The HIE Standard

Team Members


Name
Email
Phone Number
Neil Vijapura
nv11b

Alexandra Aron
ama09g

Troy Capasso
tmc10c

Joey Barrentine
jwb11f

Marc McCarthy
mcm13n

Michael Scheer
mts11

Adam Remillard
acr10

We will communicate through the GroupMe messaging app. (Removed due to group chat inception)

Project Overview


Our team wants to address the idea of standardization of health information exchange in an effort to maximize efficiency, reduce clutter, and eventually decrease the negative stigma related to sharing patient information. This will be accomplished through the integration of features into existing EMR programs in order for them to communicate with each other.

Team Meeting Notes


Meeting time: 7:00pm every Monday unless other arrangements are discussed

September 9, 2013

File of meeting transcript and project plan can be found here:


September 16, 2013

Our second meeting focused on our first assignment. We established the following problem statement to direct our research:
"In today’s healthcare system, there is a conflicting anomaly regarding patient information access. There is not only an abundance of information available, but also inconsistencies in how that information is stored and retrieved. As people continue to relay their healthcare information, tracking that data is becoming increasingly difficult for healthcare professionals.
People are inherently cautious about giving out their personal information, and this is definitely the case in healthcare. Additionally, health care providers are experiencing an information overload due to the increased use of technological systems. Electronic medical records, while helpful in recording patient information, cause problems for the provider when it comes to consistency and communication between systems. Healthcare providers are also hesitant to standardize health information exchange systems because these systems are not always affordable or efficient and they also require additional training that increase time and costs. The inconsistencies of these records stem from a lack of standardization."

September 23, 2013

In this meeting, we finalized our second assignment and made plans to format it on Wednesday, September 25. Once it is properly formatted, we will upload it here!
A working draft of data gathered by the team members can be found Here. This document was established after the Sept 16th meeting in order for everyone to collaborate on gathered information. This is where data will be pulled from for the two page assignment.
Our final document turned in for the "Two page outline" can be found below. This data will be used to populate information for our wiki.

September 30, 2013

No meeting due to group member obligations.

October 7, 2013

Individuals continued to work on research on their own time. No meeting due to midterm

October 14, 2013

Discussed research briefly and discussed the midterm and how it details of it dovetails our project.

October 21, 2013

No meeting due to group member obligations.

October 28, 2013

Discussed mock-up UI for the standardized system and possibility of a database design. Questions Mr. Randeree were gathered for Tuesday.

November 4, 2013

Plan and implement the visuals and database design for the mock-up due this week.
20131104_191152.jpg

November 21, 2013

Final review of the wiki page. We also distributed the roles for the presentation

Project Due Dates


9/12/2013 R - Project topic due, Outline 2 page paper
9/26/2013 R - 2 page paper due
11/07/2013 R- Project Prototype Due
11/21/2013 R - Project Due

Problem Statement



People are inhUntitled.pngerently cautious about giving out their personal information, and this is definitely the case in healthcare. Additionally, health care providers are experiencing an information overload due to the increased use of technological systems. Electronic medical records, while helpful in recording patient information, cause problems for the provider when it comes to consistency and communication between systems. Healthcare providers are also hesitant to standardize health information exchange systems because these systems are not always affordable or efficient and they also require additional training that increase time and costs. The inconsistencies of these records stem from a lack of standardization.
In today’s healthcare system, there is a conflicting anomaly regarding patient information access. There is not only an abundance of information available, but also inconsistencies in how that information is stored and retrieved. As people continue to relay their healthcare information, tracking that data is becoming increasingly difficult for healthcare professionals.

Research to Support the Problem


This area is to include the Problem Statement above.
Several characteristics of HIE’s that exist may lead to the rejection of HIE if they are attempted to be implemented. These characteristics include:


  1. Data Fragmentation (incomplete, inaccurate or untimely data) may impact clinician decisions and compromise patient outcomes
  2. Poor data presentation may overload the clinician and result in frustration and rejection
  3. Fear of the HIE and the uncertainty of using it questioning its overall value
  4. Lack of patient concerns for proper security with their data in HIE’s
  5. Lack of reputation with the provider creating/maintaining the HIE
  6. Overall vulnerability to technical problems (management of a complex system)
  7. Difficulty in retaining an adequately trained workforce
There are other reasons why HIE’s have failed to take off as well. Community health information networks have limited scope of businesses to communicate with, many of whom are in competition with one another that would object to sharing information to a competitor. Based on Table 1, there are different information systems which can be frustrating for data manipulation and export/import options. There is also a low return of investment, making it difficult to justify an expensive startup cost for a new system.A Regional health information organizations uses a 3rd party organization but they still face high costs, competition, and most importantly liability over privacy and legal consequence of holding valuable data.
One quantitative measure of how to determine if a HIE is successful is the average number of queries to the HIE. As it becomes used by more providers in an area this number should increase as more people use it; if this is not the case there are underlying issues that must be addressed.
One issue touched on earlier was patient concern about their data. Patients are concerned that their data may be incorrect and they will not be able to change it. In addition inappropriate access to the data is a large concern to concentrate on. Patients are also concerned about providers being biased by prior opinions and conditions and won’t make an independent judgment based on their own findings.

Potential Solutions and Feasibility of Each

One possible solution discussed is the introduction of a simple export feature to existing EMR technology. This export will use the same file format across all formats in order to facilitate data sharing between EMR systems. The data exported will be a gradual increase starting with basic data and through federal mandates increasing the requirements to include other data like lab work and medical imaging.
A solution that may be wrapped together with another one would include a certain level on transparency with how the HIE will operate. This will include: “meaningful consent” included in Notices of Privacy Practices, patient involvement in the HIE implementation process, processes that facilitate the correction of patient records, and tools to help providers explain to their patients the opportunities that a HIE has to offer. In addition, a level of control in who can access an individual on an HIE will be necessary in order to calm a lot of issues with privacy.
There have been 7 largely popular Health Information exchanges in the US, with the largest and most effective being the Indiana HIE that connects 90 hospitals, long-term care facilities, rehabilitation centers, community health clinics, and other healthcare providers throughout the state of Indiana. It covers over 6 million people with 25,000 physicians and 90% of care provided in hospitals in the Indianapolis area. With an emphasis on security and privacy, they have created file formats, such as DOCS4DOCS, which is a single source electronic results service that can send a variety of medical information including lab reports to discharge information to anyone inside the network. The effectiveness of this network is seen within the data analysis portion which helps chosen optimal treatments and therapies with the hope to reduce redundant testing and improve health outcomes for patients.
Based on this model, the Big Bend RHIO should embrace a Federated HIE architecture with is based off autonomous databases that can share information through an export/import schema. Over time this architecture can be shifted towards a Hybrid then a Centralized system in which all clinical data can be transmitted. In a centralized system refers to a central data repository which can authorize a transaction and record it for auditing purposes. In the past the Big Bend RHIO has been successful in establishing an efficient infrastructure, committed community leaders based off the hospitals. The major barrier for the Big Bend RHIO to overcome is patient consent management and concern over the cost burden which is hoped to be fixed by increasing payer engagement and demonstrating value in the system. The Big Bend RHIO should use the Indian HIE as a model to continue to increase and effectively share information within physicians and care centers. Providers in the area must willingly adopt the aspects of “meaning use” of HIT, which will allow for federal funds. Starting with an incremental, bottom up approach it should aim for care collaboration, coordination, and coherence. Finally, set up systems that use flexible and adaptable technology including conveniences like the DOCS4DOCS file system and expanding the existing master patient index the RHIO has in place.

Research on Existing/Alternate Solutions Tried by Others



  • Microsoft HealthVault.
    • A web-based application developed in October of 2007 by Microsoft that manages personal health records for patients, which contain health and fitness information. HealthVault was expanded in June of 2010 to provide services to the United Kingdom. The application is intended to be a user-friendly, transparent health record management system; it boasts such features as modifiable access to different records by specific individuals, like a mother being granted access to her children's records. Similarly, users can manage the access to their own records by other parties, like a doctor or spouse.

  • Health Level 7 (HL7)
    • This is an organization that offers standards for the interoperability of health informatic standards. This is an international organization that facilitates the framework (through standards) to share electronic health information.

Team Workload and Roles

*While roles have been divided up, people are free to help where ever it is needed in the project. This is meant to be a loose guideline.
Roles/Workload
Members
Description
Database Research and Setup
A. Aron
M. McCarthy
T. Capasso
J. Barrentine
The setup of the necessary fields for the database and how it can be implemented on a larger scale. In addition,
Wiki
A. Aron
M. Scheer
Continual update of the wiki page reflecting our progress in the project.
Visual mockup
N. Vijapura
A. Remillard
M. Scheer
A design for the visual end of our implementation to display as a non working demo of what we are invisioning for our project
Mock Patient
N. Vijapura
Look Pretty

Final Solution Prototype


Visual aid
PatientMockUp.jpg


Backend
Below contains the MySQL design, statements, and queries used behind the patient UI to ensure proper patient information exchange. You can find actual database implementation and examples within the document.


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Next Steps


The solution proposed in this project is merely the first step in a very large undertaking. This project will have to evolve to work with the largest EMR developers in order to implement this level of interoperability. Developers would have to be willing to work with us in order to allow the export and import of patient data in a format that can be understood by the master database.


Citations


Citations (these are kept in a google doc to save space on the wiki due to formatting issues)