Reconciling disparate information in continuity of care documents: Piloting a system to consolidate structured clinical documents

BACKGROUND Due to the nature of information generation in health care, clinical documents contain duplicate and sometimes conflicting information. Recent implementation of Health Information Exchange (HIE) mechanisms in which clinical summary documents are exchanged among disparate health care organizations can proliferate duplicate and conflicting information. MATERIALS AND METHODS To reduce information overload, a system to automatically consolidate information across multiple clinical summary documents was developed for an HIE network. The system receives any number of Continuity of Care Documents (CCDs) and outputs a single, consolidated record. To test the system, a randomly sampled corpus of 522 CCDs representing 50 unique patients was extracted from a large HIE network. The automated methods were compared to manual consolidation of information for three key sections of the CCD: problems, allergies, and medications. RESULTS Manual consolidation of 11,631 entries was completed in approximately 150h. The same data were automatically consolidated in 3.3min. The system successfully consolidated 99.1% of problems, 87.0% of allergies, and 91.7% of medications. Almost all of the inaccuracies were caused by issues involving the use of standardized terminologies within the documents to represent individual information entries. CONCLUSION This study represents a novel, tested tool for de-duplication and consolidation of CDA documents, which is a major step toward improving information access and the interoperability among information systems. While more work is necessary, automated systems like the one evaluated in this study will be necessary to meet the informatics needs of providers and health systems in the future.

[1]  Shaun J Grannis,et al.  The Indiana network for patient care: an integrated clinical information system informed by over thirty years of experience. , 2004, Journal of public health management and practice : JPHMP.

[2]  Mor Peleg,et al.  Analysis of the process of representing clinical statements for decision-support applications: a comparison of openEHR archetypes and HL7 virtual medical record , 2016, Journal of Medical Systems.

[3]  Julia Adler-Milstein,et al.  A Survey of Health Information Exchange Organizations in the United States: Implications for Meaningful Use , 2011, Annals of Internal Medicine.

[4]  Qingxia Chen,et al.  User perspectives on the usability of a regional health information exchange , 2011, J. Am. Medical Informatics Assoc..

[5]  Hhs Centers for Medicare Medicare Services.  Medicare and Medicaid programs; electronic health record incentive program. Final rule. , 2010, Federal register.

[6]  Kim M. Unertl,et al.  The financial impact of health information exchange on emergency department care , 2011, J. Am. Medical Informatics Assoc..

[7]  Georg Duftschmid,et al.  HL7 Template Model and EN/ISO 13606 Archetype Object Model - A Comparison , 2009, MIE.

[8]  D P Lorence.  AHIMA (American Health Information Management Association) census results: focus on compliance. , 1999, Journal of AHIMA.

[9]  D. Brailer.  Interoperability: the key to the future health care system. , 2005, Health affairs.

[10]  Richard J. Holden,et al.  Human Factors Engineering and Human–Computer Interaction: Supporting User Performance and Experience , 2016 .

[11]  Eric C. Pan,et al.  The Department of Veterans Affairs' (VA) implementation of the Virtual Lifetime Electronic Record (VLER): Findings and lessons learned from Health Information Exchange at 12 sites , 2014, Int. J. Medical Informatics.

[12]  Stéphanie Mathey,et al.  Subjective Lexical Characteristics: Comparing Ratings of Members of the Target Population and Doctors for Words Stemming from a Medical Context , 2016, Language and speech.

[13]  Maryam Ahmadi,et al.  A Service Oriented Architecture Approach to Achieve Interoperability between Immunization Information Systems in Iran , 2014, AMIA.

[14]  J. Marc Overhage,et al.  Building a Production-Ready Infrastructure to Enhance Medication Management: Early Lessons from the Nationwide Health Information Network , 2009, AMIA.

[15]  Rainu Kaushal,et al.  The United Hospital Fund meeting on evaluating health information exchange , 2007, J. Biomed. Informatics.

[16]  J. Overhage,et al.  Continuity of Care Document (CCD) Enables Delivery of Medication Histories to the Primary Care Clinician. , 2010, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[17]  G. G. Stokes.  "J." , 1890, The New Yale Book of Quotations.

[18]  C. Schoen,et al.  A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. , 2012, Health affairs.

[19]  John Morrissey,et al.  Health information exchange. , 2011, Hospitals & health networks.

[20]  Daniel J. Vreeman,et al.  The long road to semantic interoperability in support of public health: Experiences from two states , 2014, J. Biomed. Informatics.

[21]  Fiona M. Callaghan,et al.  Use of internist's free time by ambulatory care Electronic Medical Record systems. , 2014, JAMA internal medicine.

[22]  Raj M. Ratwani,et al.  Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors , 2015, J. Am. Medical Informatics Assoc..

[23]  Jeyakumar Natarajan,et al.  Stacked ensemble combined with fuzzy matching for biomedical named entity recognition of diseases , 2016, J. Biomed. Informatics.

[24]  Rajeev Motwani,et al.  Robust and efficient fuzzy match for online data cleaning , 2003, SIGMOD '03.

[25]  Joshua R. Vest,et al.  Health information exchange: persistent challenges and new strategies , 2010, J. Am. Medical Informatics Assoc..

[26]  Gunther Schadow,et al.  Enabling Joint Commission Medication Reconciliation Objectives with the HL7 / ASTM Continuity of Care Document Standard , 2007, AMIA.

[27]  Dean F. Sittig,et al.  How the continuity of care document can advance medical research and public health. , 2012, American journal of public health.

[28]  Cassi L Birnbaum,et al.  HIM principles in health information exchange. , 2007, Journal of AHIMA.

[29]  Xu Chen,et al.  Using a generalised identity reference model with archetypes to support interoperability of demographics information in electronic health record systems , 2015, 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[30]  Jennifer Smith,et al.  Assessment of the usability and impact of the Idaho Health Data Exchange (IHDE) , 2016, Journal of Medical Systems.

[31]  Gilad J. Kuperman,et al.  Health-information exchange: why are we doing it, and what are we doing? , 2011, J. Am. Medical Informatics Assoc..

[32]  Brian E. Dixon,et al.  Standardizing Health-Care Data Across an Enterprise , 2016 .

[33]  2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Final rule. , 2015, Federal register.

[34]  Gilad J. Kuperman,et al.  Application of information technology: Developing data content specifications for the Nationwide Health Information Network Trial Implementations , 2010, J. Am. Medical Informatics Assoc..

[35]  Yiming Yang,et al.  An example-based mapping method for text categorization and retrieval , 1994, TOIS.

[36]  J. Marc Overhage,et al.  Case Study 1 – The Indiana Health Information Exchange , 2016 .

[37]  Brian E. Dixon,et al.  Consolidating CCDs from multiple data sources: a modular approach , 2016, J. Am. Medical Informatics Assoc..