPs) and eligible hospitals (EHs) must report, CQM reporting options, and reporting and submission periods. For questions about these resources, contact the NLM Value Set Authority Center Help site.
The National Library of Medicine recently released two enhancements to MedlinePlus Connect. MedlinePlus Connect now returns responses for medication information in Spanish. Also, the MedlinePlus Connect Web service delivers more targeted information when responding to medication information requests. In September 2012, NLM enhanced the MedlinePlus Connect Web service response for medication code requests. Previously, the MedlinePlus Connect Web service returned a link to a search results page with the best matches from the MedlinePlus drug information. Now, the enhanced Web service returns direct links to relevant drug information pages on MedlinePlus.
Starting in October 2012, MedlinePlus Connect returns requests for medication information in Spanish. This complements MedlinePlus Connect’s responses for diagnosis and lab test information, which were already available in both English and Spanish. MedlinePlus Connect processes requests for Spanish medication information differently from requests for English medication information. For Spanish medication information, MedlinePlus Connect responds only to National Drug Codes (NDCs) or RxNorm Concept Unique Identifier (RXCUIs). It does not use text strings, which are accepted for requests for English medication information. It is possible to have a response in English and not in Spanish.
MedlinePlus Connect is NLM’s service for patient portals and electronic health record (EHR) systems, to link to patient-friendly and context-relevant information from MedlinePlus. It responds to code-based requests, and delivers information for patients that relates to a specific diagnosis, medication or lab test. Full details on sending requests for medication information, either to the MedlinePlus Connect Web service or the Web application are available on the technical information page.
In November, 2010, the federal Office of the National Coordinator for Health Information Technology (ONC) convened the Southeast Regional HIT-HIE Collaboration (SERCH) project on Health Information Exchange in Disaster Preparedness and Response. The consortium included representatives from Alabama, Arkansas, Florida, Georgia, Louisiana, and Texas, with the goal of developing a strategic plan for sharing health information data among the Southeast and Gulf States during and following a declared natural disaster. The consortium members carefully assessed the challenges of accessing medical records and coordinating health care information for patient populations displaced due to a disaster. To date, there has been limited research on how HIE could be leveraged to provide timely access to clinical information in response to a disaster. The best way to ensure that health information can be accessed during an emergency is to ensure that it can be accessed during routine care. As connectivity through HIE expands, opportunities to link exchange efforts with emergency preparedness and response to provide health information to providers and patients in response to a disaster will increase.
The final report from the project, released in July, 2012, includes an actionable plan for incorporating health information exchange into disaster preparedness efforts. The phased approached suggested by SERCH supports immediate progress in the absence of routine, widespread health information exchange. It also addresses key legal, technical, and governance issues and offers a list of steps that states can take to align their health information exchange planning activities with ongoing emergency preparedness activities. The report includes five recommendations, which offer a path forward for states wishing to integrate disaster planning and health information exchange efforts, to help ensure that when a disaster strikes, patients and providers will have better access to information, and providers will be better able to provide appropriate care.
Data dashboards provide a mechanism to use visualization, rather than words, to get a quick overview of progress made towards programmatic goals, and to engage stakeholders in the evaluation process. To use data dashboards effectively, it is important to define the user group(s) involved and to select recognizable metrics from trusted sources. There are a variety of resources available to assist with producing dashboards for web sites, blogs, etc., including Juice Analytics, Tableau Software, and Google Analytics. After registering with Juice Analytics, one resource to consider is a white paper listed in the “Visualization Resources” category, called A Guide to Creating Dashboards People Love to Use. Once established, data dashboards can monitor the progress of a program, communicate progress to stakeholders, and provide early signs of problems that may be arising.
To get an idea of a final product, a good example to view is the Health IT Dashboard showing the implementation of the Regional Extension Center (REC) Cooperative Agreement Program, coordinated by the federal Office of the National Coordinator for Health IT (ONC). The REC program is funded to provide technical assistance for EHR implementation to 100,000 primary care providers, through 62 nationwide sites. The dashboard charts the enrollment of primary care providers in this program, and monitors their efforts to become meaningful users of electronic health records (EHRs). Dashboards could be a colorful, visual way for you to show what you do to benefit the overall institution!