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7-1 Final Project Submission
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SNHU
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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
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errors, decreased patient satisfaction, delays in diagnoses, duplicate tests, and more hospital
readmissions.
B. The information and data should be exchanged between organizations:
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
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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
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). cc
F. Analysis of data in the HIE network to improve patient outcomes:
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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. Interoperability
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
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(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). 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). cc 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
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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 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
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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. cc It ensures uniformity of the data language and allows better readability across different
platforms.
Application of Data Dictionary
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,
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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 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.
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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 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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