Interview | Health Story Project: The Rest of the Story
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| Bob Dolin, MD, Chair of HL7 International, President and CMO, Lantana Consulting Group |
The project, called the HL7/IHE Health Story Implementation Guide Consolidation Project, aims to bring exchange standards for eight types of clinical documents, along with the HL7 Continuity of Care Document (CCD) standard, into one implementation package. CMIO recently spoke with Bob Dolin, MD, chair of Health Level 7 International and president and chief medical officer of Lantana Consulting Group, about the project.
Q: Why is the Health Story Project important?
Dolin: As part of the meaningful use of electronic health records, there’s a need to capture discrete data elements. There are two ways you can go after discrete data elements: One is you can say to the clinician, “I know you already have your own workflow, but can you also go ahead and capture these 20 data elements?” That can be disruptive. We believe a more efficient strategy is to embrace and build upon existing clinician workflow.Frontline clinicians today need to have clinical documents; they need to have the rich narrative. It’s embedded in our workflow. … [If] we establish this bedrock of clinical documents using the Health Story strategy, we can continue to embrace existing clinician workflow by simply adding in a couple of discrete data elements into these otherwise narrative documents. The elements that we add in today are based on the priorities in meaningful use Stage 1. Next year, there will be new priorities as part of meaningful use Stage 2.
Q: In an EMR, is this an effort to recognize natural language and abstract, or natural data?
Dolin: I’ve debated that with the Health Story group quite a bit. … We want to get toward this notion of meaningful use, which is what a lot of people think of as discrete data elements. I believe a way to get there is to build upon a foundation of narrative clinical documents where you over time, put in discrete data elements.What we’re finding is that in these narrative documents there are many techniques, some we know, some we’re just beginning to learn about, for pulling discrete data elements from these notes. NLP [natural language processing] is an emerging technology: Everyone saw Watson on “Jeopardy”, so now NLP is the new hot thing.
NLP is clearly a promising technology for extracting discrete elements out of narrative documents. Will it be a panacea, will it be the only way? I think it will be one of the ways. In some cases, [maybe] you’re creating a document that’s going to a particular registry [that has] a need for 25 fields. And you can’t simply rely on a dictated note where you expect an NLP engine to pull out that data, because I may not have stated that data to begin with.
Q: Does this effort include other kinds of data, such as diagnostic images?
Dolin: When we talk about sending narrative docs back and forth, we could talk about sending PDFs, or Word documents back and forth. What I’m talking about is sending documents back and forth that are structured based on the HL7 CDA [Clinical Document Architecture] standard; it’s an XML format for representing clinical documents. So I send you a history and physical document, but it’s an XML CDA format or I send you an operative report, it’s an XML CDA format.CDA provides a formalism whereby I can send you a narrative document today, but I can start to layer in discrete documents over time. CDA is a multimedia document representation formalism. So in a CDA document, just like with an HTML document, we can support drawings that the clinicians makes in the office, we can support multimedia.
We also have a CDA document for diagnostic imaging that we developed in collaboration with DICOM. So the ability to support multimedia was one of the early-on requirements that’s been built into the CDA document standard.