RnP Wednesday, September 2

Agenda

Review feedback

Feedback via David Tao

TYPOS OR MINOR COMMENTS ON LONG SURVEY

• Last "General Question" ("In actual meaningful use experience..." question about types of documents) should contain a "don't know" option. They may know they receive summary documents for MU, but not know what their official name is, especially since the human readable document is not required to have the same name as the CCDA document type. Also, that question has a typo, "...recieving?"
• For the Detailed Questions, the legend explaining values 1-6 is at the top, and is repeated in most of the individual sections (Medications, Labs, Procedures, etc.) but not in Problems or Allergies. It should either be in all of them or in none of the individual sections.
• Under Procedures, the second multiple choice question is erroneously labeled "Relevent Procedures" but should instead be labeled "Recent Procedures" just like in the other sections
• The last question under Immunizations should say "Patient's Profession" rather than "Your Profession" shouldn't it?
• There are too many required questions that force a response even if they don't know or don't have an opinion. I suggest making most of them NOT required answers, except for:
  • Organization Demographics page
  • The first five General Questions (up to but not including the Document Types)
  • For all the individual sections, require the two "Radio Button" relevance questions, but not the text boxes
• Can "back" and "continue" buttons also be on the top of each page, not just at the bottom? It's annoying to have to scroll down to page forward
• Shouldn't this survey also have the same "context" questions that the short survey has? While there may not be a large statistical sample, those would help to interpret the responses.

SHORT SURVEY

• I sent Bob an email last week with some suggestions. The most significant is that it was too complex and took too much time, to be a "short" survey. However, if most or all of the questions were made NOT required, then someone could complete it more easily. I think people will answer what they have an opinion about, and forcing them to answer questions that they don't care about, or are not applicable, or they don't understand, will produce more "data" but it could be worse than absence of data.

Feedback via Virginia Lorenzi

Went through the survey again. Very nice. If information is omitted, should there be a caveat that says that and tells them to contact source? I have sometimes wished for "caveat/comment" fields on each data type. When it comes to results, does the type of result matter (lab, rad, micro, pft, etc) in deciding how much to send?

What about family health history or smoking or functional status?

Sometimes I feel there can be redundancy between problems, encounter diagnosis, orders, care plan components, hospital course and discharge instructions. Also between meds and immunizations although I understand why.

Provider Feedback via Brett Marquard

Review on Short and Long HL7 Clinical Document Surveys

Short Survey

General Comments: Excessive use of required entries; initially, all acronyms should be defined; Might need separate section for consults vice referral; spelling on some words in several sections needs to be corrected; appears to be very long for a “short survey”

1. Section on Patient Mix by Payer Type: Assuming VA and DoD providers are surveyed, should be selections for these categories
   -- Decided to add VA/DoD Category
2. Section on Incorporation of C-CDA TOC Document: Patient or clinical data appears to be better than the phrase “discrete data”
   -- change to disrcete clinical data
3. Section on Value for Practice(Discharge Summary/Continuity of Care): Not certain if everyone knows what ROV means(Reason for Visit) and looks similar to ROS(Review of Systems), should be allowed to skip domains, not mandatory entries;
   --Spell out acronyms when first introduced
4. Section on Value for Practice (Ambulatory Encounters): similar to # 3 above
   -- fix as for #3
5. Section on Scope of Information for Hospital Encounters: Not clear what last x days means-will x be defined?
6. Section on Scope of Information for Ambulatory Encounters: Same as 5 above
   -- fix as for #5

Long Survey

General Comments: Too much mandatory completion; some spelling errors; overall, seems more straightforward and simpler than the “short survey”

General Questions: There is no focus or specific intention, purpose, objectives on what the intent or reasoning of the questions are. Of the documents you receive, approximately what percentage are NOT helpful to you?: This question is very ambiguous-what documents-my driver’s license application, patient care documents, passport document, birth certificate, etc.? Also, received from where?

Of those documents that are not helpful, why are they not helpful? : I believe this should be a picklist and should point to specific documents

For those documents that contain too much information, what are the main sections that cause the problem? I believe this should be a picklist and should point to specific documents

Is there a minumum core of data that should ALWAYS be sent in every instance of a summary document, regardless of the patient? If so, briefly explain what that should be. I believe this should be a picklist and should point to specific documents

Usability: I believe this should be a picklist for all sections and should point to specific documents

Detailed Questions:

Problems: No apparent significant issues noted

Medications:

Allergies: This section I believe warrants more detail than one question

Vital Signs and Body Mass Index (BMI): No apparent significant issues noted

Labs: No question pertaining to critical high or low results

Immunizations: May require additional question on problem administering the vaccine-incomplete series or shot given

Procedures: No apparent significant issues noted

Care Planning: No apparent significant issues noted, however I believe nursing input is important here

Open Ended Questions: No apparent significant issues noted