Stream: patient empowerment
Topic: Morgan Gleason's Presentation
Grahame Grieve (Jun 15 2020 at 17:53):
I'm watching this presentation and wondering whether we should standardise something like "Patient Preparation note" (or something like that). That would help with writing an App. Also, this seems like a good workflow for a student challenge to take on (e.g. MIHIN challenge)
@Morgan Gleason - thanks - that's nice work.
Dave deBronkart (Jun 15 2020 at 17:58):
@Ross Martin this is where we hang out - in the Patient Empowerment stream.
Ross Martin (Jun 15 2020 at 17:58):
@Morgan Gleason Agree with @Grahame Grieve -- that was an excellent summary of the challenges many complex patients face in coordinating their care. Two questions:
- How would you rank the various features of your "dream app" in terms of priority?
- Have you tried using any of the available patient apps (Apple Health, former HealthVault and former Google Health, etc.)? Were there features of those you found useful?
Lloyd McKenzie (Jun 15 2020 at 18:00):
I raised the question on #social, but I'll ask here too - what's the resource to use for a "patient's questions they want answered during a session"? Most of what was on @Morgan Gleason's document has a clear home, but I'm not sure about that bit. It could be 'Goal', but that doesn't quite feel right, nor does Questionnaire.
Grahame Grieve (Jun 15 2020 at 18:01):
does it need more than text in Composition.section.text?
Ross Martin (Jun 15 2020 at 18:02):
Here is a link to "Flow" -- a spoken word piece I wrote in 2012 that speaks to what you're asking for. I made this video about four years ago. https://youtu.be/dQNKSKAUV3Q
Lloyd McKenzie (Jun 15 2020 at 18:02):
I think so. I'd want the records of them captured. Perhaps Task? It acts as a 'todo'. It would also allow the answering of the questions to be delegated and to remain 'active' if they weren't answered during a session.
Grahame Grieve (Jun 15 2020 at 18:04):
Condition:
This resource is used to record detailed information about a condition, problem, diagnosis, or other event, situation, issue, or clinical concept that has risen to a level of concern
Seems to meet that definition
Ross Martin (Jun 15 2020 at 18:05):
While I do imagine there are lots of places the individual data pieces already live, what Morgan is looking for is a way to present a patient summary that is generated by the patient/caregiver that focuses on different aspects of the whole picture. This turns into a lot more tools for highlighting and notating various aspects of the record as well as managing the routing and prioritization of different content for different providers.
Ross Martin (Jun 15 2020 at 18:06):
@Lloyd McKenzie, is that picture from 20 years ago, because you look exactly the same! ;-)
Grahame Grieve (Jun 15 2020 at 18:06):
@Morgan Gleason if you send me the document source for the document you showed in your presentation, I'm happy to turn it into a formal FHIR document. (though we need to talk about how much you want to make public, of coruse)
Vassil Peytchev (Jun 15 2020 at 18:07):
I didn't see the presentation, but one potentially useful thing would be to start with the textual representation of "questions I want answered during a session", run it through NLP, then let the system/AI/Alexa/whatever process the questions according to best practices/similar-patients, and have this presented to the provider as a guide during the session...
Grahame Grieve (Jun 15 2020 at 18:09):
right. The point of a common format is to enable tool innovation like that
Grahame Grieve (Jun 15 2020 at 18:10):
Interesting story from @Keith Boone - we're getting there, but we have a long way to go: http://motorcycleguy.blogspot.com/2020/06/interpreting-negative.html
Lloyd McKenzie (Jun 15 2020 at 18:14):
Condition is something that is tracked over time. It wouldn't necessarily correspond to a 'question'. For example "I'm wondering if we can shift the dose or schedule of medication X because it's making me drowsy when I need to Y". You could potentially capture the "Medication X makes me drowsy" as a Condition, but not the full question.
Grahame Grieve (Jun 15 2020 at 18:28):
not so:
The condition could be a point in time
Lloyd McKenzie (Jun 15 2020 at 18:39):
It can be, though that's often handled as Observation. Key thing is that Condition isn't something that will have an 'answer', has an assigned responsibility of "who should answer" and the state machine doesn't really fit well for "awaiting answer" vs. "answered". ("resolved" definition is "The subject is not presently experiencing the condition or situation and there is a negligible perceived risk of the condition or situation returning." which seems a weird state for "this question is now answered"...)
Morgan Gleason (Jun 15 2020 at 19:00):
That sounds great! I love the idea of standardizing on this concept. It really is important to have a plan for everyone in the visit.
Morgan Gleason (Jun 15 2020 at 19:00):
I agree, I don’t think it is quite either of those. It is more of an agenda or visit plan.
Morgan Gleason (Jun 15 2020 at 19:01):
Thanks so much! I guess I would rank getting my appointment visit notes and radiology reports sent to my doctors and to me as first as at least that would solve the manual record requests and make sure that we all had the same information. Then, I would rank having my information aggregated and current second. Next, I would rank the summaries of the plan, and last I would rank combining it all with an issues list, reason for visit, reminders, extra details, etc.
I have tried to use other apps, and the only one I found valuable isn’t made anymore. It was the only one that actually combined all the data and had all the details. I love the Apple Health one, but it keeps each healthcare doctor or site information separated from the rest. It also doesn’t get documents so it is missing the most important parts of information. It is also only as good as the patient portals are, which I have found to be pretty terrible - all 23 of them!
Grahame Grieve (Jun 15 2020 at 19:02):
I think that the intent with Apple Healthkit is that an app could integrate information across providers. I suppose one such app exists but how to find it? (Apple have reps here so they might comment...)
Morgan Gleason (Jun 15 2020 at 19:07):
That sounds great! I would love to see it in formal FHIR format. Would you be doing that to share it as an example? If so, I can change some details and send it
Ross Martin (Jun 15 2020 at 19:08):
Grahame Grieve said:
I think that the intent with Apple Healthkit is that an app could integrate information across providers. I suppose one such app exists but how to find it? (Apple have reps here so they might comment...)
Apple bought Gliimpse from Anil Sethi, which did exactly this. Then Anil left Apple and started Ciitizen to do it all over again so the focus could be back on complex patients. The Health app is, I agree useful, but not where it needs to be for what Morgan needs!
Dave deBronkart (Jun 15 2020 at 19:31):
I'll just observe that "the Health app" is a quite different beast from HealthKit, yes?
I've never seen a clear description (ideally an illustration) comparing the Health app with HealthKit. Anyone? @Ricky Bloomfield ? We're talkin' about y'all's stuff here....
Grahame Grieve (Jun 15 2020 at 19:35):
well, I meant, some other health app, not the Apple one that comes as part of health kit
Dave deBronkart (Jun 15 2020 at 19:36):
I'm thrilled with this rich discussion ... see my further observation at the end:
Grahame Grieve said:
I'm watching this presentation and wondering whether we should standardise something like "Patient Preparation note" (or something like that). That would help with writing an App. Also, this seems like a good workflow for a student challenge to take on (e.g. MIHIN challenge)
Morgan Gleason - thanks - that's nice work.
It just thrills me that after all the thought & work that's already gone into FHIR, this additional breakthrough-level concept can arise out of listening to what one young patient is already doing to manage her care.
It validates the whole idea of having a patient innovator track, eh?
Dave deBronkart (Jun 15 2020 at 19:41):
Lloyd McKenzie said:
I raised the question on #social, but I'll ask here too - what's the resource to use for a "patient's questions they want answered during a session"?
Is there a resource for a patient's goal or declared need - a "what I want"? Seems to me that Goal in reality has long-term, short-term, and immediate flavors.
Goals also have many forms: stop my knee from hurting; get my A1c below 5.8; be able to put my socks on while standing, at age 80; get doctor's advice on X ... IMO correctly a goal needs to allow freeform text, but it needs to have a certain status as "What matters to the patient, in their own definition of well-being."
Lloyd McKenzie (Jun 15 2020 at 20:09):
"Get doctor's advice on X" could be a goal, though that seems to me to be more a process step than a "desired end state". Goal would be more "Have a good understanding of X". Also, Goal doesn't have an ability to assign responsibility or capture an answer.
Goals can absolutely be patient-authored and can be free-text (or computably expressed or both). There's also a standard extension that allows you to capture 'acceptance' of a goal - so patients can indicate whether they agree with (or not) a goal set by a practitioner or caregiver (e.g. parent, child); or for that matter, a practitioner can indicate whether they're on board with (or not) a goal set by a patient.
Dave deBronkart (Jun 15 2020 at 20:30):
Lloyd McKenzie said:
"Get doctor's advice on X" could be a goal, though that seems to me to be more a process step than a "desired end state". ```
Aha! Now we get deliciously into how we'll have to train people like Morgan (but also many providers) to think. Many times I've been asked "What are your goals for this visit?" Indeed IMO what we think of as a goal for one time zoomed-in event may just be in pursuit of one process step in a less-zoomed-in scope.So I'll back off on specifics and just note that our overall purpose for this discussion is to help make health/care more effective by weaving patient need/wants/perspectives into the fabric of everything we do. Yes?
Ricky Bloomfield (Jun 15 2020 at 21:13):
@Dave deBronkart, not sure if it's still relevant to the conversation, but the Health app is the user-facing app on your phone whereas HealthKit is the developer API/framework to read/write data to the secure database on the phone.
Dave deBronkart (Jun 15 2020 at 21:21):
Ricky Bloomfield said:
Dave deBronkart, not sure if it's still relevant to the conversation, but the Health app is the user-facing app on your phone whereas HealthKit is the developer API/framework to read/write data to the secure database on the phone.
That's my understanding too, but @Ross Martin almost without fail knows more than me, so when he talked about both in the same breath, I wanted to be sure we were all on the same page. :slight_smile:
So, to fulfill Morgan's desire to pull everything together as needed, the app of her dreams would talk to HealthKit, which is the doorway to all data on the device, some of which may also be visible in the Health app. Is that correct?
Ricky Bloomfield (Jun 15 2020 at 22:12):
Yes with the clarification that all data that can be read or written by HealthKit can also be viewed in the Health app - that's one of the guiding principles!
Morgan Gleason (Jun 15 2020 at 22:17):
@Lloyd McKenzie I think my “Items to Discuss” section is more of a to do list or agenda than a goal. It kind of seems forced to put it in the goal. I do also think goals are important, and I used to have them on my summary. However, I found that the items to discuss was more pointed to the visit. My goals didn’t seem to change much and weren’t discussed very much in my visits so I removed it. I have tried to keep it as short as possible.
Morgan Gleason (Jun 15 2020 at 22:22):
@Grahame Grieve I like to have the ability to complete the item to discuss so i can mark it off. Sometimes i don’t get to them all in a visit so i like time remember which ones i completed. I did play with a priority field but I always put everything as high :)
Grahame Grieve (Jun 15 2020 at 22:24):
I understand that part. Are you able to share an example source document for us to play with?
Morgan Gleason (Jun 15 2020 at 22:57):
@Grahame Grieve Does this google document work? I changed a couple of personal details. Let me know if you need anything else. https://docs.google.com/document/d/1-c8QnRuKP1NbnOqzsxvhYqS4HFToo04sD4IXcOZ0Eh4/edit?usp=sharing
Terrie Reed (Jun 15 2020 at 23:00):
Oh please add implant data!
Grahame Grieve (Jun 15 2020 at 23:03):
looks great. I'll see if I can have something overnight
Grahame Grieve (Jun 15 2020 at 23:03):
those are real phone numbers in there?
Morgan Gleason (Jun 15 2020 at 23:05):
@Grahame Grieve my number is not. however, the doctors numbers are but they are public phone numbers.
Vassil Peytchev (Jun 15 2020 at 23:08):
If you replace the first three of the last 7 digits of a US phone number with 555, it is guaranteed to not be a real one.
Grahame Grieve (Jun 15 2020 at 23:29):
@Vassil Peytchev thanks
Grahame Grieve (Jun 15 2020 at 23:30):
Hey @Morgan Gleason when you have a tick in "Refill Requested" does that mean that you have already requested a refill? or that you need a refill authorization during the consultation? Is there any difference between the 2 kinds of ticks?
Morgan Gleason (Jun 15 2020 at 23:35):
@Grahame Grieve it is that you need one during the consultation. and I am not sure what you mean by two ticks?
Grahame Grieve (Jun 15 2020 at 23:39):
Thanks. this is what I see in the google document:
Grahame Grieve (Jun 15 2020 at 23:39):
two different kinds of ticks.
Grahame Grieve (Jun 15 2020 at 23:39):
@Melva Peters I don't think you have an element for "I need a refill of a medication" at present?
Morgan Gleason (Jun 15 2020 at 23:40):
Screen-Shot-2020-06-15-at-6.40.05-PM.png interesting it should just be an open box not sure what happened there
Grahame Grieve (Jun 15 2020 at 23:41):
hmm so what I see as a plain tick should actually be a not-tick?
Melva Peters (Jun 15 2020 at 23:42):
@Grahame Grieve a patient can make a medicationRequest and reference the previous prescription. At least I think that’s the only way to do it at this point
Morgan Gleason (Jun 15 2020 at 23:43):
correct!
Grahame Grieve (Jun 15 2020 at 23:43):
not-tick -> tick. Google Docs evidently is not clinically safe :-(
Grahame Grieve (Jun 15 2020 at 23:44):
@Melva Peters thanks. that would be MedicationRequest.reasonReference? You can't reference a MedicationStatement as the basis?
Melva Peters (Jun 15 2020 at 23:54):
@Grahame Grieve not at this point. If it is a refill then you would include reference a previous MedRequest in MedicationRequest.priorPrescription
Bart Carlson (Jun 16 2020 at 02:23):
Most EHRs today organize the patients clinical data by "Encounters." In other words, a group of data for each appointment. If a patient happens to have a chronic condition, then they could easily have 100s of Encounters in their clinical history. Currently, most EHRs require anywhere from 3-6 keystrokes at a minimum for the doctor to review the data from each patient Encounter Record. If you multiply the number of keystrokes it takes the doctor to view a single Encounter for a patient times the number of Encounters describing a patient's clinical history, then it can easily take doctors hundreds to thousands of keystrokes just to review the patient's clinical history. And, because of this most doctors don't have the time to do so.
When we extract the patients data into a Patient App and/or Patient System, then unless we do something to solve the problem, it will also burden patients with this same repetitive keystrokes pattern to review their own clinical records.
I personally would like to see us define an HL7 standard that enables Patients, Providers and Payers to automatically "merge" all of the Patient's Encounters into a Master Patient Encounter with provenance for each data element. Many people believe this alone would help reduce the current Provider error rates for both diagnosis and treatment decisions resulting in a reduction in unnecessary appointments, in the number of deaths due to errors and in medical expenses.
Lloyd McKenzie (Jun 16 2020 at 03:37):
FHIR has an EpisodeOfCare resource which allows collecting all data across encounters (and outside encounters entirely) that is relevant to a given condition. It also supports the List resource which allows currated (and ordered) views of any collection of resources desired (meds, problems, encounters, procedures, lab results, whatever. Finally it has Composition which allows organizing collections of resources into a 'table of contents' where each section has narrative supporting the telling of a 'story'. Those three resources provide a variety of ways of organizing and providing views into the record that are more efficient/useful than navigating encounters. However, they can operate in parallel to encounters - because encounters too are useful organizers. It's just important that they not be the only ones. One of the challenges for systems now is to support better organization of data across systems, and that requires cultural change in addition to technical change.
Bart Carlson (Jun 16 2020 at 04:36):
Do you happen to know the FHIR EpisodeOfCare resource industry adoption rate for the USA? And, specifically by EHR market segment? Patient apps market segment? Payer market segment? Etc.? I'm guessing it is fairly low.
Ricky Bloomfield (Jun 16 2020 at 04:38):
@Bart Carlson No one has adopted it, yet, because it's not part of either the Argonaut IG for DSTU2 or US Core for R4 (at least in the US). The Encounter resource is now included in US Core, so we should start seeing some adoption of that soon, which will help.
Lloyd McKenzie (Jun 16 2020 at 04:48):
EpisodeOfCare is low and CarePlan is still pretty minimalist. The adoption of structures that support cross-organizational care coordination is unfortunately quite limited. Much of the early FHIR implementation was focused on merely exposing the data systems already had - and cross-ogranizational care coordination wasn't something that had a lot of penetration. As well, introducing external actors into workflow management of any kind of data creates all sorts of complexity, which isn't the sort of thing vendors are going to bite off first - especially if regulations don't make them.
Lloyd McKenzie (Jun 16 2020 at 04:49):
Note that adoption outside the U.S. isn't significantly different as far as I can tell.
Grahame Grieve (Jun 16 2020 at 07:43):
ok. @Morgan Gleason thanks for your example, here it is a FHIR document:
Grahame Grieve (Jun 16 2020 at 07:44):
@Lloyd McKenzie Task doesn't work for me at all
Grahame Grieve (Jun 16 2020 at 07:50):
But we to go with this? I think it would be awesome for someone to write an Apple health App that gathers this kind of information from health kit, allows a user to decide which to include in the document, write up their questions, and then store and submit to the provider electronically. (Obviously that anticipates some rather large clinical workflow changes).
The main reason I did this as a document is to feed it to orgs like MIHIN who run app development challenges - it seems like a really good way to spread the idea, a good project scope wise for some that are running. It if has legs, it might be worth the Patient Empowerment Group writing it as a formal spec (based on USCDI / IPS) on the grounds that the information should usually be gathered from the sources.
Morgan, are you interested in working a on joint blog post with me of what your dream workflow for
[have appointment | get data (incl follow ups) | collate document for next time] looks like?
Virginia Lorenzi (Jun 16 2020 at 07:55):
Clinical LOINC has document types. Maybe its time for the patient group to cause a ruckus over there.
Grahame Grieve (Jun 16 2020 at 07:56):
well, there's certainly no LOINC code suitable for this document - I just called it 'Patient Note'. So I meant to call for a volunteer to make a submission to LOINC asking for a code for a document like this.
Virginia Lorenzi (Jun 16 2020 at 08:00):
I have a friend who works for LOINC. But look at this: https://loinc.org/51855-5/
Grahame Grieve (Jun 16 2020 at 08:00):
That's what I used. All encompassing generic Patient Note
Virginia Lorenzi (Jun 16 2020 at 08:01):
Oops catching up with you
Virginia Lorenzi (Jun 16 2020 at 08:05):
@Debi Willis you will like Morgan's document idea - when she goes to the doctor, she manually aggregates her data from other visits, etc in a nice summary, then adds in her list of questions for the doctor and gives that to the doctor. That ensures the doctor is efficiently informed and ensures she gets what she needs out of the visit.
Virginia Lorenzi (Jun 16 2020 at 08:15):
Maybe you need LOINC code for a document section for patient questions
Lloyd McKenzie (Jun 16 2020 at 11:57):
Grahame Grieve said:
Lloyd McKenzie Task doesn't work for me at all
Can you expand?
Debi Willis (Jun 16 2020 at 12:14):
I love all the brainstorming going on! The Patient Empowerment Workgroup is also looking at ways for a patient to electronically ask for corrections to be made in their chart. We would also like to have some sort of acknowledgment to that electronic request. This would be according to patients’ rights under HIPAA. Do you think that we could use the same path that is been discussed here?
Morgan Gleason (Jun 16 2020 at 12:45):
@Grahame Grieve Thanks for working on it! I would love to work on a blog post. Why doesn’t tasks work? Also, isn’t there a resource for the plan section of the appointment visit note? Can that be used for the visit summary? I usually copy it from then Plan section.
Morgan Gleason (Jun 16 2020 at 12:46):
@Debi Willis I have also had a lot of experience with corrections! I have included them in my visit summary when I have not gotten attention from the office through my normal correction request process. I have a document for that too :)
Lloyd McKenzie (Jun 16 2020 at 12:47):
Are you willing to share that one as well?
Debi Willis (Jun 16 2020 at 13:04):
Wonderful! We would love to have you join our patient empowerment work group if you have time and are interested. We meet on Thursday is at 1 PM Eastern. We have identified four topics that we feel are important from the patient perspective: corrections, care plan, patient contributed data, and consents.
John Moehrke (Jun 16 2020 at 13:06):
I like Grahame's document. This has more of a feel of an Agenda for the appointment, and the use of Composition enables links off to the content. A well formed Composition would enable manual navigation but also automated processing. Where automated processing could make the data look integrated and related. Lots of opportunity to use the FHIR standard and do something greater upon it.
Grahame Grieve (Jun 16 2020 at 16:47):
Task:
- There was no match for any of the values for intent or status
- there was no remotely relevant code
- I didn't think the question was really the description
For those reasons, It just didn't feel like 'issues I want to discuss as part of my appointment' are right for the Task resource. Other than that, it felt like a comfortable fit, though I expect people would fight like cats and dogs over the sections and section headings
Grahame Grieve (Jun 16 2020 at 16:53):
@Debi Willis I'm not sure if this is the same document as a correction request. Generally, I find it problematic to create a single document that's subject to 2 different resolution processes, which I expect that this one is.
Lloyd McKenzie (Jun 16 2020 at 17:12):
intent would be 'order' (it's something being asked for). status would be 'requested' (no one's agreed to provide an answer yet.
No relevant code isn't a surprise. We'd have to define one.
For the question, we have a few choices - description, code.text, focus.description or task.input. My leaning is for the code to be "please answer" or "please discuss" and not to convey the question. If we had the question itself as a 'resource', then Task.focus would be the right location. However, given that isn't, I think description is fine. Though I might phase it as "To discuss: Having issues with JM rash, arm weakness, fatigue, nausea. I am concerned because I had to delay my infusions due to Covid"
Dave deBronkart (Jun 16 2020 at 18:16):
Ricky Bloomfield said:
Yes with the clarification that all data that can be read or written by HealthKit can also be viewed in the Health app - that's one of the guiding principles!
Thanks, @Ricky Bloomfield ... so is HealthKit nothing but an API to data stored in the Health app, or is it vice versa - the Health app is a viewer/editor for the data in HealthKit? Or is the database a separate thing, with two interfaces, an on-phone viewer/editor (app) and an API (Kit)?
David Hay (Jun 16 2020 at 18:29):
Just for fun, I pasted Grahames document into the Bundle Visualizer - here is the graph of resources:
Screen-Shot-2020-06-17-at-6.24.34-AM.png
(btw - there's a slight issue with the json - here's a corrected copy): document.json
Grahame Grieve (Jun 16 2020 at 18:33):
wooah - the validator doesn't pick that error up. weird
Grahame Grieve (Jun 16 2020 at 18:34):
nice visualization
Lloyd McKenzie (Jun 16 2020 at 18:49):
Tasks should also be tied to Patient
Grahame Grieve (Jun 16 2020 at 18:50):
did I forget to that do that? Well, that still doesn't resolve my general issues
David Hay (Jun 16 2020 at 19:18):
Thanks. You can also show just a part of the graph (which helps with the bigger ones like this:
Screen-Shot-2020-06-17-at-7.13.54-AM.png
and look at the text (plus associated resources):
Screen-Shot-2020-06-17-at-7.16.33-AM.png
(It's really good having example documents like this to play with)
Ricky Bloomfield (Jun 16 2020 at 19:46):
@Dave deBronkart - perhaps it's best to think of HealthKit as a system framework in iOS that consists of an API and a data store. Because of the security features of iOS, apps generally can't access the data within the "sandbox" of another app. System frameworks are designed to allow apps to interact in secure ways, and HealthKit is one example of this - apps can read/write to the HealthKit database with user consent. The Health app can be thought of as a 1st-party way to view/edit the data in the HealthKit database.
Dave deBronkart (Jun 16 2020 at 19:51):
Yeah. Okay, so you’re saying my option 3 is correct. Thanks!
Morgan Gleason (Jun 17 2020 at 00:40):
@Lloyd McKenzie Here is a sample of a record correction. I used the one from my favorite error but changed the personal details https://docs.google.com/document/d/1QDBIHmzJS7SFFUhh2T-Is6iB9QYqDFi_z1OTX9h4OtU/edit?usp=sharing
Grahame Grieve (Jun 17 2020 at 00:42):
did it get corrected?
Dave deBronkart (Jun 17 2020 at 02:26):
@Morgan Gleason that's VERY impressive. Jeeze. Have you shared this with the Unblock Health project?
And yeah, what Grahame says - did it get corrected??
It appalls me that they surely have no audit trail to figure out how the error happened, i.e. who put it in there.
Grahame Grieve (Jun 17 2020 at 04:10):
they very much have one - absolute legal obligation. Whether they can be bothered consulting it (and it is quite some work since the audit trail has everything in it..) is the open question
Virginia Lorenzi (Jun 17 2020 at 05:26):
@Debi Willis @Abigail Watson Note Morgan's correction. @Morgan Gleason we in the HL7 patient empowerment workgroup are at the beginning of a project to communication patient corrections - would you like to help? :smiley:
Dave deBronkart (Jun 17 2020 at 18:19):
Morgan Gleason said:
Lloyd McKenzie Here is a sample of a record correction. I used the one from my favorite error but changed the personal details https://docs.google.com/document/d/1QDBIHmzJS7SFFUhh2T-Is6iB9QYqDFi_z1OTX9h4OtU/edit?usp=sharing
@Bray Patrick-Lake here's @Morgan Gleason's post about her favorite of all the chart errors she's had to get corrected. (Downthread she said they told her "If it's in the EHR, you must have said it.")
Terrie Reed (Jun 18 2020 at 13:46):
I'm curious why patient's implant data continues to not show up as an important part of their health record even though it is part of USCDI
Bray Patrick-Lake (Jun 18 2020 at 14:08):
@Terrie Reed do you mean that it would be part of this schema for my health systems using Epic, for example? https://uscdi.epic.com. The majority of my devices were implanted at an AMC using Epic. I have yet to have a medical encounter where the device information has been readily available. Last month I had to put yet another cut and paste package together of my device info and tesla ratings for an imaging center so I could get an MRI. I've had to do this at least 5 times over the years. If the info is somewhere in the record it is not bubbling to the surface. The fastest way to get it is on cath lab reports, but those records just say what was implanted and doesn't have the associated product information necessary for imaging.
Dave deBronkart (Jun 18 2020 at 14:12):
@Bray Patrick-Lake I'm going to copy this over to your presentation's thread - let's continue there.
Morgan Gleason (Jun 18 2020 at 17:14):
@Virginia Lorenzi yes I would like to help. Please share the details!
Lloyd McKenzie (Jun 18 2020 at 19:44):
The Patient Empowerment's work group 'home' on Confluence is here: https://confluence.hl7.org/display/PE/Patient+Empowerment+Home. That contains information about our regular conference calls. However it's also here - on Zulip. So even if our regular call time doesn't work for you, you can read the meeting minutes on Confluence and post thoughts/feedback here.
Dave deBronkart (Jun 18 2020 at 19:45):
In fact here's the welcome message I posted here the other day with links to EVerything :slight_smile:
Dave deBronkart (Jun 25 2020 at 17:16):
On our WG call, @Debi Willis is hoping you will keep your work on this visible here!
Dave deBronkart (Jun 25 2020 at 17:17):
@Lloyd McKenzie says he's hoping this will ultimately become a formal IG (implementation guide) arising out of our WG.
Rachel Richesson (Jul 16 2020 at 17:53):
Grahame Grieve said:
I'm watching this presentation and wondering whether we should standardise something like "Patient Preparation note" (or something like that). That would help with writing an App. Also, this seems like a good workflow for a student challenge to take on (e.g. MIHIN challenge)
Morgan Gleason - thanks - that's nice work.
I could see this as an independent student project as well. I am connected with students through my university and I am sure other HL7 members could identify students looking to learn more about HL7, standards, and get some hands on experience. Does HL7 have a location to consolidate these types of projects and ideas, and facilitate getting students involved?
Last updated: Apr 12 2022 at 19:14 UTC
