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Health information exchange (HIE)
There are three key forms of health information exchange: 1) Directed exchange allows providers to electronically send and receive secure information like lab results between providers involved in a patient's care. 2) Query-based exchange allows providers to find and request information on a patient from other providers, often used for emergency care. 3) Consumer mediated exchange allows patients to aggregate and manage their health information online and help transfer it between providers.
In this document
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Introduction to Health Information Exchange (HIE) and its significance in health care.
Three forms of HIE: Directed Exchange, Query-Based Exchange, and Consumer Mediated Exchange.
Various stakeholders and components involved in HIE including data standardization, interoperability, and EHR repositories.
Explanation on how PHR integrates health data from providers with user consent, aiming for real-time data aggregation.
Details on integration between Provider Systems, EHR repositories, and Payer systems for health claims and transactions.
Interoperability layer connecting various health systems, mobile applications, and repositories for seamless data exchange.
Architecture focused on utilizing HIE for effective disease surveillance.
Architecture of a proposed health information network involving different facilities, disease programs, and APIs.
Conceptual data architecture of HIEAF, focusing on data operations, security, and metadata management.
Key aspects and potential technological solutions for building an efficient data lake in health information.
Structure of the federated data lake encompassing state-level and central data lakes for health information.
Closing remarks along with contact details for further inquiries about the presentation.
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Health information exchange (HIE)
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- 2. There are currentlythree key forms of he HIE : Directed Exchange: Directed exchange gives health care providers the ability to electronically send and receive secure information such as laboratory orders and results, patient referrals, or discharge summaries – to other health care providers involved in a patient’s care over the Internet via encrypted, secure, and reliable messaging. Query-Based Exchange: Query Based Exchange gives health care providers the ability to find and/or request information on a patient from other providers and is often used for unplanned/emergency care. Consumer Mediated Exchange: Consumer medicated exchange gives patients the ability to aggregate and manage their health information on the Internet. When in control of their own health information, patients can help transfer information between providers, correct inaccurate demographic, medical, or billing information, and track and monitor their own health. Types of HIE
- 3. 3 Patient Apps Provider EMR systems DistrictHospitals CHC PHC Subcenter/HWC Public Health Vertical Programs Pharmacies/Labs/ Imaging Centers Data Standardization (MDDS & EHR Standards ) Core Layers - Patient Identification,Anonymizer, Consent, Security Interoperability layer - Service Bus (Services,Routing,Transformation,Mediations,Messaging,Security,Queuing&Staging) EHR Repository EHR Repository EHR Registry Record Locator Service EHR Repository EHR Repository EHR Registry Record Locator Service Federated Query Exchange 1 Exchange 2 PHR Disease Registry Facility Registry Provider Registry Frontline Workforce Registry Drugs Registry Master Person Index HIEAF Continuum of Care Integrated Model Stakeholders Payers Business Functions Multiple federated Exchanges, each exchange has multiple repositories Enabling registries Messaging Patient owned, maintained instances (cloud based Medical DigiLocker) Public Health Reporting Claims Adjudication Through HCP Fraud Detection Disease Management Clinical Pathways Referral Network TeleHealth Federated Data Lake Data warehouses (Central, State) Business Architecture Applications Architecture Data Architecture
- 4. How does theproposed PHR work? Health ID and Consent from user PHR (real-time data aggregation) Hospital Diagnost ic lab Clinic Health Data Access Fiduciaries (HDAF) Health Data stays with providers (or TSPs) and is pulled together on demand with consent into a longitudinal record • Providers integrate with HDAFs using std Open APIs • Documents use embedded schemas - Initially we expect items already digitized and currently given to patients • Diagnostic reports, Discharge summaries. Over time - prescriptions, primary care encounters will come in
- 5. 5 Provider Systems Provider TMS Payer TMS Payer Systems PHR (API + Repositories) Beneficiary Patient EHRRepos Fiduciary 1 EHR Repos Fiduciary 2 EHR Registry Facility Registry (C ) Provider Registry (Doctors) (S + C) Payer Registry (S + C) Drug Registry (C ) for claim approvals Payments (benefits & contributions for beneficiaries) (S +C ) Beneficiary (Patient) Registry (S + C) Health Claims Platform Claim Transaction Pathways using eObjects Claim Adjudication System Routing FHIR Compliant eObject, messaging Clinical docs External System External Repository HIEAF component HIEAF supporting Registry EConsent Objects HIEAF API Services – Provider-Payer Clinical info exchange Registry lookup to tag or validate record with global IDs Record locator service Registration of record metadata into registry Registries Claims info Legend
- 6. Interoperability Layer Mobile Applications Clinical Record Systems Hospital Information Systems Registry of Health Facilities Registryof Clients Health Management IS (HMIS) Personal Health Records Repository Registry of Health Terms Registry of Health Workers Laboratory Information Systems M&E Applications India’s FR EMPI Medical Digilocker 3M or open source Terminology server India’s HWR Mobile First Apps & Telemedicine SEA HDIS products/ Provider TMS SEA HDIS products/ Provider TMS Lab systems Commcare
- 7. Disease Surveillance basedon HIE- Architecture
- 8. Proposed Health InformationNetwork Facility1 Facility2 Facility3 Facility1 Facility2 Facility3 Block 1 Block 2 Nutrition National Reproductive & Child Health Portal National Disease Programs e.g. Malaria, IDSP, NACO Hospital Information Systems, EMR State Health Programs e.g. EMRI, eMamta, HMIS, DHIS Birth, Deaths Private Sector HDD (Co-Directory lookups) Registry Lookup APIs MDDS ~ concept translation layer Terminology lookups E-Object Modellers FHIR APIs State Health Information Exchange Data Lake Disease Registry State Registry Indicator Registry Payment Registry Patient Registry-UID Service Registry Patient Private and Govt. e.g. NHPS, ESI, PM-JAY, JSY Payers Providers Private Sector MOHFW District Admin State HQ Reprod.& Child Health Directorates e.g. Malaria, IDSP, NACO Claim portal Block 1
- 9. HIEAF Conceptual DataArchitecture Source Systems Analysis Dashboards & Report HIEEAF Data Architecture Data Operations, Quality, Security, Privacy Metadata Management Data Governance 9 HIEAF Data Lake The data lake is implemented as a federated architecture: State-managed data lakes, and a Centrally managed Data Lake Central Data Lake State Data Lake Complete patient data from originating systems: Provider/Hospital repositories Payer repositories Fiduciary repositories Transactions at Point-of-care systems Health Claims Platform Other ancillary Healthcare applications Anonymized data Relevant data subset Modeling and trend analysis, prediction using Machine Learning Visualization of insights through HIEAF dashboards or consuming applications
- 10. Building out aData Lake: Key Aspects & Potential technology solutions 10 Data Sources Data Onboarding Data Integration Discovery & Exploration Visualization & Analytics Data Training & Intelligence Microsoft Cognitive Services Azure ML Azure application Insights
- 11. HIEAF Federated DataLake 11 Hospital Info systems Payer Claim Repositories Fiduciary Repository Data Sources CCDS NRCH (Natl Child Health & Repro. Portal) Hospital POC Beneficiary App/Portal State Data Lake Central Data Lake Beneficiary/ Patient Provider Health Care worker Payer NHA Policy Maker State Health Agency Data Scientist Data Models & Algorithms Metadata Management Tool Data Onboarding & Integration Discovery & Exploration Others… Data subset from each state ingested into the central data lake Operational or Field Data Historical Data Visualization & Analytics Data Training & Intelligence Dashboarding Reporting Machine Learning Module Data ingestion through pipelines Each state maintains their own data sets Annotations, metadata maintained throughout the information supply chain to ensure data lineage Executive dashboards, reports Data schemas created DW DM DM Training data sets Governance Tool Clearly defined data stewardship Data Security & Privacy Services Role and level-based access controls Data Services Bus Data for consuming Applications e.g. PMJAY Insights, Fraud Analytics, National Data Warehouse DW DM DM Existing Data Warehouses Data Marts E ETL (Extraction, Transformation, Loading) ELT (Extraction, Loading, Transformation) L L L L L E Q Q Q Q Q Q Q Q E L L Q Analytics Supply Chain Illustrative User Communities Stakeholders Modules at the State Level and at the Centre Modules at the State Level and at the Centre Health Claims Platform L L Existing Data Warehouse infra Search Others: PMJAY HEM, PMJAY TMS PMJAY Call Ctr Mera PMJAY app Policy Frameork Data anonymized Minimal data for analysis Patient complete data at origin Q Data Quality Check & Feedback Loop Data component Relational Data Repository External System
- 12. THANKS! Dr Pankaj Gupta Head– ACCESS Health Digital digital.health@accessh.org Twitter: @pankajguptadr, @accesshdigital LinkedIn: drpankajgupta, accesshdigital