Filling the HIT Gap

Filling the HIT Gap by Satisfying the Unmet Needs


The Patient Life-Cycle Wellness™ (PLCW™) system. It is the first comprehensive HIT blueprint to address the six unmet needs of mainstream HIT.

The PLCW system overlaps some other HIT systems in that it:
  • Provides a collaborative space with single sign-on portal technology supporting EHR/EMR/PHRs, CPOEs, e-mail, forums, HIPAA compliant file transfer, voice over IP, and end to end encryption
  • Promote secured access to specific patient data using authorization rules for Trusted Partners, as well as biometrics scans and SMART Cards for authentication
  • Protects patient privacy by allowing only the information a patient permits to be shared with each authorized recipient (i.e., “Trusted Partner”)
  • Interoperates with third-party applications.

But what makes the PLCW blueprint unique is it is the first to satisfy the following six unmet HIT needs:

1. Bridging the Knowledge Gap


  • Creation, Dissemination, and Implementation of Evidence-Based Practice Guidelines. The PLCW system is depicted in the blueprint for an integrated HIT and the evidence-based healthcare decision support process. This system:
    • Enables ongoing collection of widespread, in-depth, clinical outcomes data from the field and lab; and feeds it into growing and evolving health science knowledge bases; and facilitates data analyses, information organization, and collaborative model construction for generating evidence-based guidelines. This can be done in a largely automated manner that does not disrupt existing workflows.
    • Helps disseminate and implement the evidence-based treatment and prevention practice guidelines, continually evaluate their efficacy and usefulness and update them accordingly, and assure they are executed competently.
    • Uses an efficient process by which technical guidelines are sent to providers in a format readily usable by computerized practice guideline and clinical pathways tools, as well as making corresponding non-technical guidelines (understandable by non-providers) available to patients and other stakeholders via eLearning (i.e., “distance learning”) and other appropriate media.
  • Diagnostic Decision-Support. The knowledge bases are used by diagnostic aids to help improve care quality by suggesting diagnoses, some of which clinicians may not have considered. This is especially useful with patients suffering complex or unusual problems, as well as used routinely to assess all patient problems since problems that appear simple are actually found to complex, and because it is too easy for a clinician in a busy office to forget to ask important diagnostic questions. Diagnostic aids can also be used as a teaching tool with consumers, a way to empower consumers with a list of assessment findings to share with their healthcare provider that facilitates dialogue about treatment options and self-care strategies.
  • Integrated Tools for Research, Modeling, and Knowledge Management. A wide variety of tools are offered for use in research, modeling, and knowledge management. They include tools for statistical analysis, concept management, development and exchange of healthcare treatment and financial models, document management, strategy development, collaborative decision tools, idea management, text mining, inferential logic tools, and more.

2. Managing Plan of Care Execution


The PLCW system’s patent-pending Care Order Management System (COMS) tool is designed to help minimize errors and omissions in healthcare facilities with clinical decision support that that goes well beyond monitoring medication orders and providing basic alerts. The COMS monitors plan of care execution and alerts clinicians when orders are not carried out in a timely manner, enabling adjustments to be made in the care plan to avoid adverse events. This enables the efficient allocation of time and hospital resources — including staff, facility and space — by helping assure plans of care are carried out as ordered with minimal disruption. It tracks each procedure for every patient, computes resource requirements against current capacities, and provides staff real-time information needed to accommodate all plan of care orders in a timely manner. The COMS works in conjunction with EHR, CPOE, and clinical pathways tools by providing the “brains” that analyze clinical data using rules and to making decisions about plan of care execution. It helps providers;
  • Select the appropriate standing orders
  • Make modifications as necessary
  • Alert them if their facilities are able to allocate the resources — including staff, equipment, supplies, and space — required to execute the plan-of-care orders
  • Monitor plan of care execution and alerts clinicians when orders are not carried out in a timely manner, enabling adjustments to be made in the care plan to avoid adverse events.

3. Coordinating Care


  • Care Coordination. The PLCW system’s Care Coordination tool manages plans of care across providers involved with a patient. It gives them an integrated view of all care plans, alerting them when conflicts between plans of care are found, and enforcing negotiation among the practitioners involved to resolve such conflicts.
  • Case Management. Case management tools promote adequate follow-up on all procedures; ascertain the efficacy of the approaches taken; promote dissemination of this information to PCP and other healthcare providers for all patients in the mix (e.g., home health, hospice, and rehabilitation).

4. Protecting public health


Biosurveillance, post-market surveillance, and bioresponse support are routine and ongoing PLCW system processes executed by unique tools that protect populations and assist first responders in emergencies.

Biosurveillance and post-market drug & medical device surveillance tools notify and inform appropriate parties rapidly when there is a threat to public health from biologic terrorism, epidemics, dangerous and ineffective medications and equipment, and other such health-related crises. Biosurveillance tools should provide early detection, enable ongoing monitoring (“situated awareness), and be able to “query-back,” i.e., contact the places reporting abnormally large outbreaks and ask follow-up questions. Post-market drug surveillance looks for dangerous side effects and complications of a medicine, as well as its efficacy, after it has been approved by the FDA and is being used by the public; post-market device surveillance is similar in that it studies medical equipment for safety and effectiveness.

Also included is a patent pending bioresponse system for first responders, called the Public Accountability Knowledge System (PAKS). It equips first responders with small monitors that wirelessly transmit victims’ vital signs and other detailed information to their electronic health records; keeps track of the first responder’s own vital signs and GPS location; and monitors the environment for victims, toxic gases, biologic pathogens, etc. — all of which is sent automatically to designated individuals and systems. PAKS would be used to find disaster victims and to support a first responder, life saving healthcare delivery process. The first responder and the community affected by a disaster would integrate PAKS capability at a command-control vehicle and communications facility.

5. Enabling complete connectivity


A Computerized Health Agent (CHA) is a “node” in the PLCW system’s node-to-node (peer-to-peer) “mesh” network architecture, where every node can connect to every other node. CHAs provide a highly efficient and low cost gateway to all the applications and data sources through a desktop tool with a patented underlying technology. They enable the execution of stand-alone and network applications through APIs and can operate in Net space or utilize an automated an e-mail process to transmit patient data and related files from peer to peer. Their benefits include:
  • Exceptional responsiveness since they can operate offline using local resources, which means no delays in viewing data and interacting with applications.
  • Easy, inexpensive, rapid and secure information access and sharing, even when bandwidth is low and network access is intermittent or occasional.
  • Extensive, hassle-free connectivity without scalability problems or dealing with VPN issues.
  • Simplicity and familiarity since they are MS Excel-based.
  • Flexibility, efficiency, and economy since they allow the ad hoc networks of nodes to be created easily and enable information to be transferred between the nodes using small, secure, inexpensive e-mail attachments.
  • Extreme protection of patient privacy using a unique, multi-level, data security process.
Another benefit of this node-based mesh network is that it supports collaborative decision-making, the benefits of which have been demonstrated in healthcare settings
{1}{2}{3} and other industries (e.g., crisis management{4} and air traffic management{5}With this system, every bed, piece of medical equipment, office, facility, practitioner, patient, etc. is, in essence, a virtual node that can send and receive information to and from other nodes. Sharing this information through a network of nodes in (near) real time supports a “shared governance” model, a system that unites all professionals involved in the care delivery process by enabling them to contribute collectively to making patient care and practice decisions. Collaborative decision-making in a shared governance model is likely, in many situations, to result in better patient care (e.g., by helping coordinate care for a patient being treated by multiple practitioners) and improved utilization of resources (e.g., by helping track the availability of staff, beds, equipment, and other resources within and across units and facilities).

In addition, the PLCW system:
  • Uses patient profile data or biometrics as the index to the record, so it doesn’t need a universal clearing house for patient ID, which means the data can reside any where.
  • Operates in both federated (decentralized) and centralized environments, enabling the most appropriate architecture to be used to accommodate different business needs.
  • Accommodates and data standards and protocols.

6. Management of extensive data sets


The PLCW can manage all health-related data on every patient for an entire lifetime, across all provider types and episodes of care and generate health records tailored to the particular needs and authorization of the user. These data are exceptionally secure, and can be protected by a unique multi-key, multi-level encryption process called MultiCryption™.

Conclusion


The PLCW blueprint lays the first comprehensive HIT that bridges the wide gap between what HIT needs to be and mainstream HIT. With its unique combination of applications and architectures, it offers a fast track to systems addressing the unmet needs of 21st healthcare.


Next: Yellow Brick Road Map



{1} http://www.aetna.com/news/2001/pr_20011113.htm

{2} http://www.preemie-l.org/debbie99.htm

{3} http://www.ditis.ucy.ac.cy/publications/bookchapters/DITISeHealthIOSChapter.pdf

{4} http://www.ornl.gov/info/ornlreview/v30n3-4/crisis.htm

{5} http://www.nextor.org/Dec03/UMD_Benefits-CDM-in-ATM.pdfexternal image meter.asp?site=s24wellness