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