ONDEMANDHEALTHCARE.net

Model for Level 4 Interoperability with Health Information Exchange (HIE)

"According to the Institute of Medicine and others, the U.S. healthcare delivery system is complex, inefficient, and highly fragmented”^[1] costing $1.7 trillion in 2003.  The report reiterates interconnecting clinicians, as a national goal so that health information can be exchanged, and provides an estimate of the potential savings through the establishment of a National Health Information Network (NHIN).

The savings based on sharing information is estimated at: $78 billion with Ambulatory EHR's, and $44 billion with Ambulatory CPOE alone.  Several other studies have projected a ten to eleven digit benefit from IT adoptions.  True costs to deliver such huge savings however, cannot be easily determined.  We do not know for example, whether a 50-cent spend would deliver a $1 benefit or would it take 5x to deliver the same result.  One amongst several cost factors is Interoperability.

The healthcare system is a disparate environment of several functions such as: Registration, Laboratory, Radiology, Pharmacy, Finance, Clinical Order Entry, Medical Records, and such.

To evaluate the challenges of interoperability, it is first important to understand the information network pathways and bridges between applications across an enterprise.  Can computer 'A' communicate health information with computer 'B' inside the organization?  Can it share information with systems outside the enterprise?  What elements of technology make this possible?  What levels of data sharing are involved (paper, email, structured messages, standardized content, ...)?

When the information reaches computer 'B", how do other applications link with it.  What middleware systems would be required to integrate it in a way that target systems can easily understand information for their use?  Will systems need a language interpreter?  If HL7 standard is used for interoperability, what is required to open up legacy environments so that they can share information?

What if?  Computer A now demands the updated information from computer ‘B’?  What methods and approaches do we use to create flexibility and harmony amongst various enterprise systems?

Overlay information ownership, security, privacy policy, HIPAA regulations, goal alignment, Stark Act, and the roadmaps to go regional before health information becomes nationally, and then globally accessible from anywhere in the world by  patients. 

Now add "on demand" to every step discussed above so that you get the information when you need it irrespective of what is involved, and control mechanisms to differentiate "my data from your data, and others data," so that, you only get information pertinent to yourself, and one can begin to truly understand the challenge and the cost of bringing all of this together.

We will next discuss innovative ways to achieve Level 4 and the highest order of interoperability across all boundaries in the SaaS series.  Stay tuned.

References:
(1) David A. Powner, Director, Information Technology Management Issues, United States Government Accountability Office Memo Dated Feb 16, 2005, GAO-05-309R HHS's Estimate of Savings from Health IT

:- SOWSIA Collaborative Group
Copyright 2008.  SOWSIA Healthcare Solutions, Inc. All rights reserved. (blog@sowsia.com) www.sowsia.com 

Improving Privacy and Trust with Health Information Exchanges (HIE)

The vision for Health Information Exchanges (HIE) requires several computer systems across organizations and regions to co-operate in a harmonious fashion.  Such information Hubs would link and share various pieces of an individual's health record with other systems and networks located within the care facility, and with external networks.  However, because of the complex data flows in a possible HIE environment, maintaining patient confidentiality within a Hub and its interfaces becomes a challenging affair.  The complexity compounds even more when HIE's bridge across other disparate network environments on the Web.  To build and manage privacy across such fluid boundaries, additional capabilities are needed to secure portable health data and provision security profiles that are specific to target healthcare solutions - the ultimate recipient of patient data.

The privacy measures within such complex environments require more data monitoring, security, interface access and control management solutions for Health Networks, Health Vault or data storage infrastructures.  Another challenge relates to the growing need for strong privacy policy with virtualization technologies used to deliver patient health data on the Web.  The outcomes of service and liabilities (especially in the context of HIE) must be clearly understood beforehand^[1], and steps taken to fulfill compliance objectives.  Solutions built on such principles would build trustworthiness of service providers on the health information networks of the future.

To improve Privacy and Trust between networks of confidentiality, and to further secure Doctor-Patient interactions on the Web, data exchange solutions need to ensure privacy is implied across all information pathways right from the time a demand is placed on the network, triggered by the immediate need of a patient from anywhere, and anyplace in the world.

References:
(1) Dr. Yacine Atif, Can Business Web Services Be Made Trustworthy? UAEU Funded Research Publications, Vol. 23, 2006
(2) Business Services Network, the 2nd Generation Web, A. Jain and N. Juneja, SOWSIA Publication, 2003

:- SOWSIA Collaborative Group
Copyright 2008.  SOWSIA Healthcare Solutions, Inc. All rights reserved. (blog@sowsia.com) www.sowsia.com

Privacy in the eye of a storm

Health information privacy is achievable.  However, fulfillment of this promise requires free flow of information between systems that are used to provide care, development of common standards so that patient data can be securely ported across clinical settings, safeguarding and tracking the communication and access to medical records; with special attention given to locking the pieces of health data that are considered very personal and privileged by the rightful owner of that data - the patient.

A patient cannot be expected to negotiate the complexity to manage scattered bits of private health data unless health information is collated and unified in a simple and easily accessible manner.  We can all appreciate how the lack of availability of meaningful health information at the time when it is needed most (e.g. immunization and allergy records, medicating use history) contributes to errors and delayed care.  Current market solutions do not provide solutions that address these issues.  Actively provisioning for privacy at every step and securely protecting sensitive patient health information through patient driven control mechanisms is not something that is a burning priority lighting up their radar screens anytime soon.  For Ondemand healthcare, this was a core premise around which all solutions were designed.

While legal framework is only just beginning to take shape and while it remains our collective opinion that well guided public policies driven by public debate can improve care delivery by increasing access to information while preserving the privacy of information considered sensitive by an individual; it cannot be a pre-condition for righteous action.  And though there is little doubt that widespread use of Electronic Health Records has the potential to benefit patients and other stakeholders, lower administrative costs, reduce complexity for those providing care; much work still remains to be done by other Healthcare IT companies to ensure total privacy by patient determined choices.

The tenets of physical, organizational or informational privacy need not be subjugated to an IT enabled trade-off that mandates a servile surrendering of an individuals interests to the larger and more powerful interests of business groups whether through explicit promises or implicitly disguised yet clearly perceived benefit.

Nowadays, groups with as divergent interests as Health Insurers and Health Providers are seeking convergence in health exchanges, data banks, electronic registries, data vaults and Regional Health Information Organizations (RHIO's).  Regulation and generous Government grants are making unwilling partners travel together to their preordained destinies of a National Health Information Network (NHIN).  Conditions suddenly have now become conducive for the creation of something more than just a "privacy headwind".

Privacy, today is in the eye of a storm.  Portability of health data over a network is taking priority.  Individual patient rights thus stand threatened to become the sacrificial goat.  It is therefore very critical that individuals understand the two divergent views on health record privacy as well as clarify the position that their vendors take on this issue.

To some, privacy means controlling patient's data within their closed environments even if it means disenfranchising the rights of patients through lack of provision for access by patients themselves.  A subset of this group even openly advertises the fact that health data of patients will be mined (and sold for profit). Another variant hides behind the mechanism of "cookies" or the fact that "third party access has confidentiality agreements" which would therefore obviate the need for an autopsy of the issue.  They have blatant statements in the user agreements that they hope someone will overlook.  These statements claim “aggregated information from the Service for marketing” may be disclosed.  Users who click "I agree" will be delivering future downstream concerns about privacy that would be dead on arrival.  These vendors are so open minded that they even tout their storage in "other country(ies)" as an honor that deserves recognition from audiences worldwide.  It is not without reason though.  The thought is that downstream in some public court, this statement will somehow magically help their circumventing of HIPAA applicability on US soil and liberate them from direct accountability to their users; if not themselves.  There are others who advertise their partnering or acceptance of "oversight" by external agencies.  Sounds wonderful, doesn't it?  Except for the fact that these "overseeing" partners would also need oversight - from the little guys - the patients to whom this data belongs in the first place!

To others, like us, privacy was a moral and ethical principle that could not be compromised ever.  We chose to take the hard road.  Ondemand healthcare chooses to spend their energies in educating members on our network, increasing patient awareness, empowering and enabling them to exercise their rights and collaborating with them in ways that will contribute to the richness of an open and yet hugely secure information infrastructure, one built on the flames- not ashes of privacy.

Just as physicians, patients too need their health information to be available to them when they need it.  Their right to choose whether they consent or refuse, whether they elect to participate or not needs to be respected and embraced.  Healthcare IT organizations today, therefore, need to embody privacy concepts within the framework of a patients right to self determination as part of their corporate mantra; like Ondemand healthcare has.  Only then, can they lead the path with healthcare solutions that mirror these patient needs and develop novel methods and applications that comprehensively achieve such goals for their customers.  Investments in valiant efforts like these will eventually serve to create the building blocks for highly secure information infrastructures built on trust and respect for patient's rights.

:- Sandeep Jain, MD
Copyright 2008.  SOWSIA Healthcare Solutions, Inc. All rights reserved. (blog@sowsia.com) www.sowsia.com

Collaboration: Empowering communities to deliver themselves

Individuals have the power to improve the environment they live and work in.  Yet, their voices frequently get drowned in the corporate noise when the priorities of corporations differ from those of the individuals themselves.  The time has come for technology to become its own best propagator, through ongoing collaboration between the users and those that create it.  There is a need to cross the chasm, the digital divide - not just here, but everywhere around the world.  Life has equal value.  Saving life is no different.  Doctors and nurses can use technology to save more lives and positively impact the well being of thousands more.

With the advent of the Internet and SaaS, the time has arrived for a new kind of community that has no boundaries, one that bases the development on collaborative best effort - not on development of singular and distinctive captive technology.  Individuals within these communities can now begin to get empowered and capable of delivering themselves from situations down the road - when they become unwilling patients themselves.

Healthcare is a highly specialized and extremely complex business that continues to grow exponentially in the amount of data it creates.  Healthcare professionals worldwide are respected for their ability to thrive and work in such demanding and ever-changing environments.  They face new requirements and evolutionary changes of existing ones with great endurance and patience - whether it is medication safety alerts, refills, new reporting, pay for performance, quality measures or HMO related formularies, insurance approvals or authorization rules.  And this is on top of all the other basic business processes that need constant monitoring and alerts - whether it is health maintenance issues or patient recalls or consultation reports or abnormal labs.

ONDEMAND HEALTHCARE .net team is a great mix of healthcare professionals like yourself who live and breathe in this environment on a daily basis and highly experienced software specialists in Information Technology as it relates to the concepts of the National Health Information Network of tomorrow.  We understand the challenges that IT investments can involve at your end.  IT headaches are the last thing that you need to get distracted by.  They can not only consume a lot of time and energy but also leave you poorer and stranded with patient information locked in outdated proprietary systems.  The Physicians, Nurses, Pharmacists and Case Managers and IT professionals on our collaborative groups have solved exactly these challenges.

While we cannot take away your business challenges, we can certainly make it simple for you to embrace the obvious advantages that technology has the power to bring to your practice environment - advantages that you all know of but couldn't afford; benefits that you have known can be delivered but no one has come forward to offer payment for.

Our SaaS model is the most affordable out there.  It is based on cutting edge technology empowered by solutions that offer far more functionality than traditional systems- all designed and delivered by our collaborative group.  They are innovative, user friendly and will enable you to continue to focus on managing your business.  ONDEMAND HEALTHCARE .net team promises to take care of your software and network needs while you continue to take care of your patients and your non-IT business needs.

In keeping our end users in mind and improved patient outcomes at the center of this, we have simplified the use of software in healthcare by removing ambiguity and decreasing complexity.  What you see is what you get.  There are no hidden fees or captive contracts.  We have not just eliminated equipment purchase costs today but also your downstream upgrade costs.

So why wait? Register now. Get your unique account ID and try all applications and services free for 90 days.

We do not sell your personal information or patients information. That's our promise.

:- SOWSIA Collaborative Group
Copyright 2008.  SOWSIA Healthcare Solutions, Inc. All rights reserved. (blog@sowsia.com) www.sowsia.com