Data collection in Medicine Interoperability between Health Systems - - PowerPoint PPT Presentation

Interoperability between Health Systems

Data collection in Medicine

Khakima Khalizova

Health Information Exchange

The Sequoia Project + Direct Exchange Project + Papers Stored

Data Analysis

Data analysis and health care system can be divided into three eras according to Berwick

• D. Era 3 for medicine and health
• care. Journal of the American

Medical Association. 2016;Mar. Era one consists of establishing the roots of the medical

• profession. Era two is much like

the present day health care system dominated with awards and punishments. Era 3 according to Berwick can be transformed with nine changes in the health care

Methods

Health care involves a diverse set of public and private data collection systems, including health surveys, administrative enrollment and billing records, and medical records, used by various entities, including hospitals, CHCs, physicians, and health plans.

Health Information Exchange

Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care. Appropriate and timely sharing of vital personal information can better inform better decision making, like

• Avoid readmissions
• Avoid medication errors
• Improve diagnoses
• Decrease duplicate testing

Health Information Exchange

Despite the widespread availability of secure electronic data transfer, most Americans’ medical information is stored on paper—in filing cabinets at various medical offices, or in boxes and folders in patients’ homes. When that medical information is shared between providers, it happens by mail, fax

• r—most likely—by patients themselves, who frequently carry their records from appointment to
• appointment. While electronic health information exchange cannot replace provider-patient

communication, it can greatly improve the completeness of patient’s records, (which can have a big effect

• n care), as past history, current medications and other information is jointly reviewed during visits.

There are three key forms of health information exchange:

• Directed Exchange – ability to send and receive secure information electronically between care

providers to support coordinated care

• Query-based Exchange – ability for providers to find and/or request information on a patient from
• ther providers, often used for unplanned care
• Consumer Mediated Exchange – ability for patients to aggregate and control the use of their

health information among providers

Direct Exchange

Direct exchange is used by providers to send patient information such as laboratory orders and results, patient referrals, or discharge summaries directly to other healthcare professionals, trusted recipients over the Internet. This concept is working through a project called “Direct Project” . “These participants include EHR and PHR vendors, medical organizations, systems integrators, integrated delivery networks, federal organizations, state and regional health information organizations, organizations that provide health information exchange capabilities, and health information technology consultants.” (with the use of XTN) The Applicability Statement for Secure Health Transport is intended to provide a safe and secure methods for data transportation protecting privacy, data integrity, authentication of data sender and receiver. The document describes how to use SMTP, S/MIME, and X.509 certificates to securely transport health information over the Internet. Participants in exchange are identified using standard e-mail addresses associated with X.509 certificates.The data is packaged using standard MIME content

• types. Authentication and privacy are obtained by using Cryptographic Message Syntax (S/MIME), and confirmation delivery is

accomplished using encrypted and signed Message Disposition Notification. Certificate discovery of endpoints is accomplished through the use of both DNS and LDAP. Advice is given for specific processing for ensuring security and trust validation on behalf

• f the ultimate message originator or receiver.

Direct Exchange Project Telecommunication

Direct Exchange Project (Interaction Patterns)

RFC 5322 + MIME No Conversion No conversion - receiver expected to be able to use non-XDM format

• Transport Conversion -

Metadata is created RFC 5322 + XDM No Conversion - receiver is expected to be able to handle XDM package No Conversion Transport conversion - metadata simply transformed SOAP + XDR

• Transport conversion -

metadata is simply transformed - delivered as XDM package

• Transport conversion -

metadata is simply transformed - delivered as XDM package No Conversion

Senders

Receivers

RFC5322 + MIME RFC 5322 + XDM SOAP + XDR

Direct Exchange Project

This section is not specific to conversion, and applies to use of XDR for Direct-compliant messaging. In cases where an intermediary performs relay functions but does not need to view or examine content or content metadata, the origination and destination addresses should to be carried outside of the contents of the SOAP container to support minimization of PHI

• access. In these cases the origination point will replicate the origination and destination addresses into the appropriate SOAP

headers. An example of SOAP header as follows:

<direct:addressBlock xmlns:direct="urn:direct:addressing" env:role="urn:direct:addressing:destination" env:relay="true"> <direct:from>mailto:entity1@direct.example.org</direct:from> <direct:to>mailto:entity2@direct.example.org</direct:to> </direct:addressBlock>

Query-Based Exchange

Query-based exchange is based on the providers searching for accessible data from medical records, used by various entities, including hospitals, community health centers (CHCs), physicians, and health plans on a patient to deliver unplanned health care service. Query based exchange is used in emergency rooms as well as during hospitalization for example during pregnancy or injuries.

Consumer Mediated Exchange

Consumer mediated exchange is based on the patience storing data and having access to their health information through online websites similarly to the online

• banking. Being able access data information inline patience are able to:
• Track and monitor their own health
• Provide other institutions with their data
• Be able identify and control (in terms of being aware) of billing information
• Identify and correct wrong or missing health information

Positive vs Negative Effects

First of all of the data in the healthcare system is stored in paper or digital form. The paper version is filed and stored but it gets lost or forgotten. The digital version

• f it in the other hand is always accessible and easier to be monitored for the

patience as well as healthcare professionals. The healthcare data is stored and functions almost as banking account data therefore it can be hacked and be accessible to the reach of people other than patient himself, therefore it involves the issue of privacy, those documents store information such as race, ethnicity, weight, allergies, medications, past medical condition which could be used by non benefactors.

Infographics

Data analysis

Videos

https://www.youtube.com/watch?v=UMiPW831b1o https://www.healthit.gov/providers-professionals/multimedia

Websites

http://www.ihi.org/resources/Pages/Publications/Era-Three-for-Medicine-Health- Care.aspx http://www.beckershospitalreview.com/healthcare-information-technology/10-thi ngs-to-know-about-health-information-exchanges.html http://www.ihi.org/education/Conferences/Forum2016/Pages/default.aspx?utm_c ampaign=28%20Forum&utm_source=vanity%20url