explains why technical standards are needed in the development and integration o
ID: 108323 • Letter: E
Question
explains why technical standards are needed in the development and integration of health care information systems. Then, select three specific technical standards for health information technology (one identifier standard, one general communications standard, and one specific communications standard) and research each of these standards through a literature review. For each of these three standards, be sure to identify the health informatics-focused organization that coordinates the standard and explain the reason(s) that the organization promotes the standard.
Explanation / Answer
Technical standards are essential to improving healthcare. For health IT to reduce medical errors and risk to patient safety, improve access to medical records, and support innovations in “individual-based” care, its tools must adhere to certain data interchange standards. Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Standards also enable aggregation of information from disparate sources and sophisticated reviews of such information to glean knowledge that can inform clinical decisions.
Often these standards developing organizations (SDOs) form because of a perception that a new requirement is not met by an existing organization. The unfortunate result is a multitude of SDOs, which risks generating industry confusion over standards adoption rather than enhancing interoperability among disparate communities. The multiplication of organizations happens naturally enough. At the time of an SDO’s creation, the reasons and need for it seem realistic, at least to the individuals creating the organization. Over the subsequent years, its scope widens to meet the needs of its domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals.
Globally, similar SDOs are created to meet national and regional requirements. There has been limited collaboration to date. However, collaboration in the generation of harmonized standards from the very onset of development can be mutually beneficial, complementary, and valuable to the entire industry. The success of this approach is exemplified by the relationship of Health Level Seven (HL7) and the Clinical Data Interchange Standards Consortium (CDISC). Recognizing common interests, the two organizations agreed to share resources and build upon common interests. Joint work groups serve as forums in which members of both organizations harmonize standards and work together on common products. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management.
While not a data standard in the traditional sense, being able to link a patient’s health care data from one departmental location or site to another unambiguously is important for maintaining the integrity of patient data and delivering safe care. The administrative simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) originally mandated the implementation of a unique health identifier for individuals. However, Congress withheld funding of the implementation pending adequate federal privacy protection. Now that the HIPAA privacy rules have been implemented nationwide, means to link patient data across organizations should be revisited. In the meantime, pragmatic approaches to linking patient data have been emerging within the provider community. One approach used by many health care systems is the enterprise master patient index, which essentially creates a local unique patient identifier for persons cared for within a single health care system.
Since most health care is local, and relationships among patients, physicians, and specific hospitals are ongoing, this approach has served as a viable interim solution; however, it is costly to maintain, does not address the issue of data coming from other systems of care, and requires the development of matching algorithms to solve such problems as patients with similar names. Because no algorithm is perfect, a small percentage of attempted matches will result in errors that can be recognized and reconciled only through human intervention. Another approach under study, developed by the Patient Safety Institute (PSI) for its project to link health care providers statewide, is based on the Visa credit card network system which allows for connections among doctors’ offices and hospitals. In PSI’s network, PSI manages the automated system as a master patient index of only patient names and their identification numbers. Each hospital/clinic’s method for identifying the patient data is mapped to this index, which is maintained by PSI.
All medical data are retained by the health care organizations behind secure firewalls. Initially, authentication was accomplished through established hospital procedures. A three-key approach to authentication is in the process of being implemented: card and password for patient, digital certificate and password for physician, and permission key for the hospital or clinic. As of his writing, control features have not been implemented; access to medical information is “all or nothing.” PSI is now in the process of implementing controls for two levels: general medical information and sensitive information (e.g., mental health, drug rehabilitation, HIV). Patients voluntarily opt into the program to allow their physicians access to past diagnoses, laboratory results, medications, allergies, and immunizations. Sensitive medical data (e.g., HIV status) are excluded from level-one access.
PSI has also developed a set of guiding principles to safeguard access and limit exposure of patients’ electronic medical data. These principles include avoiding use of a patient’s social security number as their unique identifier, never releasing a patient’s medical records to anyone without the patient’s express authorization, physically separating a patient’s clinical and demographic data, and using cutting-edge encryption technology and secure private networks. Information Exchanges Standards define the structure and syntax of the electronic communication and are referred to as the standard ways of sending and receiving information. There are two information exchange standards such as a message-based, i.e., information is sent as a message; and a document-based, i.e., information is sent as a structured document (form). The goals and activities of telemedicine and health IT are complementary and synergistic. Telemedicine is a method of delivering health care that makes use of health information technologies to accomplish its goals.
Conversely, health information technologies (HIT) are an enabling component to the delivery of health services over distances, providing fundamental tools and systems. In short, HIT greatly enhances the utility of telemedicine. It is also important to acknowledge a distinction – telemedicine is not a type of HIT. Certainly tele health is dependent on the use of telecommunications and related forms of advanced technologies but it fundamentally describes the delivery of patient and consumer care. In some respects the distinction reflects a difference between clinicians and the IT world. It is important that the differences be recognized, understood and accepted so that tele health and HIT can work together in order to optimize the delivery of health care. The illustration below depicts how the varieties of tele health and health information applications fit within the larger system of medical care. The base of health information technology supports the deployment and use of electronic health records, administrative applications consumer information services and core clinical services (of which telemedicine is one component in the delivery of those services).
All applications and HIT components are interrelated. For example, the EHR supports the care delivery system in its multiple modes. Telemedicine is facilitated by access to an interoperable EHR that can allow the practitioner to review and evaluate all of the necessary information about the patient prior to and while the patient is being seen. Making use of a fully implemented EHR will improve the quality of care delivered by tele health mechanisms in the same manner that the EHR will have a general impact on the quality of care in ANY practice modality. The faculty of WCJC’s HIT program have a responsibility for the welfare of the patients treated or otherwise affected by students enrolled in the College as well as for the educational welfare of its students relative to the educational programs of the College. In order to fulfill this responsibility the Department Head for the HIT program of the College maintains that certain minimal technical standards must be present in applicants to the HIT educational program of the College.
Candidates for the associate of applied science degree must have the following essentials: motor skills; sensory/observational skills; communication skills; intellectual-conceptual, integrative, and quantitative abilities; and behavioral/social skills and professionalism. In order to fulfill this responsibility the Department Head for the HIT program of the College maintains that certain minimal technical standards must be present in applicants to the HIT educational program of the College. Candidates for the associate of applied science degree must have the following essentials: motor skills; sensory/observational skills; communication skills; intellectual-conceptual, integrative, and quantitative abilities; and behavioral/social skills and professionalism. It is also important to acknowledge a distinction telemedicine is not a type of HIT. Certainly tele health is dependent on the use of telecommunications and related forms of advanced technologies but it fundamentally describes the delivery of patient and consumer care. In some respects the distinction reflects a difference between clinicians and the IT world. It is important that the differences be recognized, understood and accepted so that tele health and HIT can work together in order to optimize the delivery of health care.
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