Healthcare Information Exchange Research Articles

Ontology driven meta-modelling of clinical documents

In recent days, distinct healthcare information systems use and exchange electronic clinical documents enormously. Further, modern technologies, such as connected home monitoring devices, incorporate contextual awareness into clinical documents. Besides this, today's healthcare domain is driven by emergence of new roles played by related stakeholders. Consequently, there is a need in healthcare information systems to achieve common semantic interpretation of clinical documents so that, 1) those can be exchanged among healthcare information systems meaningfully; 2) personalised document view in a specific context can be achieved effectively. To address these issues in this paper, an ontology driven meta-model for clinical documents is proposed. The proposed conceptualisation is implemented in an ontology editorial tool Protégé and illustrated using a case study based on e-prescription. Further, the specification is transformed towards JSON (Java Script Object Notation Schema) schema for demonstration of its practical utility.

Ontology driven meta-modelling of clinical documents

In recent days, distinct healthcare information systems use and exchange electronic clinical documents enormously. Further, modern technologies, such as connected home monitoring devices, incorporate contextual awareness into clinical documents. Besides this, today's healthcare domain is driven by emergence of new roles played by related stakeholders. Consequently, there is a need in healthcare information systems to achieve common semantic interpretation of clinical documents so that, 1) those can be exchanged among healthcare information systems meaningfully; 2) personalised document view in a specific context can be achieved effectively. To address these issues in this paper, an ontology driven meta-model for clinical documents is proposed. The proposed conceptualisation is implemented in an ontology editorial tool Protege and illustrated using a case study based on e-prescription. Further, the specification is transformed towards JSON (Java Script Object Notation Schema) schema for demonstration of its practical utility.

Institutional Approach to Healthcare Information Exchange: Focused on Medical Law

Institutional Approach to Healthcare Information Exchange: Focused on Medical Law

SAIF-refactored efficiency interpolation in the HL7 specifications development paradigm

The health standard Health Level 7-Service-Aware Interoperability Framework (HL7-SAIF) is the most popular and widely-used healthcare-related standard in global operation today. Originally introduced as HL7 in 1987 and recently melded with the SAIF technology, the standard has been embraced by the National Health Services of the most developed economies in Europe, North and South America, and Australasia. However, the standard is not without issues. Its current version v3 which supports Semantic Interoperability, the overarching and meaningful exchange of healthcare information amongst participating healthcare enterprises, has been found to be difficult to implement and maintain. A principle component of the HL7-SAIF v3 development paradigm is the recently integrated SAIF component which presents a significant and worrisome element of ambiguity. These issues in essence subvert quality specifications development, which permeates to difficult system implementation and sub-standard performance in operation. This research analysed many of the prevalent SAIF issues indepth, and effected smart, delicate, and prudent refactoring of this principle semantic interoperability driver, to derive optimal efficiencies in specifications development and implementation.

Sustainability of Healthcare Information Exchanges: A Game-Theoretic Approach

Based on our interactions with the key personnel of three different healthcare information exchange (HIE) providers in Texas, we develop models to study the sustainability of HIEs and participation levels in these networks. We first examine how heterogeneity among healthcare practitioners (HPs) (in terms of their expected benefit from the HIE membership) affects participation of HPs in HIEs. We find that, under certain conditions, low-gain HPs choose not to join HIEs. Hence, we explore several measures that can encourage more participation in these networks and find that it might be beneficial to (i) establish a second HIE in the region, (ii) propose more value to the low-gain HPs, or (iii) offer or incentivize value-added services. We present several other interesting and useful results that are somewhat counterintuitive. For example, increasing the highest benefit the HPs can get from the HIE might decrease the number of HPs that want to join the HIE. Furthermore, since the amount of funds from the government and the other agencies often changes (and will eventually cease), we analyze how the changes in the benefit HPs obtain from the HIE affect (i) participation in the network, (ii) the HIE subscription fee and the fee for value-added service, (iii) the number of HPs that request value-added service, and (iv) the net values of the HIE provider and HPs. We also provide guidelines for policy makers and HIE providers that may help them improve the sustainability of HIEs and increase the participation levels in these networks.

Sustainability Planning for Healthcare Information Exchanges with Supplier Discount Program

The Healthcare Information Exchanges (HIEs) facilitate the electronic transfer of health information among healthcare organizations. Several studies have shown that the HIEs have potential of saving billions of dollars per year and significantly improving healthcare delivery. In spite of that, only a few HIEs are operational, and even fewer have advance exchange capabilities. A key obstacle in the growth of HIEs is considered to be their financial sustainability. In spite of its importance, the issues of HIE sustainability have not been analyzed rigorously. Hence, the focus of our work is to understand the operational decisions of an HIE, and provide insights on making good'' decisions to ensure its long term financial sustainability. Some recent studies argue that the HIEs need to provide additional services in order to improve financial sustainability. In this direction, some HIEs have started partnering with external suppliers for the supplier discount program where each member receives a fixed rebate for each dollar spent via the network. Our model is developed for one such HIE based in Austin, Texas (Critical Connection). Although we present our model in the context of Critical Connection, we ensure that our model is generic enough to apply in other HIE settings as well. We investigate a two-period two-service model where an HIE offers (i) healthcare information sharing service, and (ii) supplier discount program. Our proposed model is primarily based on our interactions with a number of HIE providers in Texas. First, we present structural properties and equilibrium solution for our model. Then, based on extensive computational experiments, we present several useful insights for the HIE provider as well as the policy-makers.

Prescription Tablets in the Digital Age: A Cross-Sectional Study Exploring Patient and Physician Attitudes Toward the Use of Tablets for Clinic-Based Personalized Health Care Information Exchange.

BackgroundTo reduce the cost of health care while increasing efficiency and quality, health systems are seeking innovative means to engage and empower patients. Improved use of information technology and electronic health record (EHR) infrastructure is essential, and required for “meaningful use” as mandated by the federal government. Providing personalized health information using tablets at the point of care could enhance the clinical experience and enable efficient collection of patient reported outcome measures to guide clinical decision making.ObjectiveThe aim of this study is to explore patient and provider attitudes and interest in a proposed clinic-based tablet system for personal health information exchange. To provide a context to understand patients’ use of tablets during their clinic visit, we also examine patients’ current activities and time spent in the waiting room, and their use of health information resources.MethodsSurveys were administered to 84 patients in the waiting room of a community health center affiliated with Massachusetts General Hospital (MGH) in Boston, MA. This survey included a vignette and illustration describing a proposed tablet-based system in which the patient, upon sign in at the clinic, receives a tablet loaded with personalized information tailored to their specific medical conditions and preferences. Patients were queried about their interest in such a system in comparison to traditional forms of patient education as well as their current health information seeking behaviors and activities and time spent in the waiting room. Interviews with five MGH-affiliated health care providers were conducted to assess their opinions regarding the proposed tablet system.ResultsThe majority (>60%) of patients were “very” or “extremely” interested in the proposed tablet system and thought it would improve their knowledge about their medical condition (60%), assist them in making healthy choices (57%), and help them to feel more comfortable talking with their provider (55%). Patients thought the system would be more motivating, informative, and engaging than traditional printed health education materials. The tablet system was not considered more effective than face-to-face interaction with providers, though 44% thought it would improve their relationship with their physician. Overall, 91% of respondents were willing to learn how to use a tablet and 75% reported being “very” or “extremely” confident they could use one. Four of the five providers believed that the proposed tablet system would improve clinical workflow and patient education. Patients and providers were concerned about privacy and security of data collected using the tablets.ConclusionsBoth patients and providers were highly amenable to integrating tablets into the clinical experience, and tablets may be useful in improving patients’ health knowledge, the collection of patient reported outcome measures, and improved patient-provider communication. Further research into operationalizing such systems and their validation is necessary before integration into standard clinical practice.

Development, Validation and Deployment of a Real Time 30 Day Hospital Readmission Risk Assessment Tool in the Maine Healthcare Information Exchange.

ObjectivesIdentifying patients at risk of a 30-day readmission can help providers design interventions, and provide targeted care to improve clinical effectiveness. This study developed a risk model to predict a 30-day inpatient hospital readmission for patients in Maine, across all payers, all diseases and all demographic groups.MethodsOur objective was to develop a model to determine the risk for inpatient hospital readmission within 30 days post discharge. All patients within the Maine Health Information Exchange (HIE) system were included. The model was retrospectively developed on inpatient encounters between January 1, 2012 to December 31, 2012 from 24 randomly chosen hospitals, and then prospectively validated on inpatient encounters from January 1, 2013 to December 31, 2013 using all HIE patients.ResultsA risk assessment tool partitioned the entire HIE population into subgroups that corresponded to probability of hospital readmission as determined by a corresponding positive predictive value (PPV). An overall model c-statistic of 0.72 was achieved. The total 30-day readmission rates in low (score of 0–30), intermediate (score of 30–70) and high (score of 70–100) risk groupings were 8.67%, 24.10% and 74.10%, respectively. A time to event analysis revealed the higher risk groups readmitted to a hospital earlier than the lower risk groups. Six high-risk patient subgroup patterns were revealed through unsupervised clustering. Our model was successfully integrated into the statewide HIE to identify patient readmission risk upon admission and daily during hospitalization or for 30 days subsequently, providing daily risk score updates.ConclusionsThe risk model was validated as an effective tool for predicting 30-day readmissions for patients across all payer, disease and demographic groups within the Maine HIE. Exposing the key clinical, demographic and utilization profiles driving each patient’s risk of readmission score may be useful to providers in developing individualized post discharge care plans.

FHIR 기반 개인건강기록 프로파일링 시스템 개발방법

건강정보의 교환, 통합, 공유, 검색의 표준을 개발하는 Health Level Seven(HL7)에서 발표된 표준들은 글로벌한 의료정보 서비스에 성공적으로 사용되고 있다. 그러나 V2.x Message와 V3 Clinical Document Architecture(CDA)는 습득하고 개발하는 데 많은 시간이 소요되는 문제점이 있다. 개선된 Fast Healthcare Interoperability Resources(FHIR)를 사용함으로써 이러한 문제점을 해결할 수 있는 방법인지 모색한다. 개인건강기록이 사회적인 관심을 끌고 있고, 스마트폰 보급률이 급격히 증가하는 점을 반영하여 스마트폰으로 접속 가능한 개인건강기록 프로파일링 시스템을 개발한다. Furore에서 개발한 FHIR Profile editor tools을 통해 profile의 생성, 변경의 개선점을 찾아본다. 이와 같은 시스템을 구축하기 위해서 Electronic Medical Record(EMR) 시스템과 Personal Healthcare Record(PHR) 시스템 간의 정보교류를 FHIR Open API로 구성한다. PHR 프로파일링 시스템에서는 이들 트랜잭션을 RESTful 서비스로 제공한다. 본 연구에서는 FHIR를 통해 PHR 프로파일링 시스템 개발의 효율성을 검증한다. HL7 released V3 CDA(Clinical Document Architecture) and V2.x message standards for medical information exchange. Currently, these standards are successfully adopted by a number of nations across the globe. However, substantial amount of time is required to develop and implement these standards. Moreover, developers need a lot of time to understand these standards. To solve these issues from 2011, the HL7 standard framework started to discuss Fast Healthcare Interoperability Resources(FHIR) as next generation standard of healthcare information exchange. People's interests toward personal health record and smartphone penetration rate are growing and increasing rapidly. Therefore, our research team believes it is necessary to develop a PHR profiling system which could be accessed by using a smartphone and we developed the system. Through a FHIR Profile editor tool developed in Furore, we found that improvements could be made in generating and changing the profile. In order to build the PHR Profiling system, an Open-API on FHIR is used for exchanging information between electronic medical record system and PHR Profiling system. In the PHR Profiling system, the transactions of information between two systems are provided by RESTful service. In this study, we verify the efficiency of development of the PHR Profiling system through FHIR.

Semantic interoperability platform for Healthcare Information Exchange

Objectives: An important barrier to electronic healthcare information exchanges (HIE) is the lack of interoperability between information systems especially on the semantic level. In the scope of the ANR (Agence Nationale pour la Recherche)/TeRSan (Terminology and Data Elements Repositories for Healthcare Interoperability) project, we propose to set and use a semantic interoperability platform, based on semantic web technologies, in order to facilitate standardized healthcare information exchanges between heterogeneous Electronic Healthcare Records (EHRs) in different care settings.Material and methods: The platform is a standard-based expressive and scalable semantic interoperability framework. It includes centrally managed Common Data Elements bounded to international/national reference terminologies such as ICD10, CCAM, SNOMED CT, ICD-O, LOINC and PathLex. It offers semantic services such as dynamic mappings between reference and local terminologies.Results: A pilot implementation of semantic services was developed and evaluated within an HIE prototype in telepathology for remote expert advice. The semantic services developed for transcoding local terms into reference terms take into account the type of message and the exchange context defined within standard-based integration profiles.Conclusion: The TeRSan platform is an innovative semantic interoperability framework that (1) provides standard-based semantic services applicable to any HIE infrastructure and (2) preserves the use of local terminologies and local models by end users (health professionals' priority).

Comparison of Manual and Electronic Methods of Nursing Record: A Nurse's Perspective

Recording nursing reports is considered as a quality assurance tool for patients and nurses. Nowadays, the presence of electronic health record systems is an indicator of development. Studies on advantages and disadvantages of the electronic and manual recording methods have shown different results. In this study, electronic and manual recording of nursing reports were compared from the perspective of nurses. Methods: This descriptive-comparative study included all nurses in NICUs of two health centers equipped and non-equipped with electronic nursing records. A researcher-made questionnaire was used to evaluate and compare the viewpoints of nurses from four dimensions of accuracy and quality, time, health care information exchange, and control and management of nursing reports, after determining its validity and reliability. The data were analyzed with SPSS using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (t-test, chi-square, and Fisher’s exact test). Findings: Comparison of the survey’s subscales showed a significant relationship between the two subscales of time and control and management of nursing reports between the two centers. Nurses working in the center with manual system spent more time for writing nursing activities and there was a better control in the electronic system than the manual system. Conclusion: According to the results, despite many positive aspects, the electronic recording systems have still some defects which resolution is a responsibility of the designers of these systems.

A cross-national comparison of healthcare information exchange in primary care settings between the US and China: past, present, and future

A cross-national comparison of healthcare information exchange in primary care settings between the US and China: past, present, and future

Constrained elastic net based knowledge transfer for healthcare information exchange

Transfer learning methods have been successfully applied in solving a wide range of real-world problems. However, there is almost no attempt of effectively using these methods in healthcare applica...

Healthcare information exchange system based on a hybrid central/federated model.

The quality of care can be significantly enhanced and healthcare cost can be substantially reduced if healthcare providers can have access to patient records that are scattered among several paper and electronic based systems. Major challenges of Healthcare Information Exchange result from patient's medical records being kept in several healthcare provider offices, clinics and hospitals in different formats. There are two major problems with healthcare information retrieval. The first problem is lack of visibility and knowledge as to where patient's medical records reside. The second problem is lack of access to information and also incompatibility of data formats. A considerable coverage of Electronic Information Exchange among Electronic Health Record (EHR) systems remains to be implemented despite extensive standardization efforts toward providing solutions. The adoption pace of available standards and solutions has been slow with the exception of some public/government entities. This paper describes a comprehensive and practical solution based on a distributed system with independent subsystems that control and manage processes and data flow of information exchange. The Registrar Subsystem creates a directory of healthcare providers and patients. The Security Subsystem provides authentication and authorization services across all subsystems. The Locators address patient and medical location lookup. The Agents act on behalf of healthcare providers to communicate with other subsystems. The Mediators facilitate information retrieval. The Solution comprises of three levels of participation that allows healthcare providers to join the system easily by starting from basic semi-manual information exchange level and then migrating to a fully electronic and automated information exchange. The Solution is modeled based on variety of standards and protocols used in Internet and other application fields as well as healthcare specific standards and proposals.

A structural equation modeling approach for the adoption of cloud computing to enhance the Malaysian healthcare sector.

The investments and costs of infrastructure, communication, medical-related equipments, and software within the global healthcare ecosystem portray a rather significant increase. The emergence of this proliferation is then expected to grow. As a result, information and cross-system communication became challenging due to the detached independent systems and subsystems which are not connected. The overall model fit expending over a sample size of 320 were tested with structural equation modelling (SEM) using AMOS 20.0 as the modelling tool. SPSS 20.0 is used to analyse the descriptive statistics and dimension reliability. Results of the study show that system utilisation and system impact dimension influences the overall level of services of the healthcare providers. In addition to that, the findings also suggest that systems integration and security plays a pivotal role for IT resources in healthcare organisations. Through this study, a basis for investigation on the need to improvise the Malaysian healthcare ecosystem and the introduction of a cloud computing platform to host the national healthcare information exchange has been successfully established.

Augmenting security and accountability within the eHealth Exchange

The increased use of electronic medical records and online sharing of such records is motivated by improved quality of healthcare delivery. However, this use has raised security and privacy concerns because sensitive medical data could be exposed to a variety of threats that exist in the online world, leading to problems such as medical identity theft and billing fraud. If not addressed, such concerns could become a barrier to the large-scale adoption and sharing of electronic medical records. To ease such concerns, we argue that the eHealth Exchange, which is a federal initiative for online exchange of healthcare information, needs to be augmented to provide greater patient awareness and control. We take an approach that informs the patient when her health data is accessed by a healthcare enterprise that is not already trusted by the patient. Such awareness is ensured even when some systems in the health information sharing environment become compromised. We enhance accountability support within eHealth Exchange by using digitally signed logs of sharing records that cannot be modified or refuted. We implement and evaluate these mechanisms in the open-source CONNECT system that follows the eHealth Exchange specifications.

Professional and geographical network effects on healthcare information exchange growth: does proximity really matter?

We postulate that professional proximity due to common patients and geographical proximity among practice locations are significant factors influencing the adoption of health information exchange (HIE) services by healthcare providers. The objective of this study is to investigate the direct and indirect network effects of these drivers on HIE diffusion. Multi-dimensional scaling and clustering are first used to create different clusters of physicians based on their professional and geographical proximities. Extending the Bass diffusion model to capture direct and indirect network effects among groups, the growth of HIE among these clusters is modeled and studied. The network effects among the clusters are investigated using adoption data over a 3-year period for an HIE based in Western New York. HIE adoption parameters-external sources of influence as well as direct and indirect network coefficients-are estimated by the extended version of the Bass diffusion model. Direct network effects caused by common patients among physicians are much more influential on HIE adoption as compared with previously investigated social contagion and external factors. Professional proximity due to common patients does influence adoption decisions; geographical proximity is also influential, but its effect is more on rural than urban physicians. Flow of patients among different groups of physicians is a powerful factor in HIE adoption. Rather than merely following the market trend, physicians appear to be influenced by other physicians with whom they interact with and have common patients.

Optimal information security investment in a Healthcare Information Exchange: An economic analysis

The complexity of the problem, the increasing security breaches, and the regulatory and financial consequences of breached patient data highlight the fact that security of electronic patient information in Healthcare Information Exchanges (HIEs) is an organizational imperative and a research priority. This study applies classical economic decision analysis techniques and models the HIE based on its network characteristics to offer key insights into the issue of determining the optimal level of information security investment. We find that for an organization in a HIE, only security events with the potential loss reaching some critical value are worth protecting, and organizations would only spend a fraction of the intrinsic security risk on protection measures. Even when business benefit from security investment exists, organizations in a HIE tend to invest based on risk reduction alone. The implications of such decisions made at the node level and the resulting built-in moral hazard at the HIE level is discussed.

Network Effects in Health Information Exchange Growth

The importance of the Healthcare Information Exchange (HIE) in increasing healthcare quality and reducing risks and costs has led to greater interest in identifying factors that enhance adoption and meaningful use of HIE by healthcare providers. In this research we study the interlinked network effects between two different groups of physicians -- primary care physicians and specialists -- as significant factors in increasing the growth of each group in an exchange. An analytical model of interlinked and intragroup influences on adoption is developed using the Bass diffusion model as a basis. Adoption data on 1,060 different primary and secondary care physicians over 32 consecutive months was used to test the model. The results indicate not only the presence of interlinked effects, but also that their influence is stronger than that of the intragroup. Further, the influence of primary care physicians on specialists is stronger than that of specialists on primary care physicians. We also provide statistical evidence that the new model performs better than the conventional Bass model, and the assumptions of diffusion symmetry in the market are statistically valid. Together, the findings provide important guidelines on triggers that enhance the overall growth of HIE and potential marketing strategies for HIE services.

Connecting Patients, Providers, and Payers Improves Quality, Safety and Efficiency

Connecting Patients, Providers, and Payers Improves Quality, Safety and Efficiency