Definition of medical information exchange
The United States faces the greatest shortage of medical practitioners in our country, which is aggravated by the growing geriatric population. In 2005, for every 5,000 US residents over 65, there is one geriatrician, and only nine of the 145 medical schools taught geritris. By 2020, it is estimated that there are 200,000 doctors and more than a million nurses in the industry. Never, in the history of US healthcare, so much was required with so many personnel. Because of this lack, combined with an increase in the geriatric population, the medical community must find a way to provide timely and accurate information to those in need, uniformly. Imagine if flight controllers spoke the native language of their country, and not the current international language in English. This example reflects the urgency and critical nature of our need for standardized healthcare communications. A healthy exchange of information can help increase safety, shorten hospital stays, reduce treatment errors, reduce redundancy in laboratory tests or procedures, and provide a faster, more compact and productive health care system. The aging US population, along with those suffering from chronic diseases such as diabetes, cardiovascular diseases and asthma, will need to see more professionals who will need to find a way to communicate with primary health care providers effectively and efficiently.
This effectiveness can only be achieved by standardizing the mode of communication. Healthbridge, based in Cincinnati HIE and one of the largest community-based networks, was able to reduce its potential outbreaks from 5 to 8 days to 48 hours with a regional exchange of medical information. Regarding standardization, one author noted: “Compatibility without standards is a language without grammar. In both cases, communication can be achieved, but the process is cumbersome and often ineffective. ”
United States retailers switched more than twenty years ago to automate inventory, sales, accounting controls that all increase efficiency and effectiveness. While it is inconvenient to think of patients as inventory, this was part of the reason for the lack of transition in primary health care for automating patient records and data. Imagine a Mom & Pop hardware store on any square in mid-America, packed with inventory on the shelves, ordering repetitive widgets based on a lack of information on current stocks. Visualize any Home Depot or Lowes, and you will get an idea of how automation has changed the retail sector in terms of scalability and efficiency. Perhaps the “art of medicine” is an obstacle to more productive, effective, and rational medicine. Standards for sharing information have existed since 1989, but recent interfaces have evolved more rapidly due to increased standardization of regional and state changes in health information.
History of Health Information Exchange
Major urban centers in Canada and Australia were the first to successfully implement HIE. The success of these early networks was related to the integration with the EHR primary care systems that already exist. Health Level 7 (HL7) is the first standardization system for health status in the United States, starting from a meeting at the University of Pennsylvania in 1987. HL7 has successfully replaced outdated interactions, such as faxing, mail, and direct communication with suppliers, which often represents duplication and inefficiency. The interplay of processes increases the human understanding of network systems for integration and communication. Standardization will absolutely influence how effective communication is, since grammar standards contribute to better communication. The United States National Information Network (NHIN) sets standards that facilitate communication between health networks. HL7 is now on the third version, which was published in 2004. The objectives of the HL7 are to increase interoperability, develop agreed standards, train the industry of standardization, and collaborate with other sanctions bodies such as ANSI and ISO, which are also concerned with process improvement.
In the United States, one of the first HIEs launched in Portland Maine. HealthInfoNet is a public-private partnership and is considered the largest public HIE. The goals of the network are to improve patient safety, improve the quality of clinical care, increase efficiency, reduce duplication of services, more quickly identify public threats and expand access to patient records. In 2004, four founding groups began their work: the Access Foundation in Maine, Maine CDC, the Maine Quality Forum and the Maine Health Information Center (Onpoint Health Data).
The Tennessee Regional Health Information Agencies (RHIO) began in Memphis and the Three Cities region. Carespark, 501 (3) c, in the Tri Cities region is considered a direct project, where clinicians interact directly with each other using the Carespark HL7 system as an intermediate level for bidirectional data transfer. Veterans Affairs (VA) clinics also played a crucial role in the early stages of building this network. In the Midsouth delta eHealth Alliance is the RHIO, which links Memphis hospitals, such as the Baptist Memorial (5 sites), Methodist Systems, Lebonne Health, Memphis Clinic, St. Francis Medical System, St. Jude, Regional Medical Center and UT Medicine. These regional networks allow practitioners to share their medical records, laboratory medication values and other reports in a more efficient way.
Seventeen American communities were defined as lighthouse communities in the United States based on their HIE development. These communities focus on health varies depending on the patient population and the prevalence of chronic diseases, ie cvd, diabetes, asthma. Communities focus on specific and measurable improvements in quality, safety and efficiency by improving the exchange of health information. The closest geographic community of Beacon in Tennessee, in Byhalia, Mississippi, south of Memphis, received a grant of $ 100,000 by the Department of Health and Human Services in September 2011.
The Nashville health model for emulation is located in Indianapolis, Illinois, based on geographic proxies, city size and demographic population data. The Four Lighthouses was awarded to communities in Indianapolis, health care, and a hospital in the Marion County Corporation, Indiana Health Centers, Raphael Health Center, and Shalom Health Care Center. In addition, Indiana Health Information Technology Inc received more than $ 23 million in grants through the Cooperation Agreement between the HIE and the 2011 HIE Challenge Grant Applications through the federal government. These awards were based on the following criteria: 1) Achieving health goals through health information sharing 2 (Improving long-term and post-transition transitions 3) Consumer information sharing 4) Enabling advanced patient care query 5) Promoting distributed analytics of population level,
Regulatory aspects of health information sharing and health care reform
The Department of Health and Human Services (HHS) is the regulatory authority that monitors health problems for all Americans. HHS is divided into ten regions, and Tennessee is part of District IV, headquartered in Atlanta. Regional Director Anton J. Gunn is the first African American elected as Regional Director and brings a wealth of experience to his role based on his public service, specifically relating to poor health care patients and changes in health information. This experience will serve him well as he faces social and demographic problems for patients with insufficient and chronically ill in the southeast.
The National Health Information Network (NHIN) is a division of HHS that guides the standards of exchange and regulates the regulatory aspects of health care reform. NHIN's collaboration includes such departments as the Center for Disease Control (CDC), Social Security Administration, Beacon Communities, and the State HIE (ONC). 11. The Office of the National Health Information Exchange Coordinator (ONC) awarded US $ 16 million in additional grants to encourage innovation at the state level. Innovation at the state level will ultimately lead to improved patient care by reducing retesting, bridges to chronic patient care programs leading to continuity, and finally, public health alerts through institutions like CDC, based on this information. 12 Health Information Technology for Economic and Clinical Health Act (HITECH) funded by US dollars from the American Reinvestment and Reconstruction Act in 2009 . The goal of HITECH is to invest dollars in public, regional and state medical information export to create effective networks that are linked at the national level, the Community of Lighthouses and the Agreement on the exchange of information on the exchange of information on the exchange of information on the exchange of information on the environment were started through HITECH and ARRA . To date, 56 states have received grants for these programs totaling $ 548 million.
History of Health Information Partnership TN (HIPTN)
In Tennessee, sharing health information is slower than in places like Maine and Indiana, which are based on the diversity of our state. Delta has a significantly different network of patients and patient health than that in Tennessee, which differs from the Appalachian region in eastern Tennessee. In August 2009, the first steps were taken to establish the HIE staff, consisting of the non-profit company HIP TN. At this time a council was created, in December a council on operations was created. The first HIP TN initiatives were to link work through Carespark in northeast Tennessee with three cities in the Midsouth ehealth Alliance in Memphis. Government officials estimated the value of more than $ 200 million in 2010-2015. The company includes owners of medical, technical, legal and business personnel. Governor Phil Bredesen in 2010 provided 15 million to match federal funds in addition to issuing an Executive Order establishing an office for e-health initiatives with oversight by the Office of Administration and Finance and sixteen councilors. By March 2010, four working groups were established that focused on areas such as technology, clinical aspects, confidentiality, safety and sustainability.
By May 2010, data sharing agreements were concluded, and in June 2011, a pilot project was launched for a nationwide HIE, as well as a Request for Proposal (RFP), which was sent to more than forty suppliers. In July 2010, the fifth working group, a consumer advisory group, was added, and in September 2010, Tennessee was notified that they were one of the first states to approve their plans after the release of the Program Information Notice (IDU). More than 50 participants gathered together to evaluate vendor demonstrations, and a contract was signed with selected Axolotl supplier on September 30, 2010. At that time, the production goal of July 15, 2011 was achieved, and in January 2011, Keith Cox was hired as HIP TN. Kate brings a twenty-six year tenure in IT healthcare to collaborate. His previous ventures include Microsoft, Bellsouth, and several entrepreneurial efforts. The mission of HIP TN is to improve access to health information through a collaborative statewide process and provide a security infrastructure on this exchange. The vision of HIP TN is to be recognized as a state and national leader who supports measurable improvements in clinical quality and effectiveness for patients, providers and payers with a safe HIE. Robert S. Gordon, Chairman of the Board of HIPTN, says well: "We share the view that, although technology is an important tool, the focus is not on the technology itself, but on improving health." HIP TN is a non-profit, 501 (c) 3, which solely depends on government funding. This is a combination of centralized and decentralized architecture. Key suppliers are Axolotl, which acts as an umbrella network, ICA for Memphis and Nashville, CGI as a supplier in northeast Tennessee. The future goals of HIP TN include the gateway to the National Institutes of Health, scheduled for late 2011, and the clinician index in early 2012. Carespark, one of the original regional health networks, voted to cease operations on July 11, 2011, based on the lack of financial support for this new infrastructure. Data sharing agreements included 38 health organizations, nine communities and 250 volunteers.16 The closure of Carespark explains the need for a network that does not depend solely on government grants to fund its efforts, which we will discuss in the last section of this article.
Current state of health information exchange and HIPTN
Ten grants were awarded in 2011 by the addition of a HIE grant. They included initiatives in eight states and served communities with which we can navigate as HIP TN develops. As mentioned earlier, one of the most award-winning communities is less than five hours from Indianapolis, Indiana. Based on the similarities of our medical communities, patient groups, and demographic data, Indianapolis will be an excellent mentor to Nashville and hospital systems that serve patients in TN. The Indian Medical Information Exchange has been recognized at the national level for its “Documents for Documents” program and a way to interact since its inception in 2004. Kathleen Sibelius, secretary of HHS, commented: “The Central Indiana Beacon Community has a level of collaboration and the ability to effectively organize quality efforts from the history of building long-term relationships. We are very excited to work with a community that is far ahead of using medical information to achieve positive changes in patient care. ” Community lighthouses, which can act as a guide for our community, include the Health Corporation and Marion County Hospitals and Indiana Health Centers, based on their latest awards of $ 100,000 in HHS.
The local model of excellence in EMR practice turns into Old Harding Pediatric Associates (OHPA), which has two clinics and fourteen doctors who serve patients with 23,000 and more than 72,000 patients per year. The transfer of OHPA to electronic records in early 2000 resulted from a desire for excellence in patient care and a desire to use technology in such a way that their patients would benefit. OHPA has established a cross-functional working group to improve its practices in areas such as personnel, personnel, communications, technology, and external influences. Notably, it was chosen by the EMR provider based on user convenience and similarity with a standard tabbed patient chart for files. The software was configured in a pediatric environment with patient growth charts. Windows was used as an operating system based on supplier knowledge. Over the course of four days, OHPA ensured 100% compliance and use of its EMI system.
The future of HIP TN and HIE in Tennessee
Tennessee received about twelve million dollars in grant funds from the Public Health Information Exchange Cooperation Agreement 20. Regional Health Information Organizations (RHIOs) must be fully scalable to allow hospitals to develop their systems without compromising integrity as they grow. системы, расположенные в Нэшвилле, будут играть неотъемлемую роль в этом общенациональном масштабе с такими компаниями, как HCA, CHS, Iasis, Lifepoint и Vanguard. HIE будет выступать в качестве хранилища данных для всех пациентов, доступ к которым можно получить из любой точки мира, и содержит полную историю медицинской истории пациентов, лабораторные анализы, сеть врачей и список лекарств. Чтобы побудить поставщиков зачислять в государственную HIE материальную ценность, их практика должна быть показана с более безопасной опекой. В отчете редактора HIMSS за 2011 год Ричард Ланг заявляет, что вместо подхода сверху вниз «Более практичная идея может состоять в том, чтобы государства сначала поддерживали развитие HIE местного сообщества. После создания эти локальные сети могут подавать региональные HIE & s, а затем подключиться к центральной магистрали HIE / репозитория данных. Государства должны использовать часть стимулов для поддержки местного развития HIE ». Ланг также считает, что врач первичной медико-санитарной помощи должен быть основой всей системы, поскольку они являются основными точка контакта для пациента.
Одной частью головоломки, которую часто упускают из виду, является вложение пациентов в функциональный EHR. Для того, чтобы собрать все части головоломок HIE, необходимо будет играть более активную роль в их здравоохранении. Многие пациенты не знают, какие лекарства они принимают каждый день или у них есть живая воля. Существует несколько версий медицинской карты пациента EHR, например, 1111, но очень немногие пациенты знают или несут их.23 Один из способов борьбы с этим недостатком осведомленности - использовать больницу как уловку и разгрузку каждый пациент с полностью заряженной USB-картой через управляющие корпуса. Эта стратегия также может привести к лучшему соблюдению поста в терапии пациентов, чтобы уменьшить количество повторных сеансов.
В начале этого года началась реализация подключения квалифицированных организаций. Чтобы полностью поддержать организации в направлении повышения квалификации, Канцелярия Национального координатора HIE (ONC) назначила региональные образовательные центры (TN rec), которые оказывают помощь провайдерам с образовательными инициативами в таких областях, как HIT, ICD9, ICD10 и переход на ЭМИ. Qsource, некоммерческая консалтинговая фирма по здравоохранению, была выбрана для контроля TNrec. Чтобы обеспечить устойчивость, важно, чтобы Теннесси построил сеть частного финансирования, чтобы с компанией Carespark не случилось с HIP TN. В Отчете об исследованиях в области электронного здравоохранения за 2011 год сообщается, что из 196 инициатив HIE 115 действуют независимо от федерального финансирования и тех независимых HIE, что даже не отражается на операционных доходах. Некоторые из этих изменений существовали задолго до принятия Закона США о восстановлении и реинвестировании в 2009 году. Начало финансирования из грантов предназначено только для того, чтобы заставить автомобиль идти так сказать, устойчивое топливо, как это наблюдается в случае Carespark, исходит из стоимости которые могут быть монетизированы. Согласно исследованиям KLAS, 54% общественных HIE были обеспокоены будущей устойчивостью, в то время как только 35% частных HIE разделяли эту озабоченность.
Больничные последствия HIP TN (призыв к действию)
С финансовой точки зрения, перенос нашей больницы в будущее с помощью ЭМИ и интегрированной сети в масштабе штата имеет глубокие последствия. В краткосрочной перспективе затраты на поиск поставщика, создание ЭМИ в амбулаторных условиях и в амбулаторных условиях будут дорогостоящим предложением. Переход не будет легким или конечным и будет включать постоянную эволюцию, поскольку HIP TN интегрируется с другим состоянием HIE. Чтобы получить реалистичное представление о преимуществах и расходах, связанных с интеграцией информации в сфере здравоохранения. мы можем взглянуть на HealthInfoNet в Портленде, штат Иллинойс, государственном HIE, который рассчитывает сэкономить 37 миллионов долларов на предотвращенных услугах и 15 миллионов на снижение производительности. Конкретные области сбережений включают бумагу или факс стоимостью 5 долл. США по сравнению с 0,25 долл. США в электронном виде, экономию виртуальных медицинских записей составляет 50 долл. США за реферал, 26 долл. США, сэкономленные за посещение ED, и 17,41 долл. США на пациента / год из-за избыточных лабораторных тестов, которые составляют 52 млн. Долл. США для населения в 3 миллиона пациентов. В Grand Junction Colorado Health Health Network снизила расходы на оплату медикаментов на душу населения на 24% ниже среднего по стране, получив признание президента Обамы в 2009 году. Обмен информацией о здоровье в Санта-Крус (SCHIE) с 600 врачами и двумя больницами обеспечил устойчивость в первый год и использует абонентскую плату для всех организаций, которые взаимодействуют с ними. Что касается доступных правительственных долларов, существуют значительные стимулы для использования, чтобы побудить больницы выполнить двадцать двадцати пяти целей на первом этапе (2011-2012 годы), а также принять и внедрить утвержденного поставщика EHR. ARRA определила три способа использования EHR для получения возмещения Medicare. К ним относятся электронное предписание, обмен медицинской информацией и представление клинических мер качества. Цели второго этапа в 2013 году будут расширяться на этом базовом уровне. Реализация расходов на ЭХП и больницу HIE обычно взимается с постели или по количеству врачей. Плата может варьироваться от 1500 долларов США для больницы меньшего размера до 12 000 долларов США в месяц для больницы большего размера.
Возможно, самым убедительным аргументом в создании функционального обмена медицинской информацией является безопасность пациентов и сообщества. Прекрасным примером этого преимущества безопасности является сокращение Healthbridge при обнаружении вспышки заболевания 3-5 дней. Представьте себе последствия в случае необузданного вируса, такого как птичий или свиной грипп. Цель состоит в том, чтобы избежать повторения вспышки гриппа 1918 года и чрезвычайно спасти жизни наших наиболее подверженных риску. Рик Крон из Healthsense делает случай для социально ответственного HIE, который обслуживает тех, кто хронически болен, незастрахован и бездомных. Поскольку налогоплательщики крайне несут общественную нагрузку на здравоохранение нашей страны, необходимо уменьшить сокращение увольнений, повысить эффективность и обеспечить здоровье, достойное Соединенных Штатов. Прямо сейчас наше здравоохранение находится в Отделе критической помощи, чтобы стабилизировать его с помощью передового опыта, начиная с нашей больницы. Позвольте воссоздать Вавилонскую башню и улучшить общение, чтобы обеспечить нашим пациентам здоровье, которого они заслуживают!
