Our current research builds onthe original AHRQ-funded research project in which we developed an information model for the patient centered medical home (PCMH) concept of care delivery. Intrigued by what we had discovered on the AHRQ project, we decided to continue doing research on our own.
We looked into interactions and information flows -- and associated workflows -- within and between different types of healthcare organizations and how they were directly connected to the healthcare services those organizations provided. We soon realized the framework of constructs, tools and techniques -- the approach we had developed to build an information model for the PCMH -- could also be used to build an information model of any type of healthcare providing organization (HCPO). That could lead to IT systems that were customized to the workflows of different types of HCPOs.
We were intrigued by the impact such a common specifications development approach, able to be used across all types of healthcare organizations, could have on health IT vendors and the systems they produce.
A Design Reference Model for Health Information Flows
As we looked at different interactions and information flows in different organizations, we came to understand that all organizations -- and individuals -- in the healthcare ecosystem can be viewed as nodes in a huge virtual network. From our perspective as informaticists they are heterogeneous nodes in a dynamic, adaptive, distributed network. Nodes use a variety of channels (phone, fax, F2F, Internet, etc.) to connect to other nodes. Once a connection is established, they exchange messages. The resultant IT design model mirrors the natural activity taking place in the healthcare ecosystem.
Our framework and approach also makes it possible for those interactions and information flows to be observed, isolated, mapped, and defined in detail -- down to the message level and even the data element level. From a health IT vendor's perspective, the network model -- which mirrors the landscape and the normal cycles and flows of the healthcare ecosystem -- could serve as a useful reference model for designing the next generation of their systems.
As the research progressed, we began to understand the ramifications of the totality of the pieces we had assembled. Having a common, high level reference model -- for the design of systems to support the delivery of healthcare -- would not only enable the next generation of health IT systems, but the next generation of our national health information infrastructure. The result would be systems that were more useful, more useable and truly interoperable.
We realized there was no way we could commercialize the approach by ourselves. We also recognized it was too important to just drop. We came to the conclusion that the healthcare community itself would have to coordinate such the effort -- nobody else was going to do it for them. In 2012, we established New Health Networks to coordinate our continuing research activities and to house, manage, and coordinate the contribution of our research results to the healthcare community.
Our Model Supports the Health IT Six (HIT6) at the Point of Care
Subsequent research revealed the six different lifecycles and information flows -- we're calling them SuperFlows until we come up with a better name -- that converge and intersect at the point of care. In an ideal situation, health IT systems would accommodate, support and integrate those six SuperFlows. Today's generation of standalone electronic health record (EHR) IT systems can't do that. It will take a new generation of health IT systems, architecturally congruent with a common design reference model of a networked healthcare ecosystem,
The Health IT Six SuperFlows are:
Patient -- The information about the patient. Information about their individual preferences and health history. Much of this information will come from the patient. We believe patients using trusted third parties to house and protect their online health data is a viable option to simplifying health information exchange. A patient-mediated data store houses both patient and provider entered data, each of which is segregated and clearly identified.
Patient Issue(s) -- Information about the condition or conditions prompting the interaction with the healthcare ecosystem. Latest treatment news, current trials, access to additional resources, etc.
Site -- Information, policies and procedures related to the organization/physical location where care is being provided. Includes the site/organization's electronic medical records (EMR) that were created/updated during patient interactions. Typically, the site would provide the infrastructure to integrate the Health IT Six into an easy to use application.
Role -- Information about the responsibilities and authority of the role of the individual interacting with the patient or providing care. Typically there are limits on what a role is allowed to observe, or enter into, the electronic record of a patient interaction it is important to differentiate the role from the individual.
Individual Care Giver -- Information about the preferences, availability and expertise of the specific healthcare provider interacting with the patient. Includes calendar, authorizations, system user interface preferences, etc.
Function(s) -- Information about the function(s) or clinical procedure(s) being considered or performed during the interaction with the patient. Latest published information, leading practices in performing the function or procedure, etc.
We believe the next generation of health IT systems must be able to accommodate and support the Health IT Six.
The CURE ProjectSM is a community service project of New Health Networks, LLC