APPENDIX - A
DETAILED PROJECT DESCRIPTION
Project functionality and benefits:
The development of the proposed Interactive Consumer Health Portfolio (iCHP) services system addresses many different areas of concern in this request for proposal, namely, health, education, public service and community networking. The iCHP essentially provides health related content integration, presentation and distribution services. Users will be able to access it easily from a variety of clinic sites in the Greater Miami area as well as from any computer from which the Internet access is available. In particular, the iCHP services system provides several functions that can significantly promote consumer health wellness.
1)It provides a user-friendly way for consumers to create, maintain and effectively utilize their health records. The proposed services serve consumers at many different levels, from a simple recording of a journal of symptoms for a particular instance of illness or a checklist of health indicators provided by the system, to the creation of a comprehensive long term personal health and medical record.
2)The iCHP system will be electronically linked with a Computerized Patient Record (CPR) where healthcare providers store clinical data about the patients. By doing so, we make certain patient-oriented aspects of medical record, e.g. patient discharge information from the hospital, medication prescribed, their medical diagnosis, and other special instructions, available to consumer. Consumers will then be able to retrieve their confidential electronic health portfolio in a timely fashion which in turn should increase the level of their wellness. Such information can be used in many valuable ways to promote consumer health care and wellness as described below.
3)It channels filtered, approved and validated healthcare information and data to consumers with specific needs. Based on the stored or dynamically created consumer profile, the iCHP allows the healthcare provider to guide the patient to relevant factual and educational information.
4)It provides a vehicle for consumers/patients to interact and communicate with physicians and healthcare providers. Through the iCHP services, consumers can chat with physicians about their health conditions, can report their medical condition and experiences to their physicians and other healthcare providers.
Therefore, iCHP services make it possible for patients to have a control over their health care. It also improves the communication between the patient and the healthcare providers, and makes appropriate health care available in a timely fashion. Figure A-1 gives the overview of the proposed system.
Access to the system will be made possible through the Internet and a user interface will be developed that makes using it extremely simple even for novice users. We expect that there will be many consumers who have computers at their homes, and hence, access to the system will be very easy for them. For consumers who do not fall in this group, we will provide computers at
Figure A-1. The proposed interactive consumer health portfolio (iCHP)
Selected health clinics in their neighborhoods. We will design the system to encompass differing levels of security clearances for access to an individual patient's information.
The iCHP system will be very beneficial to the people in South Florida, including those belonging to under-served populations. Moreover, the services proposed here are not limited to regional applications but represent a model that can and should be expanded on a national scale. Some of the benefits derived from the system are described below.
Timely healthcare for the participants.
The iCHP services will improve communication between patients and their healthcare providers. Availability of up-to-date information about the medical conditions of their patients will allow the doctors to provide timely and accurate instructions to them, thereby making personalized healthcare available to them in a timely manner. Two possible scenarios are described below.
When a person becomes sick at an out-of-town location, permission can be given to the local doctors to access the health portfolio that will contain the patient’s history of that ailment, medications being taken at the time, allergies experienced, etc. The patient may not be in a state to convey this information or may not be knowledgeable of the medical description of the ailment. Accurate medical information will allow the doctor treating the individual to make more informed decisions.
When a woman observes a lump in her breast during a routine exam at home, general tendency of most people will be to postpone telling their doctor about it and not call him/her at that instant. However, if the iCHP system were available, the patient could immediately input this information making it available to the doctor instantaneously. Appropriate care could then be provided in a timely fashion, and possibly avoid a future traedy.
Better education for the patients.
If a person is suffering from a sickness that has many types, like diabetes, it is not easy for the patient to acquire the relevant knowledge from among the general information available. The doctor could convey this information simply by placing a pointer to the approved and validated health literature on the world-wide-web in the patient’s record in the iCHP system, thereby making it available in a very timely fashion. This additional information would increase the patients’ knowledge about their specific problem.
Greater control of their healthcare on the part of the consumers.
Increased awareness about their wellness along with timely information about their health available to the consumers will result in providing a higher degree of control to them over their own health.
Potentially, automatic notification about an emergency situation.
The iCHP services will have the current as well as historical medical information of an individual available electronically. Some of this information will come from the CPR with which the iCHP system is appropriately linked. The healthcare professionals will be able to program the system to trigger automatic generation of clinical alerts to the patient and the doctor based on occurrence of a particular event. For example, an increase in blood pressure of a heart patient to a particular level may cause the system to notify the patient to contact his doctor immediately or go to an emergency room. Another example is if the weight of a pregnant woman increases to an unacceptable level, a clinical alert will be generated advising the patient to contact her doctor immediately. Once again, health care provided in a timely fashion can save lives.
Decrease in health care costs.
It is common knowledge that an ounce of prevention is better than a pound of cure. For all the reasons explained above, the iCHP system will be able to provide wellness information to individuals in a timely manner that will result in patients receiving medical care early in the game. It is always cheaper to treat an ailment early than later, and hence, this system will reduce healthcare costs in the future.
The system will be developed by a team of professionals from Baptist Health Systems of South Florida (BHS) and Florida International University (FIU). FIU, a Hispanic Serving Institution, is the largest university in the region with approximately 32,000 students. The School of Computer Science is a designated Program of Excellence and the university administration is very supportive of this program. BHS has been one of the most respected medical centers in South Florida for 39 years. In January 1999, it was included in the list of “100 Best Companies to work for in America” by Fortune Magazine. Last year, the American Nurses Association named it one of the 11 “Magnet Hospitals” in the United States for Excellence in Nursing. This high quality partnership between two leading entities in the region excelling in their own spheres will guarantee the success of the project.
iCHP Usage Scenario:
A typical iCHP usage scenario is illustrated in the figure A-2. This usage scenario will first be presented from an enterprise viewpoint, describing the functional aspect of iCHP. Appendix C will review the iCHP in terms of the technologies and the open standards used in designing the architecture of the system, including security considerations.
The usage scenario depicts a consumer, as an actor (the stick figure), interacting with a use case (circle). In Figure A-2, a use case is the process of accomplishing a specific task within the scope of the iCHP functionality. In this scenario, the iCHP case utilizes many other cases in reaching its goal of placing the consumer in the personalized context of relevant healthcare information.
Figure A-2 iCHP Usage Scenario
Placing the consumer in the personalized context of relevant healthcare information
Definitions
The usage scenario introduces the notion of a Health Agent, which is a collection of closely related processes that manage the consumer’s context information. Use cases are labeled using the notation <label>. There are four types of labels; iCHP, CPR, BHS Web Site and External Content Sources which denote the system where the process is executed. The use cases of the type iCHP are within the scope of the project, the other types of use cases are provided by BHS for use within iCHP.
Heath Agent Technology
The iCHP "intelligence" is represented by a set of processes that, based on the CPR and consumers' self proclaimed interests, will exactly place the consumer in an information context that is meaningful, useful and empowering. This set of processes is collectively called a Health Agent (HA).
CPR Services
Note that the CPR services, although a part of the iCHP integration architecture, are not within the scope of the iCHP project. BHS is independently implementing these services as a part of its strategy of constructing a CPR. iCHP will integrate into these CPR services.
Use Case: iCHP: login
The iCHP login process initiates two other use cases. First is the authentication process where the identity of the consumer is established and which produces other credentials of the consumer that are utilized in the iCHP:Construct Session Profile use case which is the second process initiated by iCHP:Login.
Use Case: iCHP: Health Agent: Construct Session Profile
The Construct Session Profile combines information about the consumer from a multitude of sources. In interacting with the CPR, the session profile outlines the consumer's basic demographic information (such as date of birth, postal address, medical record number and email address), the clinical conditions of the consumer, the consumer’s relationship with healthcare providers, and so on. Other interest areas defined directly by the consumer also augment the session profile.
Use Case: CPR Service: PIDS
The Person Identification Service (PIDS) is an OMG (Object Management Group) standard for identifying a person based on a number of traits. In this use case, demographic information would be obtained through the PIDS.
Use Case: CPR Service: HDS
The Healthcare Demographic Service (HDS) will be used to gather additional demographic information from the CPR.
Use Case: CPR Service: SLiMS
The List Management Service (SLiMS) provides a mechanism to query the CPR for clinically identified healthcare problems, allergies and the current set of medications consumed by the consumer.
Use Case: CPR Service: HRS
The Healthcare Relationship Service (HRS) establishes the consumer’s relationship to healthcare providers and insurance companies.
Use Case: CPR Service: COAS
The Clinical Observation Access Service (COAS) represents a set of standardized interfaces for accessing clinical data, such as transcribed reports or laboratory results. The use of this service within the iCHP system will require the use of the OMG Lexicon Query Service. Clinical terminology used in the CPR would correspond to coded concepts and would be mapped to English descriptions for presentation to the consumer (not shown in Figure A-2).
Use Case: iCHP: Health Agent: Consumer Interests
The iCHP provides an interactive feature that allows the consumer to register interest (at different levels) about particular health topics.
Use Case: iCHP:Health Agent: Determine Health Plan
The process Determine Health Plan evaluates the consumer’s Session Profile and identifies the corresponding pre-defined workflow that relates to the Session Profile. A workflow describes the related consumer health information, CPR information and interactive services on a timeline for a particular clinical condition.
Use Case: iCHP:Health Agent: Determine Workflow State
The Session Profile also allows the Health Agent to place the consumer of the workflow timeline, for each workflow, within the Health Plan.
Use Case: iCHP: Presentation: Create View
The Create View use case utilizes the completed Session Profile to initiate the workflow processes that are to be activated, including gathering the corresponding content. The information gathered is organized for presentation.
Use Case: iCHP: Health Agent: Gather Consumer Information
Based on the Workflow State, information is gathered from pre-defined sources.
Use Case: iCHP: Health Agent: Gather CPR Data
Based on preferences and access rights, this process gathers clinical data from the CPR, via the COAS interfaces on clinical systems.
Use Case: iCHP: Health Agent: Construct Interactive Services
Based on the Workflow State, interactive services are initiated.
Use Case: BHS Web Site: Gather BHS Services & Procedure Information
Information about BHS Services & procedures are gathered.
Use Case: BHS Web Site: Gather BHS Wellness Education Program Information
Information about BHS educational wellness programs is obtained here.
Use Case: External Content Sources: Gather Consumer Health Content
Consumer health information is provided by sources external to BHS and to iCHP.
A Walk-Through of the Usage Scenario
In order to illustrate the iCHP usage, let us walk through a specific instance. Jane Doe, a 25 years old female, is logging into iCHP. Supplying her private username and password authenticates her into the iCHP, including establishing her credentials. The login process also initiates a use case of creating her session profile. This is accomplished in part by querying server CPR services to obtain demographic information (postal address, email, religion, etc), healthcare provider relationships (e.g., identification of the primary care physician, the dermatologist, etc.), and current problem or conditions (allergies, diagnosis, medications) for Jane Doe as recorded by the clinical professionals. In addition, the interests defined directly by the consumer augment the session profile (for example, the consumer might be interested in a topic that is a health condition of a relative).
The session profile is supplied to a use case dedicated to determining the corresponding workflow, which becomes the consumer's iCHP Health Plan. Each attribute of the session profile may guide the selection of the Health Plan. Furthermore, the Session Profile refines the Health Plan by exactly defining the consumer's position in each workflow.
Let us assume that the session profile for Jane Doe indicates that she is a few weeks into her first pregnancy and has asthma. It also includes the list of medications Jane is taking for her asthma. Jane has also recently declared an interest in breast cancer, and indicated that it is a common illness in her family. The Health Plan includes the pregnancy workflow as well as the asthma workflow and a high-risk breast cancer workflow. The session profile aids in positioning Jane within these three workflows. Jane has informed her obstetrician (as it was a planned pregnancy) but she has not pre-registered for the maternity program with the health system yet. She has is not yet registered for any child birth classes. Her medication list has not been altered. And she has not seen a physician in regards to being identified as a potential high-risk candidate for breast cancer as it is not in the clinically managed problem list.
The completed session profile and the health plan are the key components in creating the presentation to the iCHP. The health agent is instructed to initiate the three workflows and set the state. The workflow state drives the gathering of the consumer health information, such as presenting Jane Doe with a big "Congratulations, we heard you are expecting!! " banner, including pictures of the clinical staff related to Jane's wellness. Jane is also prompted with pointers to registration forms for the maternity program. The health system has maternity wards at four hospitals, but given Jane's postal address, she is most likely to select one of the two hospitals closest to her home. The maternity programs at these hospitals are primarily featured on the interactive web site, including virtual tours. Jane can also register for upcoming "what to expect when you are expecting" classes and other child birth classes. A generic timeline of events is provided. A consumer health story on the potential risks of using certain asthma medications during the pregnancy is also presented with an encouragement to see the obstetrician and her respiratory physician. An electronic message is auto-generated to both physicians, which would be sent instantly, with Jane's consent (hit the send button). The last healthcare issue in the health plan is the potential high risk for breast cancer. Jane is encouraged to fill-in some more information about the family history and iCHP asks for permission to have a clinician review her responses along with other pertinent information in the CPR. A set of related consumer health articles are provided if Jane is interested in reading more about early detection techniques. If it is also the topic for one of the upcoming wellness lectures, Jane is invited.