Architecture for new health care Systems

Questions before Today futuristic Health care management Systems are ?

  1. Hospital information interfacing system and its info effects on SDLC.
  2. Incorporating regulation in software for healthcare systems
  3. Patient privacy and risk of stale data due to delta what should be changed in SDLC to effect software and right time?
  4. Unified knowledge management for healthcare systems and relation to Laws and its roles in requirement engineering
  5. Check these Medicade Vs Medicare in IT lifecycle.
  6. Acute Vs Chronic disease prevention and treaking through  Health information network.
  7. What Models can be implemented for each classification
  8. Health and Medical informatics for infectious diseases. Targeted Pharmacy and information dissemination. How software should be modelled on it?

eHealth Initiative Stages of implementation framework are contant ly chanllegened throughout the ages : The Traditional PDCA cycle to PMI not suffice to healthcare industry.

Plan Do Check and Act PDCA. Similarly there are Project management frame work model for tracking progress of any project:

Project Management  Framework:

Project_Management_(phases)

These models were sufficient once project is well defined . And with respect to healthcare there are lots of factors which makes it mandatory to interact with multiple actors/systems/interfaces.

Under new eHealth initiatives the new eHealth initiative this model  is not sufficient  owing to complexity and large interfacing with Health care Information network. eHIN.

Here after initiation-> Organizingà planningà (Piloting)   has been introduced as its not optional here to start with pilot since huge number of interfaces which are available in healthcare informatics network e.g there are 3 major categories of HIN Healthcare Information Network according to Architecture:

Centralized : with central repository  disseminate data into eMR,PHI,HIE,EHR . like used in IHIE.

HyBrid: Central data store, maser index,with document indexing features. Like in Biosense 2.0.

Fedrated: data is kept near to source ,

To tide Over these complexity and model introduced phase Poilet and Piolet is also important as concern of privacy of PHR, complex , deperate Health information networks.

Similary Health information network segmented by area of scope Regional HIN, and by functionality

Also sustaining phase is added as healthcare system interfaces so many entity like e-scribe etc it may not be sustainable for long sun to check this Sustainability phase is added.

The Standards for Transactions on Information for heath care systems:

Standard Meaning Comment
HL7 Health-Level Seven A family of standards used in many aspects of health data exchange.
X12 (or ANSI ASC X12) Official designation of the U.S.national standards body for the

development and maintenance of

Electronic Data Interchange

(EDI) standards

Includes many XML standardsfor healthcare and insurance.
NCPDP National Council for PrescriptionDrug Programs A family of pharmacy data standards
DICOM Digital Imaging andCommunication in Medicine Standard for handling, storing, printing, and transmitting information in medical imaging.Both a transaction and a semantic standard
IHE Integration Profiles Integrating the HealthcareEnterprise Integration Profiles IHE developed a family of interoperability profiles by utilizing HL7 standards forspecific purposes
IHE Integration Profiles Integrating the Healthcare Enterprise Integration Profiles IHE developed a family of interoperability profiles by utilizing HL7 standards for specific purposes.
HITSP Interoperability Specifications Health Information Technology Standard Panel HITSP has developed a whole system of specifications including creating processes to harmonize standards, certify EHR applications, develop nationwide health information network prototypes and recommend necessary changes to standardize diverse security and privacy policies
CDA Clinical Document Architecture XML-based “standard” intended to specify the encoding, structure and semantics of clinical documents for exchange
CCR Continuity of Care Record Patient health summary standard developed by ASTM, several medical societies and a number of vendors
CCD Continuity of Care Document XML-based markup “standard” intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange. The CCDspecification is a constraint on the HL7CDA (further limits it). HITSP has selected the CCD (not the CCR).

Semantic  Standards:

Bringing data from various disparately wide sources the systems and standards used will differ hence data normalization is very important.

Standard Meaning Comment
ICD International Classification ofDiseases Published by the World Health Organization
CPT Current Procedural Terminology Describes medical, surgical and diagnostic services. Maintained by the American MedicalAssociation
HCPCS Healthcare Common ProcedureCoding System Based on CPT and designed to provide a standardized coding system for describing the specific items and services provided in the delivery of healthcare. Used for reporting to Medicare, Medicaid and other payors
LOINC Logical Observation IdentifiersNames and Codes Database and universal standard for identifying medical laboratory observations developed byRegenstrief Institute
SNOMED Systematized Nomenclature ofMedicine A multiaxial, hierarchical classification system where 11 axes represent classificationfeatures
RxNorm Standardized nomenclature forclinical drugs Produced by the U.S. National Library of Medicine.
NDC National Drug Code Universal product identifier for human drugs

Process Standard:

There exists different workflow for different processes which govern the communication of transaction for data standards and

HIE Health Information Exchange networks :

HIE

Over the years we’ve focused primarily on ambulatory care, staying out of the hospital based environments but as time has gone on those are kind of merging.

We’re heading into larger environments what we call enterprise environments. We cover about 30 specialities in primarly about a third of the practices are in primary care. About a third now are OB/GYN and the rest are primary, some specialties in medicine and surgery. We probably have over 10,000 physicians using the system currently, and over 25 million patients actually on the system across the country.

problems with electronic medical records is the interface between the physician and the computer.On the one hand you want to collect detailed high quality data, on the other hand you can’t have a huge impact on physician productivity and many physicians don’t really want to become computer operators on top of that.

electronic health records, one of the challenges is actually getting information into the system.

And a lot of the hardware options were also in evolution, hand writing recognition was coming along, most point and click type environments were there but typing was a challenge for certain folks Now there was a,a voice recognition. speech understanding or may be splitting here’s a bit it does make a difference in opinion.

Data standards and interoperability standards I, I think I know what you mean When you say that the technology goes all the way from dictated text to a structured XML document but can you drill down on that a bit more?

a history in physical structure that’s pretty standardized across most of the use in the United States. It means Joint commissionist’s have a certain standard to it and we kind of follow that.

Flexibity of modelt is also challenged by chading architecture of interfacing from click to voice etc So having the ability to dictate, when Istart off a dictation and say chief complaint now the next statement I make ends up being tagged to that chief complaint. I’ll state HPI and it interprets it as if your present illness. And whatever I dictate after that then gets put into that situa-, into that, paragraph.

Having the ability to do that allows it to be tagged and structured in a clinical document archetiect, CDA, And that’s returned to us and then we, we basically have a style sheet about it and formulate it into a document type that is usable product called Prime Suite. So, having that structure allows  to have the information in appropriate areas within a document, and then we can extractout.

Taking it a step further for instance, if I describe a medication.

If we say a patient is on 81 milligrams of aspirin a day, that actually can get, betagged as an Rx norm reference code, and that’s available, then, for me, our teamto be able to extract that out and put it in our medication history. or, having the ability to have discreet tagged information, pull it out, and be

it’s natural speech understanding, but the point being is that there is a mechanism in the textual word to extract informatoin. And effectivly their transition services were training their neural network or their machine learning algorithms. So this is a fabulous example of using the internet the way it can be used to garner knowledge from many, many, many sources and build a robust knowledge based system

which is actually being applied in the real world now to help out one of the most difficult and intransitive problems in electronic medical records.

 MEANINGFUL USE 42 CFR 495.6(d)-(e)
 CERTIFICATION CRITERIA 45 CFR 170.302 & 170.304
 STANDARD(S) 45 CFR 170.205, 170.207, & 170.210
 §495.6(d)(1)(i) – Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
 §170.304(a) – Computerized provider order entry. Enable a user to electronically record, store, retrieve, and modify, at a minimum, the following order types:(1) Medications;(2) Laboratory; and(3) Radiology/imaging.
 §495.6(d)(1)(ii) – More than 30% of all unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE.§495.6(d)(1)(iii) Exclusion: Any EP who writes fewer than 100 prescriptions during the EHR reporting period.
 §495.6(d)(3)(i) – Maintain an up-to-date problem list of current and active diagnoses.
 §495.6(d)(3)(ii) – More than 80% of all unique patients seen by the EP have at least one entry or an indication that no problems are known for the patient recorded as structured data.
 §170.302(c) – Maintain up-to-date problem list. Enable a user to electronically record, modify, and retrieve a patient’s problem list for longitudinal care in accordance with:(1) The standard specified in §170.207(a)(1); or(2) At a minimum, the version of the standard specified in §170.207(a)(2).
 Problems. § §170.207(a)(1) – The code set specified at 45 CFR 162.1002(a)(1) for the indicated conditions.§ §170.207(a)(2) – IHTSDO SNOMED CT® July 2009version

Standards for instance, we are rolling out a mobile application here which will use iPhone

access where doc can dictate on an iPhone, they’ll be able to pick through a menu of items, pick their documents and all that. expanding the flexibility of the speech product and I would say I would hope within a year we would be at a point where it fundamentally change the approachin the speech or the mindset about speech.it because what it means to physicians and clinicians is to be able to pick up adevice, dictate into it.Have it capture all the discrete information, parse it out where it needsto go into database, have it available and yet in their minds be able to get their, their job done, taking care of patients, yet capture all this discrete informationthat we find so valuable in medicine, that we for years in the paper world we basically had a challenge of ever trying to extract that information.

It was very laborious to, to extract information out of medical records after.Nowadays we can structure things in much better fashion and it, we’re excited.Some of the things we’re working on in the future, it’s going to hinge of the ability to take structured information in, and move forward, or with lots of different fashion.

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