Академический Документы
Профессиональный Документы
Культура Документы
2017
Overview
*
1. National Health IT perspectives on SDH
2. Interoperability as a key challenge
3. Role of vocabulary standards in SDH
4. Planning to incorporate standardized
SDH data elements in your EHR
*Thanks to Albert Taylor, MD from the ONC for this content
CMS (HHSM-500-2016-00040C)
FDA
bioMrieux
NCATS (3UL1TR001108-04S1)
NIDDK (HHSN275201600752P)
NLM (HHSN276201400239P)
LOINC User Community
University of Wisconsin Population Health Institute. County Health Rankings & Roadmaps 2017. www.countyhealthrankings.org. Used with permission.
SDH Matter
Independent variable of health outcomes
Housing insecurity linked to lead poisoning, respiratory conditions
Food insecurity linked to hypertension, hyperlipidemia, overall poor
physical and mental health
Unemployment linked to overall poor health, heart disease or stroke
Bachrach D, Pfizer H, Wallis K, et al. Addressing Patients Social Needs: An emerging business case for provider investment. The CommonWealth Fund, The Skill
Foundation, and the Pershing Square Foundation. May 2014. Available online.
Why in EHRs?
Inform care decision-making
Health history
Patient-generated
EHR
Genetics
Basic science
photo via Heather | cc-by-sa
The 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. photo via nosha | cc-by-sa
Reality:
patients move faster and further
than their health information
MO MONEY MO PROBLEMS
data
It's like, the more money
we come across
The more problems we see
MO DATA MO PROBLEMS
Problems
Health IT systems often lack
common mechanisms for MO DATA MO PROBLEMS
exchanging data.
Semantic Standards
Vocabulary/code systems
LOINC, SNOMED CT, RxNorm, CPT, ICD
No single vocabulary
standard covers it all
Screening and measurement: LOINC
Diagnosis (assessment): ICD, SNOMED CT
Interventions: SNOMED CT
Medications: RxNorm
Reimbursement: CPT
Similar name, different meaning
Est. 1994
LOINC is a rich trove of 84,000+ standardized variables
Genetics Lifestyle
75547-0 Noninvasive prenatal fetal aneuploidy 75296-4 Carbohydrate intake 24 hour Estimated
and microdeletion panel based on Plasma cell- 82289-0 Rating of perceived exertion [Score]
free+WBC DNA by Dosage of chromosome-specific
circulating cell free (ccf) DNA 72166-2 Tobacco smoking status NHIS
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.
Social, psychological and behavioral howRU
observations - 2015 Edition Health IT Living with HIV (LIV-HIV)
Certification Criteria set
Morse Fall Scale
Adverse Childhood Events
My Mood Monitor
Borderline Symptom List - 23 Item
Neuro-QOL
Brief Interview for Mental Status (BIMS)
PROMIS (e.g. Social Isolation item bank)
Confusion Assessment Method (CAM)
PhenX (eg. Social Environments domain)
Core behavioral health terms (SAMHSA)
PHQ
Edinburgh Postnatal Depression Scale
VR 12 and 36
FACIT
Geriatric Depression Scale (GDS)
Humiliation, Afraid, Rape, and Kick
questionnaire
HIV Signs and Symptoms Checklist
CE (coded element)
means the answer
Observation Identifier:
will be coded this is a overall financial resource strain question
63503-7 Are you now married, widowed, divorced, separated, never married
or living with a partner?
76508-1 In a typical week, how many times do you talk on the telephone
with family, friends, or neighbors? {#}/wk
76509-9 How often do you get together with friends or relatives? /wk
Pantell M et al. Social isolation: a predictor of mortality comparable to traditional clinical risk factors. Am J Public Health. 2013 Nov;103(11):2056-62. Epub 2013 Sep
12. PubMed PMID: 24028260.
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If
Then