Scenario Background
Summary
The final project examines the Health Information Exchange (HIE) network establishment case at Memorial Hospital. Manchester Health Access Network (MHAN) must consolidate providers in 12 local hospitals and cover 2.6 million people (Southern New Hampshire University [SNHU], n.d.). The motivations for the introduction of such innovation were the challenges the organization faced, namely the difficulties of tracking the patients’ status after discharge and the long-term acquisition of information and medical history (SNHU, n.d.).
Problems in the records led to errors, readmissions, and increased treatment duration (SNHU, n.d.). While MHAN is able to solve highlighted concerns, its establishment also requires attention to many issues. Notably, in conditions of a limited budget, participants need to install the necessary equipment and hire and train employees. Moreover, providers need to make decisions about the HIE model and measures to ensure interoperability and compliance with standards.
Exchanged
Involvement in the HIE network will allow specialists to exchange a significant amount of data. However, the goals and characteristics of information that can be sent are regulated by laws and ethics. The case indicates that the hospital needs information such as current medications, test results, history, comorbidities, and similar details (SNHU, n.d.). Such data can be included in the exchange, as well as notes made by specialists during the treatment, referrals, and allergies (“Health information,” n.d.). Having the information highlighted allows providers to consider the specifics of the patient’s condition and make informed decisions for treatment.
Not Exchanged
Some data cannot be sent without the patient’s permission. It includes sensitive data such as notes taken during psychotherapy or the history of substance abuse (“Health information,” n.d.). Providers also cannot send the results of genetic testing of a patient without written authorization (“Health information,” n.d.). The unrestricted exchange of such data can harm the patient, for example, when calculating insurance payments or even establishing trust with the provider. Some sensitive data can lead to bias and expectations regarding patients’ health and, as a result, negatively affect treatment or the cost of insurance.
Model
Providers involved in MHAN have several options when choosing the HIE model – centralized, federated, and hybrid. They have contrasting features, and on this basis, the hybrid model is the most suitable for the case. Mainly, this approach uses the best characteristics of the other two models (Lee-Eichenwald, 2018).
The model implies the use of multiple clinical data warehouses (CDWs), but not all participants are required to have it (Lee-Eichenwald, 2018). Moreover, the hybrid type of HIE needs less resources and time investment than the centralized model but does not slow down the exchange of information as the federated one (Lee-Eichenwald, 2018). Since MHAN has a limited budget and time but needs a fast and safe exchange, the hybrid model is the best option.
Data Extraction
The architecture of the hybrid model affects the extraction of data by providers. With this approach, part of the information is stored in a centralized database available to all members, and some remain under the control of individual participants until the request is received (Lee-Eichenwald, 2018). As a result, query-based exchange is a form of exchange that is necessary for data extraction by MHAN members.
In this case, providers can search for information about the patient that they need in the system and send a query to receive it (The Office of the National Coordinator for Health Information Technology [ONC], 2019). At the same time, the data in the central repository are de-identified, and therefore, providers can quickly obtain and use them for research (Lee-Eichenwald, 2018). This format maintains a balance between security and data availability.
HIE Network
Establishing a HIE network has significant practical benefits for its members. It provides a safe and appropriate way to obtain vital information about the patient’s health and thereby improve the quality, speed, and safety of treatment (Lee-Eichenwald, 2018). The reason is that with information available about the patient, specialists make decisions based on facts and adapt care plans.
Moreover, the availability of a large amount of data makes it possible to apply statistical methods to analyze and obtain insights about the population’s health. Finally, the exchange of knowledge between professionals has the potential to reduce the variability of care, as proven methods will be used (Lee-Eichenwald, 2018). Therefore, HIE is necessary to improve services and patient health outcomes continuously.
Interoperability
Standards and Terminologies
Classification standards and terminologies are necessary to support security and interoperability. MHAN participants want to embody the standards set by the Nationwide Health Information Network (SNHU, n.d.). They include the use of the 10th edition of The International Statistical Classification of Diseases and Related Health Problems (ICD), SNOMED CT, Health Level Seven (HL7), and policies and formal procedures supporting standardization (SNHU, n.d.). Such clinical classifications, including dictionaries, nomenclatures, and vocabularies, contain lists of phrases, words, and codes with their meaning and are critical for interoperability and security (Palkie, 2018). Therefore, MHAN participants set the right task to support the operation of their network.
Technologies
HIE networks require the consistent work of employees and the application of technologies to support their benefits, security, and interoperability. In particular, when installing a network, it is necessary to use technologies such as master patient index, CDWs, record locator service, and data collection and storage systems (Lee-Eichenwald, 2018). application programming interface is also an essential technology for interoperability and security. It supports the ability to securely exchange data between different programs (Hopkins, 2020).
Other technologies for such purposes are cloud fax for storing information, direct messages for secure communication between providers, and query-based exchange (Hopkins, 2020). As a result, by providing themselves with the necessary technologies, MHAN participants will be able to maintain a safe HIE.
Legal and Ethical Standards
HIE is limited by laws and ethics to advocate patients’ interests. The patient’s right to decide on the sharing of information in such a network is protected by the principle of autonomy (Varkey, 2021). Moreover, this right is supported by state and federal laws – the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (Lee-Eichenwald, 2018). Simultaneously, legal and ethical regulations oblige providers to protect parts from unauthorized access and limit data types that can be distributed even after having permission to exchange information.
Compliance
From a compliance standpoint, organizations must follow ethical and legal standards and take specific measures to protect patient information. For example, HIPAA requires organizations to limit access to the information (Lee-Eichenwald, 2018). The law also requires the establishment of policies and procedures promoting protection, the use of reliable equipment, and technical measures such as encryption and risk monitoring (Lee-Eichenwald, 2018). Organizations need constant control over information systems and training of personnel to comply with the standards of practice.
Information Governance Life Cycle
To ensure adequate work with data, MHAN participants should set an information governance plan, considering the information governance life cycle stages. The first step, creating information, involves data collection and generation, and the plan should describe procedures to support their quality (Houser et al., 2017). The second stage is data processing and organization – attention to this measure in the plan will facilitate the search for information and navigation in available details.
The third step is the use of information in the hospital operation, and organizations, in their governance plans, must establish policies and procedures for this stage to comply with standards and regulations. The fourth step, storage and archiving, is also controlled by laws, as organizations must prevent privacy from breaking through (Lee-Eichenwald, 2018). Finally, the plan must specify the storage time to set a time frame for the fifth step – deleting information.
Data Dictionary
Data Dictionary
Data dictionaries are essential components for the operation of information exchange networks. The content of such a document usually includes information about the type of data, allowable values, and their meanings (National Library of Medicine, n.d.). For example, when interpreting numeric ranges presented in documents after checking blood pressure, 0 can mean that the indicators do not exceed the norm; one is close to the borderline, and two is high pressure (National Library of Medicine, n.d.). In this way, the dictionary provides data on data, clarifying their valuable definitions (The Centers for Medicare and Medicaid Services [CMS], 2021). Effective use of the dictionary requires careful maintenance from providers.
Manage and Maintain
Organizations must invest certain efforts and resources in dictionaries management and maintenance. Dictionaries built into information systems often have special tools and functions useful for maintenance (CMS, 2021). Moreover, hospitals can also attract specialists who will be responsible for controlling the dictionary. It is essential to ensure that dictionaries are constantly updated, and policies are set that will support a single record format (CMS, 2021). Policies and procedures should cover issues of dictionary security, access control, and repository reliability.
Vocabulary Standards
Another aspect of interoperability in HIE is the use of vocabulary and the support of their standards. The critical importance of setting standards is due to the fact that they eliminate ambiguities in the data perception (Healthcare Information and Management Systems Society, n.d.). When relying on standards, providers will be confident that they interpret terminology the same way, and therefore, their decisions will be clear. Such circumstances support interoperability and prevent problems that may interfere with the work.
Data Standardization
Data dictionaries are necessary for HIE as they contribute to data standardization. In particular, they provide clear definitions that support trust in and understanding of data (CMS, 2021). As a result, all data used by providers have the same format, which leads to consistency and standardization (CMS, 2021). Thus, data dictionaries have significant benefits, improving the quality of documentation, the use of data, and decision-making based on the information provided.
Communication
Affected
Considering the details of the case under study, one can highlight several stakeholders who will be significantly affected by the changes. In particular, 12 hospitals are involved in the creation of the network, where almost 2 thousand providers work, and the total number of the affected population includes about 2.6 million (SNHU, n.d.). Consequently, hospital staff, administration, and patients are critical stakeholders in the case.
The introduction of the HIE network means changes in the usual work routine, the need to teach new information and skills, and the use of new functions, which will affect the work of employees. The administration, in turn, should act as leaders in transformations and also influence the allocation of resources when creating a network. Finally, patients should be aware of how their information is treated and given permission to use it and are, therefore, also influential stakeholders. Given that HIE has significant benefits to practice, each party should be interested in establishing MHAN.
Communicating the Impact
Given the significant impact on stakeholders and the scale of transformations, organizations should communicate effectively about change. When announcing the shifts to stakeholders, it is essential to explain the reasons that prompted the modifications and the potential benefits (Swenson, 2018). Moreover, it is crucial to address the concerns of the parties caused by the changes, especially for patients, as they may fear for the safety of their information. This approach will provide the necessary attention to change, as well as support for trust in them. However, organizations still need to take action to engage stakeholders.
Participation
The strategy of attracting the attention of stakeholders and ensuring their participation in changes includes several stages. According to The Health Information Technology Research Center (HITR, 2013), there is a need to create a sense of urgency for change. Such a step may indicate problems that exist in the current position and suggest that transformations are required. Stakeholders should also understand what vision of the future is behind the changes, that is, learn how the practice will improve (HITR, 2013).
Finally, stakeholders should also know what expectations they have for the changes presented. For example, employees need to understand what contribution they need to make to change. In the case of patients, providers need to explain how their information will be used and obtain consent. In this way, organizations will ensure mutual understanding with stakeholders and will be able to engage them in change.
References
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Health Information Technology Research Center. (2013). Change management in EHR implementation. The National Learning Consortium.
Healthcare Information and Management Systems Society. (n.d.). Interoperability in healthcare. Web.
Hopkins, B. (2020). Four technologies that promote secure exchange of health data. Security Magazine. Web.
Houser, S. H., Slovensky, D. J., & Wang, L. (2017). Information governance for analytics support: Remember the life cycle component. Journal of AHIMA, 88(6), 38-40.
Lee-Eichenwald, S. B. (2018). Health information technologies. In P. Oachs & A. Watters (Eds.), Health information management: Concepts, principles, and practice (6th ed, pp. 355-404). AHIMA Press.
National Library of Medicine. (n.d.). Data dictionary. Web.
Palkie, B. (2018). Clinical classifications, vocabularies, terminologies, and standards. In P. Oachs & A. Watters (Eds.), Health information management: Concepts, principles, and practice (6th ed, pp. 143-173). AHIMA Press.
Southern New Hampshire University. (n.d.). HIM 350 case study. Web.
Swenson, D. X. (2018). Managing and leading during organization change. In P. Oachs & A. Watters (Eds.), Health information management: Concepts, principles, and practice (6th ed, pp. 645-689). AHIMA Press.
The Office of the National Coordinator for Health Information Technology. (2019). The 3 key forms of health information exchange. HealthIT.gov. Web.
Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28. Web.