Happy New Year to everyone! I’m on my back to work tasks!
We’re revisiting the document indexing that we are using in Health Connect South. This is based on the NHS Clinical Document Indexing Standards & HISO, so we’re trying to associate the right metadata with the document, standardised presentation in the portal document tree, etc.
Has anyone got any standards documentation that could be shared? Or point me in the direction of where to look.
We really could do with a national standard for how to do this, eh?
I’m talking an operational standard that is vendor agnostic - so we are all doing this the same way. Or at least working towards it.
If we get this right it would make sharing clinical documents across the NZ health system (not just within Te Whatu Ora) oh so much easier!!! And it might be easier to initiate this at the grass roots rather than from centrally.
I would love a national standard that would be shared with all vendors and organisations! I’m working with Orion clinical portal in mind at the moment, and hoping it will be applicable to a wider base!
I had a look through the Standards section and couldn’t see anything that would help me, but happy to ask in there too and see if anyone else feels my pain!
Take a look here…
Not sure of the current status of this. I suggest asking @alastairk on the standards forum.
PJ
This is an excellent start - but what’s needed is agreement on the document classifications - ie the ‘type’ of document. I believe that Orion was working on this a few years back with one or more of the DHBs. Not sure where that work got to…
cheers…
Totally agree that we need a nationally agreed and standardised information (‘documentation’) type index set.
We’ve been working on one as a foundational enabler for Hira. We consulted nationally and have an endorsed version from the Hira Clinical Advisory Group and are certainly looking at progressing it onto HISO for further development/consultation as a standard.
It’s aligned across the SI version/and several NI versions.
I’ve moved the Topic here to Standards
Very happy to pick this up @debbie.beesley
As well as the input work @BeckyGeorge has underway, I learnt at DHWNZ that there’s interest on the industry side too - the plan was to meet early in the new year so let me keep you in touch with that
My view is that with too much focus on documents we may perpetuate the problems we have at the moment with documents in our CDRs eg. lots of documents of varying quality where key information is hard to find, and that we are “digitising paper”. We are doing some work on building some tools that will allow us to automatically codify content in documents (NLP stuff but it is early days - negation is a particular issue).
Something I posted before Xmas was about duplication in EHRs which is a growing issue, there was also a conversation on this forum about the proliferation of forms. I have had a few conversations around the motu about hospitals using the same tools for different uses which further muddies the waters.
We are also doing some work as a system to move to FHIR which defines a number of these types of things loosely and very technically, so there is a need to understand that.
Having had a chat with @robyn.whittaker we were both thinking there needs to be some work on “what tools clinicians need” - which could then be broken down and matched to more detailed standards and linked to FHIR. This could then be used to understand who has what and understand what good tools look like. Might be a good thing for this new council to get its teeth into.
Anyway my starter list on this is (somewhat aligned to FHIR):
Preconditions/enablers - search, accurate dictation, codification of free text, user driven form creation (and public sharing of these), user interface design to help navigate understand and collect the right data. One last thing I think there is probably a difference between capture and consumption we need to think about.
Sorry for the long post, I have been thinking about this for a little while.
Hi @jon_herries , from a design perspective, I have a slightly different take. When I worked in a resource-constrained, intensive role, one of my few friends was the PMS, so I needed to get smart about how I used it.
The construct was that all data was stored in atomic formats. It might be entered via a “form”, which is just a collection of data entry fields on a page, so the tired and burned out did not mess up. The labour is on the way in (cue complaining), and skipping data fields was a (capital) crime.
The gain is on the way out. All outputs were reworked to be a collection of atomic data fields in a template plus one line to ask the key question. A referral letter was completed in under a minute because the printer took 20-30 seconds. The administration and organisation of care are all automated as much as possible, triggered by the atomic data fields. The mantra was I should only be doing those things that only I should do. If the computer can do it, no one should be doing it.
The overall belief was that if you wanted a better airline, optimising the paddle steamer was never the solution, so don’t do it. Health EMR needs a new paradigm from this century, not a better version of last century’s paradigm.
I am sure I could have gotten it faster with voice dictation software. I have seen some impressive demos, but unfortunately, I am useless at dictation.
Yeah - I thought taking that position out of the gate might have been a bit too extreme for many clinicians - although probably not this audience and tempered my comments based on this: topic - The big idea: what’s the secret of innovation? - Emerging Tech - eHealth Forum (hinz.org.nz) )
But I agree with you wholeheartedly - that was where I was heading with my references to the “digital paper” and the overlap between the free text and forms (Discharge Summary’s being a classic example).
Jon
Thanks, and to be fair, I tempered my comments as well. The equal reality is the secondary care EHR discussion has gone nowhere, despite some valiant individual efforts, in the last 20 years. When are we going to stop being unfair to clinicians and patients? They deserve better than death by a 1000 platitudes.
Good point @Greig.
I well remember the hours, days and weeks spent when NICLG developed a standardised hospital discharge summary (from memory Paeds and Ts and As were not included by request). It was developed by a range of clinical and consumer stakeholders from across the health sector and would connect with PMSs like GP2 GP rather than a pdf doc. It was never adopted.
Is this the same category David as when I go into 3M Viewer perhaps? The user sorts documents by type, except you need to know what it’s called! This is my experience @ Auckland and following scanning.
Not sure you have the right person 
Sorry David. I just wanted to clarify your post on classification of documents.
Ah - that post :). I was just wanting to indicate that a nationally agreed set of document classifications (aka document type) would be a good thing…
We have a lot of staff comming & going. Why not use an international standard?
LOINC Document Ontology
LOINC is certainly what we’ve used for document type in HISO 10040.4 Clinical Document Metadata Standard but most probably we will extend this to a SNOMED CT refset based on ‘record artifact’ in the new iteration