HIM 3000 - chap 12: health information technology (part C)

what is interoperability

- Ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged (HIMSS)

health information exchange is the electronic movement of

- health-related information among organizations according to the nationally recognized standards (HIMSS)

health information exchange enables healthcare 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 (ONC)

what is the variability within interoperability and HIE challenges

- products

- services

what is the variability within interoperability and HIE challenges

- systems

- multiple clinical domains

what are interoperability and HIE challenges

- lack of cooperation between marketplace competitors

- legacy hardware integration

what are interoperability and HIE challenges

- commitment and trust relationships

- information complexity

what is information complexity

- Document structure used to share patient information at transition of care

what are different examples of information complexity

- consolidated -clinical document architecture (C-CDA)

- continuity of care document (CCD)

in a consolidated -clinical document architecture (C-CDA) the document markup standard

- specifies the structure and semantics of clinical documents for the purpose of exchange

a consolidated -clinical document architecture (C-CDA) is a

- specific type of CCD

in a consolidated -clinical document architecture (C-CDA)

- data exchange is machine-readable

- machine readable format only

a consolidated -clinical document architecture (C-CDA) can be used by the

- HIE systems and parsed out into patient records

a consolidated -clinical document architecture (C-CDA) format is specified as a

- requirement for ONC EHR certification

a consolidated -clinical document architecture (C-CDA) is also specified as a requirement for

- stage 2 of meaningful use

what is a continuity of care document

- an electronically generated, patient-specific clinical summary document using the clinical data architecture to create a machine-readable data transfer

data typically shared in a CCD includes

- patient demographics

- patient history

data typically shared in a CCD includes

- medications

data typically shared in a CCD includes

- procedures

- allergies

data typically shared in a CCD includes

- lab results

- immunizations

data typically shared in a CCD includes

- diagnosis

- health risk factors

information complexity includes models for

- HIE (help us overcome lack of interoperability - trying to get two different types to share their information between each other)

what are different models for HIE

- centralized HIE architecture

- decentralized HIE architecture

what are different models for HIE

- hybrid HIE architecture

- health record banking model

a centralized HIE architecture model has

- querying information

in a centralized HIE architecture model has

- all data stored in a shared repository

in a centralized HIE architecture model has

- data are pushed in a shared repository

in a centralized HIE architecture model has

- data are accessed through queries to the database

in a centralized HIE architecture model governance policies between

- the participants in the data warehouse dictate the scope of the data usage, patient consent for data sharing, and the specific standards and information that are exchanged

the advantages in a centralized HIE architecture model include

- uniformity of data

the advantages in a centralized HIE architecture model include

- quick response time to queries

the advantages in a centralized HIE architecture model include

- consistency in data accessibility

the disadvantages in a centralized HIE architecture model include

- increased changes of data duplication

the disadvantages in a centralized HIE architecture model include

- information not being current due to scheduling of data transfer from participants

the disadvantages in a centralized HIE architecture model include

- increased costs for development of data warehouse and support software

decentralized HIE architecture is

- called federated, most familiar with (how the internet works)

decentralized HIE architecture has a

- Record locator service (RLS) is the focal point for a query on a patient

decentralized HIE architecture data is more

- current in this model

decentralized HIE architecture RLS provides

- the ability to identify where records are located based upon criteria such as person ID and record data type

decentralized HIE architecture RLS provides

- functionality for the ongoing maintenance of the location information

decentralized HIE architecture manages

- the pointers to the information on the servers of the HIE participants

decentralized HIE architecture has pointers in an RLS that include

- a person ID number and metadata

decentralized HIE architecture RLS do not provide

- information about the record

advantages of a decentralized HIE architecture

- data remain under control of the HIE participant until needed

advantages of a decentralized HIE architecture

- there is data redundancy in the event of a disaster

advantages of a decentralized HIE architecture

- data is more current

disadvantages of a decentralized HIE architecture

- data potentially not available when needed due to a technical challenge

disadvantages of a decentralized HIE architecture

- potential lack of data sharing

disadvantages of a decentralized HIE architecture

- incomplete data because a patient across several participants

decentralized HIE architecture has

- Data and information remain on the servers of the participant hospital unit called for through a query - only occurs when there is a query

a hybrid HIE architecture model is a cross between

- the centralized and decentralized models

a hybrid HIE architecture model has some data

- stored in a centralized database and some remain on the servers of the HIE participants until queried

a hybrid HIE architecture model combines

- the functionality of a RLS and a centralized data repository

a hybrid HIE architecture model is a centralized database which enables

- the data for research queries from HIE participants and entities that have contracted for de-identified data

a hybrid HIE architecture model has a centralized warehouse that makes the

- data available faster and potentially more readily available to patients through a common patient portal tethered to the HIE instead of one hospital

a hybrid HIE architecture model has decentralized aspects providing more

- current data in the participants EHR and enhanced security for patient records that remain within the system so the most recent participation

a hybrid HIE architecture model has information

- remain tied to the indv participants creating redundancy that enhances data availability and integrity

a health record banking model is controlled by

- the patient

a health record banking model is an organization

- with information-sharing agreements between a group of healthcare providers that enables that aggregation and delivery of patient information to the patient under the control of the patient

a health record banking model utilizes

- a centralized data repository

a health record banking model received patient information from

- participating organization

a health record banking model is a

- longitudinal health record

a health record banking model has all the

- patient medical information collected

what are different HIE legal considerations

- opt-in, opt-out

- default-in, default-out

what are different HIE legal considerations

- consent portal

• ADT message

what does opting into the HIE do

- makes information available through the HIE

opt-in and opt-out depend on the

- state, HIE consent policy determine if the default decision for being part of an HIE is a default-in or default-out

if a state is a default-in decision state the provider is required to

- provide the patient with meaningful disclosure on the right not to participate in the HIE and must ask the patient if there is a preference not to participate

if a state is a default-out decision the provider needs to provide the patient with the

- opportunity to join the HIE - this makes the patient's information available to other participants in the HIR on an as-needed basis

where are consent portals used

- more rural areas use - used in organization that do not use an HER or PMS that generates an ADT message

what are ADT messages

- for those organization where the HIE interface is integrated into the HER, a decision to participate in the HIE or not to participate is communicated to the exchange through the transmission of an admission, discharge-transfer (ADT) message

what are different exchange methodologies

- direct exchange

• query based

what are different exchange methodologies

- consumer mediated

what are exchange methodologies look to improve

- public health recording, easier transfer or information

for direct exchange messaging exchange is an

- encrypted email platform

the encrypted email platform is with a

- health information internet provider (HISP) that restricts membership to verified medical providers

a direct message is viewed as an

- email in an HTML format and attachments are sent as PDFs

direct exchange are available to any provider that has access to

- an internet connection

what is direct exchange

- push technology

what is query based

- pull technology

- used in ER when there is an unexpected visit

for a query based, boolean search is in a

- centralized database or across multiple databases (using a record locator service) in a federated architecture

what is consumer mediated

- pull technology

- similar to how we view our bank information, public-private partnership

what does a consumer mediated provide to patients

- access to their health information, allowing the patient to manage their information exchange

a consumer mediated triggers a search across

- affiliated databases (centralized or federated) to aggregate their medical information for presentation to a provider

aggregating information is

- collecting information

what is stage 1 of HIE implementation include

- connectivity and aggregation of data

• MPI

• RLS

Once a participant is transmitting messages and data to the HIE's interface

- the aggregation of data that will enable the creation of the registry that allows the system to identify patients within its system begins

an MPI is a patient-identifying directory referencing all

- patients related to an organization and which serves as a link to the patient record or information, facilitate patient identification, and assist in maintain a longitudinal patient record from birth to death

an RLS provides the ability to identify where records are located based upon criteria such as a

• person ID and record data type and provide functionality for the ongoing maintenance of this location information

what do an MPI and RLS allow for the retrieval of

- information for indv patients

what is stage 2 of the implementation of the HIE

- exchange

• when you add information

what does stage 2: exchange use for its readable format for machine and humans

- HL7 (health level 7)

stage 2: exchange includes

- the exchange of clinical data

• CDA

what does the exchange of clinical data include

- Labs, radiology reports, medications, CCDs, discharge summaries, physician notes, and others

clinical document architecture is used as the

- standard for document exchange

a CDA document can include

- text

• images

• multimedia content

what is stage 3 of implementing HIE

- availability

the HIE is made available to the

- ambulatory care facilities and providers that refer patient to the acute-care facilities

the HIMSS identifies 5 categories of value the HIT provides and the value in HIE mirrors, they include:

- Improved communications with all stakeholders

the HIMSS identifies 5 categories of value the HIT provides and the value in HIE mirrors, they include:

- Improved patient safety through a reduction in medical errors and readmissions