In our mission to create the best places to give and receive care we have long held the vision of an integrated healthcare system in which includes sharing patient information of the highest accuracy and integrity to those that give and receive care.  This calls for new ways of thinking about how clinical documentation is intentionally designed and tagged to support professional processes of care and standardized taxonomies and quality measures.

The Elsevier Clinical Practice Model (CPM) Resource Center submitted written comments on September 23, 2011 on the advanced notice of proposed rulemaking (ANPRM) entitled, “Metadata Standards to Support Nationwide Electronic Health Information Exchange” posted in the Federal Register on August 9, 2011.

Building off of CPM’s comments on the President’s Council of Advisors on Science and Technology (PCAST) Report submitted on January 19, 2011, we believe there is a need to “think differently” about a universal exchange language in order to expedite the exchange of meaningful patient information both between professionals and between healthcare settings.

CPM’s interest in the PCAST Report and the Office of the National Coordinator for Health Information Technology’s (ONC’s) subsequent work to develop metadata standards stems from our work as the only provider of evidence-based clinical content solutions and services that are built on a proven professional practice framework.  Elsevier CPM Resource Center works with a growing healthcare consortium to develop standardized tools and resources to minimize duplication and repetition and to prevent potential medical problems for patients.  The CPM Framework™ consists of six clinical practice models that can be applied across the continuum of care.  These practice models are:  (1) Health and Healing Model; (2) Applied Evidence-Based Practice Model (with evidence-based guidelines for chronic care); (3) Health Informatics Model (with integrated care processes and documentation); (4) Partnership Culture Model; (5) Interdisciplinary Integration Model; and (6) International Consortium Model.

CPM has unique experience with an updated and unified relational database that stores tagged data elements for comprehensive care planning/coordination and documentation of clinical services by a diverse interdisciplinary team.  This database can be used in virtually any health information technology system.  The result is standardized clinical documentation support that is evidence-based and designed to capture individual details at the patient level.  The content of the database is available in XML, and each data element is tagged to allow integration into a facility’s EHR.  In addition, each tagged data element supports practice and content interoperability by supporting common terminology and language for comprehensive patient information exchange.  Today, nearly three hundred healthcare settings use the CPM Framework™ embedded within their health information technology systems with proven results of increased care coordination, reduced medical complications and decreased costs. 

Elsevier CPM Resource Center also urged ONC to consider using metadata to tag evidence-based clinical content and the National Quality Forum (NQF) e-quality measures related to specified diagnostic conditions to achieve performance-related standards.  We also advocated for the inclusion of NQF’s ten care coordination performance measures (2010) and the nurse sensitive outcomes as delineated by the American Nurses Association (ANA) on pressure ulcers as key performance indicators.

We hope to see some of our hundreds of consortium sites engaged in future piloting of metadata standards and patient information exchange because of the robust and standardized CPM content.  Together we can demonstrate how the PCAST vision can be realized and play a significant role in expediting what could be a long and lengthy process.  In so many ways we are living the future today and we hope to serve in creating paths to the future of healthcare tomorrow. 

Cheers!

Michelle