CIA Principle 5: Documentation Patterns
“Documentation will be constructed from standardized building blocks or “patterns” that are interactive and support decision-making.”
A “pattern” is a collection of clinical content and system functionality that supports a specific care activity that is part of an overall assessment (e.g. vital signs, Glasgow Coma Scale assessment). Patterns are reused across the region. Patterns will be used as building blocks.
Pattern development, including the creation of resulting detailed data models and data definitions will be tightly controlled by the CARB. Patterns will be approved by EHR SC. The design will consider current documentation standards, redesigned care processes, and advanced EHR functionality, such as CDSS. Patterns will be applied to all regional systems in VIHA. Patterns will be shared.
There will be several versions of some patterns to support variable needs of providers across the region. They will have varying levels of detail, depending on clinical need (e.g. Vital Signs may have 4-5 patterns, depending on details required, context, and user). Amount of structure in patterns will vary.
The collection of patterns and their various versions will constitute VIHA’s “Pattern Collection”. Specific clinical electronic tools (e.g. electronic documentation) can be built up through the selection of patterns that best fit the best practices for specific programs. There will be a recommended order for patterns, such as SOAP.
Not adopting a pattern approach will result in increase work as common assessments are repeatedly rebuilt across the region. Continuity of care, user training, and health planning would all be affected if data is not consistently captured and stored.
Commentary:
I have written about this concept before here and here.
For VIHA, the concept of patterns is very focused — this principle describes a new way for VIHA IM/IT to consider how to develop electronic documentation, not other aspects of their clinical information systems. Instead of building unique (or similar) forms for each particular need, forms can be thought of a collection of building blocks (called patterns). Patterns could be Vital Signs, ADLs, etc etc. Once they are designed, they can be reused throughout the organization and perhaps shared more broadly. This is not that dissimilar to the openEHR design, especially if you notice on the diagram where there are also models that relate the various data elements.
This structure and reuse should (a) make the data more consistent and (b) speed form design one the patterns are developed. The patterns are meant to be designed independently of a particular system, so they can be replicated in the various CISs in VIHA.
The tricky part for VIHA is to find the natural joints or break points in clinical content so that reuse is maximized. If too many unique patterns are developed, then the work to maintain these external to any system is negated.
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