Running Head: HIM 350 1
7-1 Final Project Submission
Lauretta Krakue
HIM 350
SNHU
HIM 350 2
Abstract
The purpose of the milestone is to provide an explanation and overview of the
interoperability and data dictionary. The paper sheds light on the classification standards as well
as terminologies essential for successful interoperability and security, technologies required,
legal and ethical standards impacting health information exchange, and steps involved in the
information governance life cycle. The paper also highlights the content that must be included in
the data dictionary, ways to maintain and manage elements in the data dictionary, the importance
of vocabulary standards, and the application of the data dictionary.%
I. Introduction
A. A summary of the hospital issues:
Memorial Hospital is based in Manchester County, which is known as the largest trauma
hospital. Presently, this hospital consists of 6 surrounding outpatient and specialty clinics along
with 1,100 beds in the main hospital. It has been found that the present largest trauma hospital in
Manchester County is experiencing problems while coordinating the care with its patients and
sharing information with them throughout the care cycle. Even Memorial Hospital is not getting
the patient’s track records until the patient is not visiting the hospital again. Also, the hospital is
experiencing a problem in retrieving the patient’s medical information like tests received,
comorbidities, past medical history, current medications, and many others. If a new trauma
patient is getting admission or transferred, then the hospital does not have the proper
information. These hospital issues have brought more challenges for the hospital in the present
context, including increased medication errors, decreased patient satisfaction, delays in
diagnoses, duplicate tests, and more hospital readmissions.
B. The information and data should be exchanged between organizations:
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As the Memorial Hospital is going through many issues, it has planned to create a new
community-wide health information exchange (HIE) network or build the Manchester Health
Access Network (MHAN) that can help to govern the entire local community public health topic.
Here, HIEs frequently work with communities directly to provide secure health-related
information through electronic sharing. This system helps in transferring health information by
conducting digital access at either a national, regional, or state level (Sorkin, 2021). For instance,
the hospital can share or exchange clinical information such as allergies, current medication, test
results, and other clinical information that are vital to health care. Moreover, certain
demographic information related to the individual's identity, such as an address, name, and birth
date, might also be exchanged (Health Information Exchange (HIE) - ahima. Health Information
Exchange (HIE), 2021).
C. The information and data should not be exchanged between organizations:
While using the health information exchange (HIE) network, the Memorial Hospital needs to
also understand the pros and cons of the network. Though the HIEs are helping the hospital by
easing their workload, there is much information that the hospital needs not to share or exchange
with other organizations. These HIEs have some barriers: security concerns, the need for
standards, federated systems, and economic loss to competitors (Edwards et al., 2010). Here,
exchanging patient information can help the service providers to avoid medication errors, reduce
readmissions, and decrease duplicate testing, but the hospital needs to look into state privacy
rules and HIPAA regulations that do not harm the patient's information.
D. The implementation of the health information exchange (HIE) model:
The health information exchange (HIE) usually permits pharmacists, doctors, nurses,
patients, and other health care providers to securely access and exchange vital medical
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information of the patients by improving the cost of patient care, speed, safety, and quality (What
is Hie? HealthIT.gov, 2020). There are different forms of health information exchange such as
directed exchange, query-based exchange, and consumer-mediated exchange. Among them, the
present hospital must implement the directed exchange health information exchange (HIE)
model where the health care providers can securely share or exchange the data of the patients
with other healthcare providers directly. This model has given priority because the two
healthcare providers can exchange the data more securely where the presence of trust factor can
be witnessed.
E. The extraction of data from the health information system:
The data can be extracted from the health information system based on the directed exchange
HIE model. Here, the health care service provider can use the directed exchange model to
securely send and receive the health information that includes non-clinical staff, clinicians,
public health agencies, registry or quality reporting organizations, local health departments, and
laboratories. The data extraction process is directed exchange model include secure internet
collaboration platforms, web-services exchange standards, secure messaging applications, direct
technical standards, and point-to-point interfaces (What is Hie? HealthIT.gov, 2020).
F. Analysis of data in the HIE network to improve patient outcomes:
Healthcare professionals, policymakers, and the healthcare industry have identified that a
proper solution to improve the overall quality of care and patient safety is Health Information
Exchange (HIE) (Hincapie & Warholak, 2011). Here, the healthcare provider can pair HIE data
with DOS that can provide advantages like machine learning, workflow, data governance, and
professional services. Similarly, the patient’s health outcome data can be improved.
II. Interoperability3
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Standards and Terminologies
There are a number of standards and terminologies that are essential for successful
interoperability and security. The most significant classification standards are the Healthcare
Common Procedure Coding System (HCPCS) and the International Classification of Diseases
(ICD). Centers for Medicare and Medicaid Services (CMS) is responsible for developing the
Healthcare Common Procedure Coding System (HCPCS). HCPCS refers to the collection of
standardized codes representing medical procedures, products, supplies, and services (American
Medical Association, 2001).%%The codes allow appropriate health insurance claim processing by
different insurers like Medicare. International Classification of Diseases (ICD) has been
developed by the World Health Organization (WHO) (Health Information and Quality Authority,
2013).% It is an international coding system of signs, symptoms, diseases, social circumstances,
and causes of diseases, death, or injuries. It allows effective retrieval and storage of diagnostic
information for clinical use and health management.%
The essential terminologies that are vital for successful interoperability and security are the
Diagnostic and Statistical Manual of Mental Disorders (DSM), Current Dental Terminology
(CDT), Current Procedural Terminology (CPT), National Drug Codes (NDC), and International
Classification of Primary Care (ICPC).%
Technologies
There are various technologies that are needed for successful interoperability and
security. One of the prominent technologies is the Master Patient Index (MPI). MPI plays a vital
role in enabling healthcare organizations to gain an understanding of their patient population and
evaluate its own performance (Lintz, 2018).% It helps in easy identification of the patients treated
by the healthcare facilities. Another significant technology is the Record Locator Service (RLS).
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The RLS offers authorized users about the location of the different patient health information
across various clinical data sources (Milton et al., 2021).%
Legal and Ethical Standards
The legal and ethical standards impacting health information exchange are HITECH and
HIPPA. The core aim of the Health Information Technology for Economic and Clinical Health
(HITECH) Act is to accelerate the adoption as well as to promote the meaningful use of EHRs or
electronic health records (Mennemeyer et al., 2016).% The Health Insurance Portability and
Accountability Act (HIPPA) of 1996 lays out the national standards for protecting the medical
records of individuals and vital personal health information (The HIPAA Privacy Rule.
HHS.gov, 2021).% It sets out the various requirements for disclosure and use of patient health
information. Obtaining the consent of the patient is also a regulation that impacts health
information exchange.
Compliance Measures
In order to ensure optimum protection of patient information, a number of measures can
be taken. One of the measures is to use firewalls. Firewalls can help in monitoring the incoming
as well as outgoing network traffic and block particular traffic on the basis of set security rules.
Another measure is the use of cryptography. The information of patients needs to be encrypted.
This will ensure that the information can be accessed by authorized medical users only (Kruse et
al., 2017).%
Information governance life cycle
Information governance lifecycle refers to the process of effectively managing
information in an organization. The first step in the cycle is the identification of information that
the healthcare organization already has (Information governance lifecycle. BSI, 2021).% The
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second step is the analysis as well as classification of the information. The third step is the
management of information. The fourth and final step is monitoring progress and identifying the
need for potential improvements.
III. Data Dictionary
Content of Data Dictionary
The important content of the data dictionary includes patient identifiers, admitting
diagnoses, principal and secondary diagnoses, allergies, length of stay, and other vitals. Patient
identifier examples are the name of the patient, gender, and date of birth. It helps in storing the
correct information of patients. The diagnoses refer to the illness or diseases for which the
patient is receiving treatment. Examples of allergies are allergic to certain medications. Other
vital information examples are heart rate, blood pressure, and more.
Management and Maintenance of Data Dictionary Elements
In order to maintain as well as manage the vital elements of the data dictionary, it is
important to develop it with the approval of the key stakeholders by making use of the nationally
recognized standards. ICC and ISO guidelines must also be taken into consideration for
registering metadata. The main rationale behind this is to ensure interoperability between
systems.%
Importance of Vocabulary Standards
It is essential to adopt as well as use vocabulary standards in the HIE. Vocabulary
standards provide the language for capturing primary health data that is vital for meaningful use.%
It ensures uniformity of the data language and allows better readability across different
platforms.%
Application of Data Dictionary
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The use of a data dictionary ensures the standardization of patient data and health
information throughout the system. It ensures that data from other healthcare facilities can be
read as well as interpreted in the same manner throughout the organizations with the use of HIE.%
IV. Communication
A. The stakeholders that will be affected by the change:
A stakeholder is an individual who has a vested interest in the change in the context of
change management. These stakeholders include the employees who must help implement
change, the managers who will lead change, and clients whom the changed services and products
will impact. Here, each stakeholder group gets affected differently from the change management
process (How to communicate change to stakeholders. Brighter Strategies, 2020). In the present
scenario, the introduction of a new community-wide health information exchange (HIE) network
along with electronic medical records (EMRs) to the Memorial Hospital will affect the major
stakeholders in the healthcare system. The stakeholders are health care insurance companies,
patients, employers, physicians, government, pharmaceutical firms, and many others. According
to Joanna Jasinska and Hab, the stakeholders who have an impact on the health care system are
the major health care players, politicians (health committees, minister of health, parliament), the
management of health care institutions, patients, state healthcare institutions, the mid-level
medical staff managed, private healthcare facilities, insurers, trade union and religious
organizations, pharmaceutical companies, associations, and suppliers (Stakeholders identification
affecting - biomedres.us, 2021). In the modern healthcare system, the arrival of change in the
current functioning system is a string of introducing innovations and solutions. When making a
change, it is not easy for all parties to accept it quickly. The change in the health care
management process can disturb the existing order, threaten the economic situation and sense of
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security, raise fear of the unknown, and can cause resistance from people to accept the new
solutions (Stakeholders identification affecting - biomedres.us, 2021).
B. Communicate the impact of this change to those stakeholders:
Based on the current situation of the Memorial Hospital, change in the health care
management system is very important as the hospital is facing issues with the patient’s track
records and others things. In this change, the stakeholders like patients, the management of
health care institutions, health care insurance companies, physicians, and pharmaceutical firms
will get affected. For instance, it becomes very important to communicate with those individuals
regarding the impact of this change. There is a need to explain to them the benefits of the health
information exchange (HIE) network to the hospital sector. Also, the communication process
needs to involve what are the things the hospital wants to change and accordingly plan the
change. Along with this, it is important for hospital management to prepare people to accept the
changes in the healthcare system. While communicating with the stakeholders, discuss the details
of making the change, and then there is a need to focus on controlling the adaptation process
(Stakeholders identification affecting - biomedres.us, 2021).
Furthermore, it is essential to practice the change presentation before delivering the
stakeholders and getting the critics. Also, carefully crafting the message and structuring it is
important to get success ineffective communication (Communicate with impact, 2021).
C. Ensure buy-in and participation from stakeholders:
While changing the healthcare management process, it is essential to ensure buy-in and
engagement from stakeholders by making them central to the outset process. In the process of
honing or defining the vision, many simple ways can be engaged to the stakeholders. Here, I will
request them to provide their valuable ideas by holding them accountable. Also, I will make sure
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to keep maintaining open communication regarding the merits and demerits of the health
information exchange (HIE) network throughout the change process. In addition, these
stakeholders will have the scope to share their varying experiences, knowledge, and expertise.
Furthermore, it is important to establish a unified understanding of the project stakeholders and
the expectations of the stakeholders from the projects. Accordingly, the management tactics and
engagement can be set and defined. Additionally, it is also essential to identify what exactly
motivates the stakeholders to ensure buy-in (Learning. Project Management Institute, 2021).
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References
American Medical Association. (2001).%Hcpcs 2002: Healthcare Common Procedure Coding
System: Medicare's National Level II Codes. American Medical Association Press.
Communicate with impact. (2021, February 9). Retrieved December 11, 2021, from
https://thewilltochange.com/leadership-mastery-program-for-organizations/communicate-
with-impact/#:~:text=%20Communicate%20with%20impact%20%201%20Start
%20with,someone%20to%20critique%20you%20before%20important...%20More%20.
Edwards, A., Hollin, I., Barry, J., & Kachnowski, S. (2010). Barriers to cross--institutional health
information exchange: a literature review.%Journal of healthcare information management:
JHIM,%24(3), 22-34.
Health Information Exchange (HIE) - ahima. Health Information Exchange (HIE). (2021).
Retrieved November 13, 2021, from https://bok.ahima.org/PdfView?oid=104129.%
Hincapie, A., & Warholak, T. (2011). The impact of health information exchange on health
outcomes.%Applied clinical informatics,%2(04), 499-507.
How to communicate change to stakeholders. Brighter Strategies. (2020, December 1). Retrieved
December 11, 2021, from https://www.brighterstrategies.com/blog/there-is-no-such-thing-
as-too-much-communication-during-change/.
Health Information and Quality Authority. (2013). Overview of healthcare interoperability
standards.
Information governance lifecycle. BSI. (2021). Retrieved November 24, 2021, from
https://www.bsigroup.com/en-IE/our-services/cybersecurity-information-resilience/
Services/Information-Governance-Lifecycle/.%
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Kruse, C. S., Smith, B., Vanderlinden, H., & Nealand, A. (2017). Security techniques for the
electronic health records.%Journal of medical systems,%41(8), 1-9.
Lintz, J. (2018). A Qualitative Study of Master Patient Index (MPI) Record Challenges from
Health Information Management Professionals' Perspectives.%Perspectives in Health
Information Management.
Milton, A. C., Hambleton, A., Dowling, M., Roberts, A. E., Davenport, T., & Hickie, I. (2021).
Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating
Disorders: Participatory Design Study.%Journal of Medical Internet Research,%23(2),
e19532.
Mennemeyer, S. T., Menachemi, N., Rahurkar, S., & Ford, E. W. (2016). Impact of the HITECH
act on physicians’ adoption of electronic health records.%Journal of the American Medical
Informatics Association,%23(2), 375-379.
Learning. Project Management Institute. (2021). Retrieved December 11, 2021, from
https://www.pmi.org/learning/library/secure-360-stakeholder-buy-in-9306.
Sorkin, C. (2021).%What is Health Information Exchange (HIE)?%Wheel. Retrieved November
13, 2021, from https://www.wheel.com/companies-blog/what-is-health-information-
exchange-hie.%
Stakeholders identification affecting the ... - biomedres.us. (2021). Retrieved December 11,
2021, from https://biomedres.us/pdfs/BJSTR.MS.ID.004512.pdf.
The HIPAA Privacy Rule. HHS.gov. (2021, July 13). Retrieved November 24, 2021, from
https://www.hhs.gov/hipaa/for-professionals/privacy/index.html.%
What is Hie?%HealthIT.gov. (2020, July 24). Retrieved November 13, 2021, from
https://www.healthit.gov/topic/health-it-and-health-information-exchange-basics/what-
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hie#:~:text=Electronic%20health%20information%20exchange%20(HIE,and%20cost
%20of%20patient%20care.%
