Reference no: EM133514845

Case Study: Memorial Hospital is the largest trauma hospital in Manchester County. It consists of a main hospital with 1,100 beds and six surrounding outpatient and specialty clinics. Memorial has been having a difficult time sharing information and coordinating the care of its patients throughout the care cycle. Currently, when a patient is discharged from the hospital, there is no way to track the patient's outcomes unless he or she revisits or is readmitted to the hospital. Additionally, when a patient comes into Memorial as a new trauma patient or is transferred from a different hospital, it takes a great deal of time to retrieve the patient's medical information (past medical history, comorbidities, tests received, current medications, etc.). These challenges have led to further issues such as duplicate tests, delays in diagnoses, increased medication errors, more hospital readmissions, and decreased patient satisfaction.

In an attempt to combat these issues, Memorial Hospital recently joined a board that is leading an initiative toa new community-wide health information exchange (HIE) network. Greater Manchester County is planning to build the Manchester Health Access Network (MHAN). The MHAN is a nonprofit HIE system that would be governed by this local community public health board. The primary objective for establishing the MHAN is to link all healthcare providers in the region and improve care coordination via a secure network of electronic medical record systems. The MHAN would cover ten boroughs with roughly 2.6 million people and would involve 1,950 providers in 12 member hospitals.

The community board received state funds to complete the project, but it is on a tight budget. The good news is that all the providers in the network already store patient information electronically via electronic medical records (EMRs) that consist of useful portals and interfaces that can quickly and securely transmit information. However, while Memorial Hospital has a functional clinical data warehouse (CDW) and an accompanying data dictionary that describes the collected data types, formats, structures, and usage components, not all of the hospitals in the network do as yet. The existence of the CDW and data dictionary will help facilitate interoperability, which is a key component of the project.

The board will need to consider additional building blocks for interoperability as well. The standards that MHAN would like to employ to achieve successful interoperability include those set forth by the Nationwide Health Information Network (NHIN). The NHIN was established by the Office of the National Coordinator for Health Information Technology (ONC) to provide recommendations for a common, web-based platform for health information exchange. These recommendations involve securing HIE transmission via services, protocols, standards, specifications and legal agreements such as the following: standardized healthcare classifications and vocabularies like ICD-10-CM and SNOMED CT for homogenizing meanings; HL7 for normalizing structures; laws, policies, and formal procedures for regulating the transport of information; National Institute of Standards and Technology (NIST) standards for controlling security; and application programming interfaces (APIs) for standardizing services. Moreover, MHAN would like to use a master patient index (MPI) to ensure patient information is stored in one record and is not duplicated. This MPI database makes certain that every patient is listed just once within all hospital data systems.

The board must decide which model is the best to achieve interoperability and stay within budget all while improving the efficiency, coordination, and quality of care. It must also determine what type of data extraction techniques to use. The board can choose between centralized, federated/decentralized, or hybrid models.

The centralized model will come with a single clinical data warehouse (CDW) that will be maintained by the board but will also include a health information manager (HIM) from each member organization. With this model, the patient information from each member hospital will be securely stored in and transmitted from the CDW. Additionally, the information will be continually updated through interfaces that connect each member hospital's electronic health record (EHR) to the CDW using unique patient identifiers. This model enables a high level of interoperability. However, it is very expensive to develop and difficult to maintain.

The alternative is a decentralized or federated model. Rather than a single CDW, the federated HIE model is composed of multiple CDWs belonging to each member hospital. Each member hospital provides the central HIE-governing body with patient identifiers unique to the particular hospital, which are then stored in an overall HIE registry. This registry will be filled with various unique types of identifiers based on those given by each hospital. In order to obtain patient data in this type of HIE, the member hospital must send a query to the overall HIE registry. The HIE registry has a record locator that is searchable by patient identifiers, and the central governing body supplies the physical location of the record to the requesting organization. The requesting organization must then request the patient information from the facility that houses the information. The facility will then send the information via some kind of secure service (e.g., VPN, email, portal). Although it is quicker to develop, less costly, and easier to maintain, this decentralized model involves several steps to acquire data, is more time-consuming, and is less interoperable than the centralized HIE model. Furthermore, it generates such challenges as increasing the risk of duplicate health records due to CDWs existing at multiple locations and hindering the consolidation of a patient's complete, updated health record.

The hybrid model would be a combination of the two, likely including a centralized CDW interfacing with data from each local remote CDW. The remote CDWs would transmit information to the centralized CDW, all systems would use the same unique identifier, and the patient information would be directly accessible to the representatives of each member hospital. The healthcare leaders on the MHAN central governing board need to determine the best HIE architecture model to implement. Regardless of which model is chosen, it appears that adopting the MHAN infrastructure is just what Memorial Hospital needs to resolve its current challenges.

Specifically, the following critical elements must be addressed:

Question 1: Introduction

• Based on the details provided in the scenario, summarize the issues the hospital is experiencing.
• Determine what information and data should be exchanged between organizations. Justify your reasoning.
• Determine what information and data should not be exchanged between organizations. Justify your reasoning.
• Describe the health information exchange (HIE) model you would implement. Justify why you selected this model.
• Based on the HIE model you would implement, describe how you will extract data you are seeking from the health information system.
• Explain how you will analyze and use the data in the HIE network to improve patient outcomes.

Question 2: Interoperability

• Determine the classification standards and terminologies necessary for successful interoperability and security.
• Describe the technologies needed for successful interoperability and security.
• Determine the legal and ethical standards and regulations that impact a health information exchange.
• From a compliance standpoint, describe the measures that should be put into place to protect patient information
• Explain the steps in the information governance life cycle, justifying the importance of including these components in an information governance plan.

Question 3: Data Dictionary

• Explain the content that should be included in a data dictionary, justifying your explanation with examples.
• Explain how you would manage and maintain the elements in a data dictionary.
• Explain the importance of adopting and using vocabulary standards.
• Explain how the application of the data dictionary to the organization's information system infrastructure can support data standardization and exchange.

Question 4: Communication

• Describe the stakeholders that will be affected by the change.
• Based on who will be affected by the change, describe how you will communicate the impact of this change to those individuals.
• Describe how you will ensure buy-in and participation from stakeholders.