Tuesday, December 13, 2011

Standards for Social History

As we all think about the increasing needs of telemedicine and home care to support healthcare reform efforts, I was asked about integrating home monitoring devices into EHR social history data.

To my knowledge, standards for structured social history are still a work in process, but Microsoft has worked hard to standardize exercise data from home equipment as part of their Healthvault device integration effort.

Here's an overview from Sean Nolan:

"We didn't start from any existing standard for exercise data, because none really were forthcoming --- but we did work with the folks at Polar and other fitness-related companies to establish our current representation within HealthVault. The XML schema for our exercise items is documented here.

It consists of two required fields:

* time started
* activity mode (optionally coded against a custom vocabulary)

This follows our practice of trying to keep required fields to a minimum --- so "jogged on 1/1/2011" is a reasonable item

and optional fields:

* distance
* duration in minutes
* name/value attributes (e.g., "average heart rate", etc.)
* segments which each can hold their own distance/duration/attributes (represent splits - there may be one for each leg of a race)

It's amazing how detailed some of the fitness machines get, but this approach seems to be the right balance."

Thanks Sean.    Monitoring diet, exercise, and other observations of daily living are going to be increasing important in a world that reimburses clinicians for wellness rather than procedures and episodic visits.    I suspect observations of daily living standards will be part of the Meaningful Use Stage 3 effort, so is very useful to understand any work in progress.

1 comment:

Anonymous said...

I have to admit, I am woefully uninformed about some of the changes that are headed our way, and I am terrified about the ones I do know about.
But do I understand that my physician will be paid on whether I get my tush off the couch and exercise? That I am going to have to report how many Reece’s Pieces I eat vs how many lima beans? (My poor doc will be very poor, as that last ratio will be about 120 million to zero).