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Blueprint for an Integrated HIT system - The Patient Life-Cycle Wellness System
The six scenarios previously presented show how some of the HIT tools supporting the Wellness-Plus model would be used by certain stakeholders. The scenarios, however, do not offer a complete view of the entire integrated software system.
The flowcharts in Figures 1 (below) and 2 (on the next page) put it all together and present a complete picture of the
Patient Life-Cycle Wellness System
. The name of this HIT system reflects a patient-centered, whole-person, birth-to-death view focused on continually improving care and wellness through use of data management and decision-support tools by all stakeholders across the entire healthcare continuum.
The Patient Life-Cycle Wellness System is an integral part of a rational healthcare system that delivers ever better and more affordable care through a collaborative, compassionate, knowledge-based effort that increases positive outcomes, minimizes errors and omissions, and ensures improvements in quality of care and patient safety. This approach recognizes the responsibility of all stakeholders in creating a sustainable healthcare that brings greater wellness to all in an effective and affordable way.
These HIT tools help drive a “cradle to grave” continuous improvement model for transforming the current reactive healthcare system — that operates on a “fix it and pay for it when it breaks” process — to a quality driven approach that includes:
Proactive maintenance & preventions programs
Personalized care supported by secure, economical, and useful health information technologies for exchanging patient data, studying clinical outcomes, guiding evidence-based treatment decisions, reducing errors and omissions, and assuring appropriate continuity of care for every episode of care
Development of a sane payment system that encourages continuous quality improvement, while controlling costs and insuring everyone through shared risk.
Patient Life-Cycle Wellness System Blueprint (Figure 1)
Figure 1 (below) shows the technological components of the Patient Life-Cycle Wellness System and the flow of data between the components. Note that the numbers below correspond to the numbers on the flowchart.
Each person in each of the stakeholder groups uses a computerized health agent (CHA)--aka "health node"--that is designed to input, share, and access the information the person needs the way they need it. A CHA launches all the tools they need from their computer desktop or handheld device. Data and information are sent between CHAs via encrypted e-mail. The CHAs are interconnected via a node-to-node (app-to-app), publisher-subscriber, store & forward architecture supporting loosely coupled social networks. Note that in addition to CHAs interfacing people (i.e., semi-automated CHAs manned by humans), there may be fully automated (unmanned) CHAs performing sensor monitoring and transmission, data integration, data transformation, data analytics, data flow control, and other such functions that do not require human interaction.
The red double-headed arrow between the CHAs and data storage systems depicts a CHA’s ability to retrieve data and information from and send data to any data sources/stores, including databases, data warehouses, legacy systems, XML files, delimited and unstructured text files, spreadsheets, document repositories, graphic images, multimedia files, etc. The vertical red arrow indicates information flowing to the CHAs from business intelligence and knowledge tools that process the data stores.
The wide arrow depicts the connectivity between a CHA and its HIT tools. A CHA connects to its tools via APIs (Application Programming Interfaces), which is software code that enables programs to communicate with one another. An API launches a tool from the CHA’s user interface. In addition, a CHA can query a database used by one of its tools to retrieve data from that database.
With this in mind, the top of the arrow pointing to the CHA indicates data coming into the CHA by querying the databases used by its tools. This is typically done when the CHA needs to build a report or to transmit data to other CHAs.
The star symbol at the other end indicates data flowing from a CHA to its tools. This occurs when data from one tool is passed to another tool through the CHA, and when data the CHA obtains from remote sources is delivered to its tools. The star symbol also indicates a CHA sending API instructions to other tools to launch them.
Through these processes, a CHA and its tools enable data to be:
Input into local and remote databases
Accessed from local and remote databases
Disseminated to other CHAs
Retrieved from other CHAs
Transformed, integrated, and analyzed
Displayed as interactive or printed reports
Arrow #4 depicts a CHA storing the original quality improvement metrics and practice guidelines in local database #5 for later access. The metrics and guidelines are sent from other CHAs whose job it is to disseminate them to authorized individuals.
This box represents Administrative tools used for patient admission, authorization, billing, scheduling, and other non-clinical functions. The CHA launches these tools when necessary. Their data are stores in their respective databases.
This arrow depicts data sent back and forth between a Diagnostic Aid tool and EHR (or PHR). Data are sent to the Diagnostic Aid tool for processing to determine possible diagnoses, and data are sent to the EHR from the Diagnostic Aid tool for inclusion in the patient’s record.
This blue dotted arrow represents data being sent from a victim’s EHR (e.g., symptoms, diagnoses, and geographic information) to data storage systems and certain healthcare stakeholders in an emergency. Note that the data is sent from victim’s CHA, as per #3. In addition, the stakeholders may communicate with one another as per #1, enabling strategic dialogue and query-back orders.
This arrow depicts data sent back and forth between an EHR and Computerized Practice Guidelines or Clinical Pathways. Data are sent to the Guidelines or Pathways tools for processing to determine possible guidelines/pathways best suited for the patient, and data are sent to the EHR from the Guidelines or Pathways tools for inclusion in the patient’s record.
This arrow depicts quality improvement metrics and practice guidelines being accessed by from storage by the Computerized Practice Guidelines and Clinical Pathways tools for use.
This arrow depicts data sent back and forth between an EHR and CPOE. Patient clinical data are sent to the CPOE for functions such as drug warnings. Data about the practice guidelines to be implemented are sent to the CPOE for automated selection of orders (medications and procedures). After the provider confirms or modifies a guideline’s orders, these data are sent to the EHR from the CPOE for inclusion in the patient’s record. Note that the EHR and CPOE may actually be part of the same application, such as an integrated practice management tool.
This arrow depicts data sent back and forth between a CPOE and Administrative tools. Data are sent to the Administrative tools such functions as confirming the orders are covered by the patient’s health plan, and data are sent to the EHR from the CPOE for inclusion in the patient’s record.
» Once the orders are approved, the CPOE displays the orders to be followed as a plan of care, and tracks the execution of the plan of care as clinicians input confirmation of each order as it is carried out.
This arrow depicts a part of the continuous quality improvement (CQI) feedback loop in which process and outcome data that are defined by the practice guidelines quality metrics are being sent by the Computerized Practice Guidelines and Clinical Pathways tools for analysis by knowledge services teams (e.g., consensus groups) using research, modeling, and knowledge management tools). Note 1: This CQI process also includes enabling clinicians to indicate when the guidelines are not followed (i.e., "at variance"), why they weren't followed, and what was done instead. Note 2: Clinicians are also able to share with researchers, and other collaborating clinicians, their lesson learned, best practices, observations, questions & answers, etc.
This arrow depicts newly created and modified quality improvement metrics and practice guidelines — established based on the analysis of quality metrics coming from the evidence-based CQI Feedback Loop — being stored and later used by the Computerized Practice Guidelines and Clinical Pathways tools.
This arrow depicts data about the selected practice guidelines being sent from the Computerized Practice Guidelines or Clinical Pathways tools to a Care Plan Coordination tool, which coordinates plans of care across providers.
This arrow depicts data about the selected practice guidelines being sent from the Computerized Practice Guidelines or Clinical Pathways tools to a Case Management tool, which assists the case manager.
This arrow depicts part of the Case Management tool sending data through the CQI Feedback Loop as per #13.
This arrow depicts data about the selected practice guidelines being sent from the Computerized Practice Guidelines or Clinical Pathways tools to the Care Execution Management tool. This data is used to help providers avoid adverse events due to order execution problems, and help providers make available the resources necessary to carry out the plan of care.
This arrow depicts the Care Execution Management tool sending data to the CPOE when an emergency or other occurrence creates a problem with order execution or a conflict in available resources, which alerts the providers involve that modification in a patient’s plan of care is necessary.
This arrow depicts part of the Care Execution Management tool sending data through the CQI Feedback Loop as per #13.
This arrow depicts part of a Continuous Survey Readiness tool sending data through the CQI Feedback Loop as per #13.
This arrow depicts the use of business intelligence tools and knowledge services and tools to analyze and interpret data stores.
Evidence-Based Healthcare Decision Support System (Figure 2)
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