CIMI Patient Care Projects Update Skin and Wound

CIMI Patient Care Projects Update Skin and Wound Assessment, Vital Signs, and Pain Assessment Susan Matney, Ph. D, RNC-OB, FAAN, FACMI, FHIMSS CIMI Vocab Facilitator

The Interoperable App Development Process Domain Analysis Project Needs Pediatric Growth Chart Neonatal Bilirubin OPA Data Collection PE Risk Assessment MQIP Registries Comm Acq Pneumonia Etc. Create Logical Models (CIMI) Approve Models Model Repository Terminology Server (+Solor Content) Conformance Testing Create FHIR Profiles Create Software (Apps, CDS) Artifact Repository (FHIR profiles) 2

Skin and Wound Assessment

Background • KP-VA Collaborative in 2010 defined an information model • 2013 ONC mandated the model and terminology for a Mobilizing Data for Pressure Ulcer Challenge Grant • 2014 HL 7 leveraged the model in the Skin Risk Assessment Domain Analysis Model • 2016 pressure injury criteria updated by National Pressure Ulcer Advisory Panel (NPUAP) • 2016 Project Approved for CIMI pilot project under Patient Care • 2017 HSPC collaborative project • VA nursing subject matter experts

Project Use Case and Scope Initiated by: Nursing Knowledge Big Data Initiative Use Case • Wound care is a clinical domain of high interest • The National Quality Forum endorsed pressure ulcers as a nursing sensitive outcome measure • CMS views hospital acquired pressure ulcers as a preventable hospital acquired condition • Current wound care e. Measures being developed Scope • To develop a skin and wound assessment model and FHIR profiles. Implementers • HL 7 Podiatry Group, Tissue Analytics, Intermountain Healthcare

Data requirements Element Display Name LOINC Code SNOMED CT CID Condition Question Wound Identifier Wound present on admission 81666 -0 89251 -3 8621000205100 8631000205103 Panel Question Wound Size Panel Width Length Depth 72287 -6 39125 -0 39127 -6 39126 -8 401239006 401238003 425094009 Question Wound Volume Requested Panel Site 72369 -2 Question Wound Anatomic Location Modifier 39111 -0 39112 -8 1371000124108 8771000205106 Question Anatomic Location Laterality 20228 -3 272741003 1

LOINC Wound Assessment Panel (39135 -9 )

Wound Assertion Clinical Element Model

Progress • Terminology creation complete for v 1 • Added additional body locations for podiatry • • Clinical Element Model Complete FHIR Profiles FHIR R 4 first draft Complete FHIR profiles tested at a connectathon (Done in Montreal) Implementation Guide (IG) R 4 complete Collaborate with implementers FHIR enable their applications Pilot test HL 7 ballot in Sept 2020 https: //confluence. hl 7. org/display/CIC/Skin+and+Wound+PSS

FHIR Implementation Guide http: //build. fhir. org/ig/HL 7/cimi-wound-assessment/branches/master/index. html

Discussion • HL 7 projects HAVE to be U. S. Realm because they contain SNOMED CT codes (FMG Rule) • • Body Location – discussed new resource with O&O to include landmarks • New LOINC codes for Wound Volume and Wound Shape Proprietary instruments cannot be standardized (not open source) Wound Gradation – different grading and staging scales • • National Pressure Injury – stages (in LOINC) Wagner – 5 grades - – diabetic foot ulcers University of Texas – four grades, four stages – diabetic foot ulcers …. and more Synchronization of profiles • Wound Assessment profile was profiled by podiatrists

Vital Signs

Objective To create the terminology content, logical models, FHIR profiles and implementation guides for all of vital signs including all qualifying observations (patient position, body location, device, method, etc. ) and coded value sets, building on the FHIR Vital Signs profile currently in place.

Project Use Case and Scope Initiated by: Intermountain and the Federal Health Information Model Use Case • Vital signs are collected on nearly every patient encounter. • Oftentimes, the clinician needs to know the patient position, device, body location or method the measures were taken. Scope • Extend current FHIR profile to include all qualifying observations with associated coded value sets. Implementers • Intermountain Healthcare. Pen. Rad, University of Utah, AMA

Progress • • • Terminology creation complete Clinical Element Model Complete FHIR Profiles Complete FHIR profiles tested at a connectathon Convert to FHIR R 4 FHIR and expand body locations (in progress, target 9/30). Updated the Implementation Guide (IG) Collaborate with implementers FHIR enable their applications Connectathon HL 7 ballot in Sept. 2020 or January 2021 https: //confluence. hl 7. org/display/CIC/Skin+and+Wound+PSS

Associated Precondition • Values used to record previously existing conditions or states that could affect a measurement or assessment. For example; a patient's heart rate taken during or after a procedure, heart rhythm taken after an apneic episode. These temporal period concepts can be used as allowed qualifiers to postcoordinated/precoordinated vital signs concepts. • Guidance – Needs link to Precondition • SCT Range – Children of 307142001 |Temporal periods (qualifier value)| • Examples: • • • • During surgery During anesthesia Before anesthesia After anesthesia Pre-dose Post-dose Pre-admission Before procedure During procedure Postprocedural period Postpartum Antepartum During Condition

Vitals IG http: //build. fhir. org/ig/HL 7/cimi-vital-signs/

Pain Assessment

Project Use Case and Scope Initiated by: Nursing Knowledge Big Data Initiative Use Case • Pain is the most common symptom documented in healthcare. • Many questions about the pain (qualifying observations) are also recorded (quality, exacerbating factors, body location etc. ) knowledge about pain. Scope • Standardized pain assessment including the assertion of pain and all possible qualifying elements. Implementers • New York Presbyterian, Epic, University of Utah, Pen. Rad

Data requirements

LOINC Pain Assessment Panel (38212 -7)

Pain Assessment Instruments • FLACC • Baker-Wong Faces • QA FHIR profiles within CIMI (Target 3/31/2020) • Collaborate with implementers • Connectathon • HL 7 ballot in Sept 2020 or Jan. 2021

Progress and Status • Terminology • SNOMED CT curated • • • Develop Clinical Element Models complete Develop the FHIR profiles (Target 2/28/2020) QA FHIR profiles within CIMI (Target 3/31/2020) Collaborate with implementers Connectathon HL 7 ballot in Sept 2020 or Jan. 2021 https: //confluence. hl 7. org/display/CIC/Pain+Assessment+PSS

Discussion • Alleviating and Exacerbating Factors • Molecular and atomic values requested • Lack of access to pain SMEs • Need definitions! (For both questions AND answers)

Questions

QUESTIONS?

CONTACT SUSAN AT SUSAN. MATNEY@imail. org