Health information exchange analysis

Health Information Exchange analysis

Summary

Each line in the summary will be deployed into the web hrefs to the page. 


Introduction

The publishing of EHR refers to electronic health records which are a synonym of EMR.  EHR analysis suggests strengths and weaknesses:
  • The EHR provides an integrated record of the health systems notes on a patient including: Diagnosis and Treatment plans and protocols followed, Prescribed drugs with doses, Adverse drug reactions;
  • The EHR does not necessarily reflect the patient's situation accurately. 
  • The EHR often acts as a catch-all.  There is often little time for a doctor, newly attending the patient, to review and validate the historic details. 
  • The meaningful use requirements of HITECH and Medicare/Medicaid specify compliance of an EHR system or EHR module for specific environments such as an ambulatory or hospital in-patient setting. 
  • As of 2016 interfacing with the EHR is cumbersome and undermines face-to-face time between doctor and patient.  Doctors are allocated 12 minutes to interact with a patient of which less than five minutes was used for recording hand written notes.  With the EHR 12 minutes may be required to update the record!
data is architected to be facilitated through RHIO is regional health information Organization facilitates the HIE transfer of health information electronically across organizations.  There are four components to an RHIO: convenor, transactor, grid, and last mile.  RHIOs are viewed as key components of the NHIN.  Two technological architectures are used to implement the HIEs: (1) Data warehouses and (2) federated database systems.  This results in two RHIO architectures:
  1. Centralized - where local nodes data is extracted, transformed and then loaded into the central warehouse.  Technically this suffers from central data being out of date by the time between batch updates generated by the distributed extract and transform processes. 
  2. Federated - where record locators are stored in data bases at each RHIO node linking to the actual data.  There were no protocols defined and standardized initially for supporting the operation of the federation.  INPC and IHIE are examples of operational federated RHIOs.  
agents via health information exchange a Health Information Exchange is responsible for the transmission of health care-related data among facilities, health information organizations and government agencies according to national standards.  They are designed to address legal, organizational and technical challenges that would otherwise impede the sustainability of health information interchange.  An HIE is a component of the HIT.  It must enable reliable and secure transfer of data among diverse systems and facilitate access and retrieval.  The two main types are private and public exchanges.  Private exchanges may be able to leverage homogeneous IT infrastructure to facilitate data sharing.  Public exchanges are likely to be heterogeneous.  RHIO provide the regional organizations to support such HIE.  They are there to ensure that infrastructure amplification initiates.  The government will ensure that low healthcare density areas are served by public HIE infrastructure.  Both centralized and federated technical solutions were initially considered for implementation by the RHIOs for deploying HIE as specified in the Markle Foundation's NHIN common framework.  Common framework clients such as appropriately architected HIE use SOAP messaging to interact with their local SNO's ISB and RLS.  The HIE SOAP query transactions follow the HL7 Query Model.  Alternatively some HIE's are now using direct messaging to support interoperation.  HIE deployment goals have been phased (1 - supporting care transitions, 2 - Quality and care management, 3 - Population health).  Some HIEs will support "EHR-lite" as part of their functionality.  HIE does not yet solve some difficult challenges:
  • Safeguarding the security of health information.  Currently HIEs conforming to the common framework only provide locations of clinical data held remotely.  
  • Providing effective life cycle management.  The HIE is dependent on the local set of entities to provide updates that match the current state of the entity data. 
infrastructure. 



RHIO is regional health information Organization facilitates the HIE transfer of health information electronically across organizations.  There are four components to an RHIO: convenor, transactor, grid, and last mile.  RHIOs are viewed as key components of the NHIN.  Two technological architectures are used to implement the HIEs: (1) Data warehouses and (2) federated database systems.  This results in two RHIO architectures:
  1. Centralized - where local nodes data is extracted, transformed and then loaded into the central warehouse.  Technically this suffers from central data being out of date by the time between batch updates generated by the distributed extract and transform processes. 
  2. Federated - where record locators are stored in data bases at each RHIO node linking to the actual data.  There were no protocols defined and standardized initially for supporting the operation of the federation.  INPC and IHIE are examples of operational federated RHIOs.  
s are organizational emergent agents which are structured to enhance the funding, deployment and effective use of EHR refers to electronic health records which are a synonym of EMR.  EHR analysis suggests strengths and weaknesses:
  • The EHR provides an integrated record of the health systems notes on a patient including: Diagnosis and Treatment plans and protocols followed, Prescribed drugs with doses, Adverse drug reactions;
  • The EHR does not necessarily reflect the patient's situation accurately. 
  • The EHR often acts as a catch-all.  There is often little time for a doctor, newly attending the patient, to review and validate the historic details. 
  • The meaningful use requirements of HITECH and Medicare/Medicaid specify compliance of an EHR system or EHR module for specific environments such as an ambulatory or hospital in-patient setting. 
  • As of 2016 interfacing with the EHR is cumbersome and undermines face-to-face time between doctor and patient.  Doctors are allocated 12 minutes to interact with a patient of which less than five minutes was used for recording hand written notes.  With the EHR 12 minutes may be required to update the record!
and HIE a Health Information Exchange is responsible for the transmission of health care-related data among facilities, health information organizations and government agencies according to national standards.  They are designed to address legal, organizational and technical challenges that would otherwise impede the sustainability of health information interchange.  An HIE is a component of the HIT.  It must enable reliable and secure transfer of data among diverse systems and facilitate access and retrieval.  The two main types are private and public exchanges.  Private exchanges may be able to leverage homogeneous IT infrastructure to facilitate data sharing.  Public exchanges are likely to be heterogeneous.  RHIO provide the regional organizations to support such HIE.  They are there to ensure that infrastructure amplification initiates.  The government will ensure that low healthcare density areas are served by public HIE infrastructure.  Both centralized and federated technical solutions were initially considered for implementation by the RHIOs for deploying HIE as specified in the Markle Foundation's NHIN common framework.  Common framework clients such as appropriately architected HIE use SOAP messaging to interact with their local SNO's ISB and RLS.  The HIE SOAP query transactions follow the HL7 Query Model.  Alternatively some HIE's are now using direct messaging to support interoperation.  HIE deployment goals have been phased (1 - supporting care transitions, 2 - Quality and care management, 3 - Population health).  Some HIEs will support "EHR-lite" as part of their functionality.  HIE does not yet solve some difficult challenges:
  • Safeguarding the security of health information.  Currently HIEs conforming to the common framework only provide locations of clinical data held remotely.  
  • Providing effective life cycle management.  The HIE is dependent on the local set of entities to provide updates that match the current state of the entity data. 
.  It was argued that they should be formed from the collaboration of RHIO convenors is an organization that brings together RHIO stakeholders.  , transactors provides community-wide exchange of healthcare administrative data.  , grids supplies the clinical exchange network.  and last miles ensures that RHIO services can connect to provider offices through EHR systems.  .  That logic is followed in the case of the Massachusetts's virtual RHIO

The HIE infrastructure has been implemented using both centralized and federated technologies. 

The complexity of HIE information security and privacy prompted the office of the National Coordinator for Health IT at HHS is the U.S. Department of Health and Human Services.  , AHRQ is the Agency for Healthcare Research and Quality.  It provided the definition of a medical home (PCMH) as both a place and a model of the organization of primary care that delivers core functions of primary health care. 
and the National Governors Association to sponsor the Health Information Security and Privacy Collaborative (HISPC is a project of the AHRQ to address privacy and security policy issues affecting interoperable HIE.  It is managed by RTI, the NGA, AHRQ, and HHS Office of the National Coordinator for health IT.  It aims to identify variation among states on privacy and security practices and laws, to propose solutions to address challenges, and to increase expertise about health information privacy and security protection.  Phase I of the project resulted in the identification of four key public policy concerns: patient consent to the use of HIE networks, use and disclosure of sensitive medical information, implementation of access controls, and application of community standards. 
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Health Information Exchanges (HIE a Health Information Exchange is responsible for the transmission of health care-related data among facilities, health information organizations and government agencies according to national standards.  They are designed to address legal, organizational and technical challenges that would otherwise impede the sustainability of health information interchange.  An HIE is a component of the HIT.  It must enable reliable and secure transfer of data among diverse systems and facilitate access and retrieval.  The two main types are private and public exchanges.  Private exchanges may be able to leverage homogeneous IT infrastructure to facilitate data sharing.  Public exchanges are likely to be heterogeneous.  RHIO provide the regional organizations to support such HIE.  They are there to ensure that infrastructure amplification initiates.  The government will ensure that low healthcare density areas are served by public HIE infrastructure.  Both centralized and federated technical solutions were initially considered for implementation by the RHIOs for deploying HIE as specified in the Markle Foundation's NHIN common framework.  Common framework clients such as appropriately architected HIE use SOAP messaging to interact with their local SNO's ISB and RLS.  The HIE SOAP query transactions follow the HL7 Query Model.  Alternatively some HIE's are now using direct messaging to support interoperation.  HIE deployment goals have been phased (1 - supporting care transitions, 2 - Quality and care management, 3 - Population health).  Some HIEs will support "EHR-lite" as part of their functionality.  HIE does not yet solve some difficult challenges:
  • Safeguarding the security of health information.  Currently HIEs conforming to the common framework only provide locations of clinical data held remotely.  
  • Providing effective life cycle management.  The HIE is dependent on the local set of entities to provide updates that match the current state of the entity data. 
) can be viewed as schematically generated phenotypic infrastructure for supporting the signal and sensor deployment necessary for the interaction of complex adaptive system (CAS) agents within the health care provider network is the owned health system and its extended network of partners.  
HIE Core Services:
The Markle Foundation has been a significant influence on the early approaches taken to HIE architecture and deployment. 

It is suggested that HIE automatic reporting will reduce labor costs. 

The current nature of the foundation's common framework is the Markle common Framework used by connecting for health.  The common framework provides information about setting up the agents of a CAS based electronic health network that allows emergence of the NHIN.  It includes:
  • Policy guides for how information is protected
    • The architecture for privacy in a networked information environment
    • Model privacy policies and procedures for health information exchange
    • Notification and consent when using a record locator service
    • Correctly matching patients and their records
    • Authentication of system users
    • Patients access to their own health information
    • Auditing access to and use of a health information exchange
    • Breaches of confidential health information
    • A common framework for networked personal health information
  • Technical guides for how information is exchanged
    • Technical issues and requirements for common framework implementation. 
      • There is an architected hierarchy.  The NHIN is viewed as a network of SNOs - while entities within an SNO are free to communicate directly with other entities in the SNO, inter SNO communications is required to go via an ISB so that all flows between SNOs can be observed. 
    • HIE architecture implementation guide
    • Medication history standards
    • Laboratory results standards
    • Background issues on data quality
    • Technical background of record locator service
    • Consumer authentication for networked personal health information
  • Model contractual language
signal generation mechanism seems remarkably indirect.  Markle's approach to external standards resulted in common framework based systems being complicated and acts as a barrier (due to high development costs and limited value of the initial emergent entities) to emergence of networks (NHIN) based on such systems.  As ONC funding in 2012-13 has dried up the various state HIEs have been collapsing. 

Some exchanges, such as Tennessee's have been terminated in favor of use of the Direct Project at ONC specifies (2) a simple, secure, scalable, standards-based way for participants to send via email authenticated, encrypted health information directly to known, trusted recipients over the Internet.  The email addresses are trusted having been issued by ONC.   which they concluded is simpler.  KLAS sees rising dissatisfaction with the HIE approach.  Dissatisfaction has increased over time. 

Deployment of HIE has been slow.  This has been attributed to:
However, as providers have worked with HIE, failure to scale appears to be the major issue with HIE based solutions.  With the requirement to construct the query results each time and then resolve the associated data with networked gets this is no surprise.  (recall RPC - 'its like a procedure call only slower'!)  In comparison Epic Care Everywhere is viewed by the customer base very positively.  KLAS is a healthcare technology rating organization.   also promote athenaHealth's strategy as an attractive alternative. 

Providing filters which remove sensitive information is only a partial solution to the privacy and security constraints.  Medication information that is withheld may be important to know to effectively prescribe new treatments and medications. 

Can CAS architectures effectively represent individual agents (patients)?  Typically they use ubiquitous equivalence to support flows. 

































































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