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Programming Healthcare Silos


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Slides for Vaibhav's OSCON Talk -

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Healthcare IT is characterized by various silos encompassing payment systems, labs management systems, medication management systems, imaging systems and various other hospital management systems. In addition to maintaining these systems, a Healthcare IT professional deals with multitude of standards for data protocols and terminologies.

It has been established that Healthcare can be streamlined and associated costs can be reduced drastically if a patient is able to have greater control in the current ecosystem. Several personally controlled health record systems have been proposed and implemented, including solutions from Google, Microsoft, and Dossia. Standards like CCR & CCD have been gaining ground. Recommendations and guidelines for preferable medical terminologies like SNOMED-CT or ICD-10 has been order of business at office of national coordination (ONC) of Health.

This talk will take a deep dive with practical examples of how to interface various Hospital systems through CCR &CCD to various Personally controlled health record systems. We will take specific examples from use cases encompassing explanation of benefits, labs, medications, imaging, H1N1 reporting and master patient indexes. The talk will weave all the above use cases in one simple application.

While discussing the working code and solution architecture we will touch on various aspects of privacy and security needed to be addressed while dealing with HealthCare data.

Published in: Technology
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Programming Healthcare Silos

  1. Vaibhav, Health Solutions Group)<br />across<br />Programming Healthcare Silos<br />^<br />?<br />@vaibhavb#oscon #silostalk<br />
  2. Agenda<br />Challenges of Health IT<br />Standards exist but..<br />Open Solutions Exist<br />Opportunities in Health IT<br />
  3. Silos of Health Information<br />
  4. Silos in the Enterprise – “On the Floor” <br />Electronic Medical Record<br />Nursing Workflow/ Documentation<br />Clinical Notes<br />Emergency Department<br />Procedure Documentation<br />ICU/Critical Care<br />OR Management<br />Dictation<br />Pharmacy<br />CPOE<br />Advanced Analytics<br />Cardiology<br />Labs<br />Medication Administration<br />Hemodynamics<br />Pathology<br />Imaging<br />Charting<br />Medication Dispensing<br />RIS<br />Orders<br />Image Distribution<br />PACS<br />Mobile Data<br />
  5. Silos in the Enterprise – “Behind the Scenes”<br />Contract Management<br />Enterprise Scheduling<br />Claims Management<br />Financial/ERP<br />Business Decision Support<br />Inventory<br />Medical Records Coding<br />Purchasing<br />Revenue Management<br />Document Imaging<br />Bed Management<br />Registration<br />Transcription<br />Call Management<br />Staff/Nurse Scheduling<br />Outcomes Management<br />Physician Practice<br />Access Management<br />
  6. Meaningful Use<br />ICD-9 to ICD-10 Translation<br />SNOMED-CT<br />Master Patient Index<br />EMR/EHR<br />IHE<br />HL7<br />
  7. Meet Jim<br />
  8. Jim’s ER visit..<br />
  9. Lab<br />Emergency <br />EMR<br />HL7 Lab Order<br />MSH|^~&|EMERGENCYEMR|RC90|INSIGHT.LAB|GUH.ER|20080114085834||ORU^R01|H20010816374944.7274|P|2.1|1<br />PID|01||1430043|1572c552-f02b-49bf-b7e2-acc74765cb3e|SMITH^JIM||19790127|F||1||||||||cfd9ce6b-dc81-459d-9415-7913eb4635ec|804171277<br />PV1|01|O|TPC||||331|||||||HIS|||331|O||||||||||||||||||||||||||20060721|19990921<br />OBR|1||1234^LAB|88304<br />
  10. Lab<br />Emergency <br />EMR<br />Lab Result<br />MSH|^~&|EMERGENCYEMR|RC90|INSIGHT.LAB|GUH.ER|20080114085834||ORU^R01|H20010816374944.7274|P|2.1|1<br />PID|01||1430043|1572c552-f02b-49bf-b7e2-acc74765cb3e|SMITH^JIM||19790127|F||1||||||||cfd9ce6b-dc81-459d-9415-7913eb4635ec|804171277<br />PV1|01|O|TPC||||331|||||||HIS|||331|O||||||||||||||||||||||||||20060721|19990921<br />OBR|1||1234^LAB|88304<br />OBX|1|CE|88304|1|T57000^GALLBLADDER^SNM OBX|2|TX|88304&MDT|1|MICROSCOPIC EXAM SHOWS HISTOLOGICALLY NORMAL GALLBLADDER TISSUE<br />
  11. Creating & Processing Lab Order<br />HAPI HL7 Parsing Library <br /><br />
  12. X12 Message for Eligibility Request<br />ST*270*1234*005010X203~<br />BHT*0022*13*10001234*20060501*1319~<br />HL*1**20*1~<br />NM1*PR*2*ABC COMPANY*****PI*842610001~<br />HL*2*1*21*1~<br />NM1*1P*2*EMERGENCY CLINIC*****SV*2000035~<br />HL*3*2*22*0~<br />TRN*1*93175-012547*9877281234~<br />NM1*IL*1*SMITH*JIM****MI*11122333301~<br />DMG*D8*19430519~<br />DTP*291*D8*20060501~<br />EQ*30~<br />SE*13*1234~<br />Lab<br />Emergency <br />EMR<br />Health Plan<br />
  13. X12 Response for Eligibility Request<br />ST*271*1234*005010X203~<br />BHT*0022*13*10001234*20060501*1319~<br />HL*1**20*1~<br />NM1*PR*2*ABC COMPANY*****PI*842610001~<br />HL*2*1*21*1~<br />NM1*1P*2*EMERGENCY CLINIC*****SV*2000035~<br />HL*3*2*22*0~<br />TRN*1*93175-012547*9877281234~<br />NM1*IL*1*SMITH*JIM****MI*11122333301~<br />DMG*D8*19430519~<br />DTP*346*D8*20060101~<br />EB*1**30**GOLD 123PLAN~<br />…<br />Lab<br />Emergency <br />EMR<br />Health Plan<br />
  14. Jim’s Ready to Go Home<br />Lab<br />Emergency <br />EMR<br />Health Plan<br />
  15. CCR For Jim’s Visit<br />Lab<br />Emergency <br />EMR<br />Health Plan<br />
  16. CCD or C32<br />
  17. HealthVault Interaction<br />
  18. Direct To Clinical<br />
  19. Data In Jim’s Account<br />Jim<br />Lab<br />Emergency <br />EMR<br />Health Plan<br />Jim<br />
  20. NHIN-D<br />@ HealthVault address<br /> Easy integration through SMTP S-MIME<br />Exciting Future<br />
  21. HealthVault Medical Imaging<br /><ul><li>Applications can upload large files to a users’ HealthVault record
  22.</li></li></ul><li>HealthVault Client & Mobile Applications<br />Client Applications<br /><br />
  23. Leaving the Clinical Silo<br />Clinical Silo<br />While in enterprise your application need to comply with HIPAA 5010<br />When Jim log’s in to HealthVault then the data is flowing in to consumer domain<br />Lab<br />Emergency <br />EMR<br />Health Plan<br />
  24. HealthVault Open Source Resources<br />Community Promise<br />Open Source SDKs<br />Java : CodePlex<br />Ruby : RubyForge<br />Python : Google Code<br />PHP: SourceForge<br />Reference License .NET SDK<br /> <br />
  25. Connected Health Platform Open Source Resources<br />Microsoft Health Common User Interface (MSCUI)<br /><ul><li>Microsoft Public License (MS-PL):
  26. Main site:
  27. Toolkit:</li></ul>IHE Cross-Enterprise Document Sharing XDS.b <br /><ul><li>Microsoft Public License (MS-PL):
  28. Main site:
  29. Toolkit:</li></ul>Clinical Documentation Solution Accelerator (CDSA) <br /><ul><li>Reference License for CDSA Toolkit:
  30. Main site:
  31. Toolkit:</li></li></ul><li>Takeaway<br />Lots of opportunity to bridge the silos and empower the patient with open technologies and platforms!<br />
  32. Thank You<br />Be Well. Be Protected.<br />?<br /><br />@vaibhavb#oscon #silostalk<br />