18 pages-Single-spaced-Class Journal
http://www.csun.edu/~dn58412/IS531
Lecture 7
Health Information Exchanges
(Chapter 17)
Learning Objectives
Health Information Exchanges (HIE) and Users
Key Factors in HIE
HIE Business Models
Driving Forces for HIE Development
Obstacles to HIE Development
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Health Information Exchange
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Health Information Exchange
Electronic movement of health-related information among organizations,
A process within a state health information organization or a regional health information organization
A bidirectional sharing of patient health-related information among providers and other authorized healthcare professionals
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National Health Information Network
NHIN provides a standardized, secure, and confidential way to link information systems together for authorized users to share reliable health-related information
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Users of Health Information Exchanges
Individual level: enhance personal health outcomes
Professional level: clinical decision making
Agency/organization level : managing operations and quality improvement
Public health and national level: accreditation bodies to evaluate population health, health policy
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Architecture of
Heath Information Exchanges
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Key Issues in
Heath Information Exchanges
Data storage
Master person index (MPI)
Record locator service
Authentication
Authorization
Security policies
Auditing and logging
Standards
Scope of services
Knowledge of workflow
Portals for access
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Data Storage
To enable the aggregation of data from many sources
Infrastructure models
- Centralized
- Decentralized / federated
- Hybrid
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Centralized Data Storage
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Decentralized Data Storage
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Hybrid Data Storage
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Master Person Index (MPI)
To uniquely identify an individual
To match the person’s data from many sources
Could be a complex identifier with multiple identification attributes (name, DOB, address)
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Record Locator Service
- A service to search health information that matches the identified individual
- Locator can point to a specific types of information / criteria
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Authentication
To identify authentic users to the systems
Valid users: clinical professionals, public health professionals, supporting IT professionals
Will include patients in future
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Authorization
Authorized user matrix: WHO can access WHAT information for WHAT purpose
CRUD Function Matrix in database: Create-Read-Update-Delete
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Authorization: Data-to-Process
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Authorization: Data-to-Location
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Security Policies & Procedures
Agreement among organizations to share patient data (retrieve, reuse)
Track requests for information
(Require patient consent)
Opt in vs. Opt out
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Auditing & Logging
Keep track all accesses to network services
- Intentional vs. unintentional
- Connection vs. disconnection
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Criteria-based Standards
To assure the interoperability and reuse of information from many sources
Data communication protocols
Data content, format
Technical compatibility among systems
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Scope of Services Provided
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Knowledge of Workflow
Data processing procedure (When, Who, How)
Patient data types (What, Whose)
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Portal for Access
Different portals for different types of information exchanges
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Health Information Exchange Models
Government-led HIE: direct government program
Public utility HIE: with government oversight
Private sector-led HIE: government as a stakeholder for collaboration and advisement
Public authority HIE : a government created nonprofit authority with powers to operate in a business-like manner
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Health Information Exchange Business Models
Business models designed for financial sustainability:
Membership fee model
Transaction fee model
Program and service fee model
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Driving Forces
Reduce data duplication and related costs
Reduce discrepancies among information from may sources and related fixing costs
Provide a uniform holistic picture of the patient’s health to improve care quality
Underlying key success factor: Electronic Health Records (HER) and Electronic Medical Record (EMR) must be first broadly adopted/implemented
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Current Obstacles
Size and scope of the project
Time / Costs
Critical mass of data to be exchange
Collaboration between competitors (providers)
Technical skills / necessary clinical knowledge to use the system
Resistance to change
Composition and structure of governing agency
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Future Directions
Statewide HIE initiatives have started
HIE enabler/readiness (coordinating initiaties)
HIE outsourcing/technical partnership (technology implementation and services)
HIE operator (implementation and management)
A national health information network to be build
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References
http://www.himss.org/library/topics
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