Data Provenance in Telemedicine, Patient Generated Health Data and HIE to EHR Exchange

This is an ONC funded dProv Toolkit implementation project

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July 2017 Project Update

The growing scope and complexity of digital health records exchange has created a need for tools to better validate, present and organize data provenance to provide reliable information on the origin and authorship of received documents. Increased use of health information exchanges (HIEs) has made available more robust patient health records, but this has created challenges in using and maintaining provenance in records consolidated from multiple data sources spanning numerous providers, labs, and medical organizations. High-needs and chronic care patients, such as veterans and senior citizens, often require care from many facilities, multiple doctors and may have received medical attention while traveling. We now have the HIE technology to bring together these disparate repositories to form a unified medical document, but once in hand, such a document does not convey adequate information regarding the provenance of individual components such as exam notes, lab results, photographic/radiological images, and patient generated health data (PGHD).

Data Provenance, as recommended for implementation by HL7 v2, provides this information and establishes consistency in CCD-A provenance exchange. There is a need to establish a set of tools which ensure that data provenance as a standard will be implemented. Equally important is the development of consistent policies that allow for the efficient adoption of HL7v2 data provenance standards without creating conflicts with regional, state or federal policies.

Our current ONC sponsored project will address this problem through the introduction of enhanced Data Provenance tools applied to participating health record systems to generate, record and exchange metadata on the origin, authorship, and validity of records. Use of digital signatures within the provenance record as a form of identity certification will be studied as well.

These data provenance tools are designed to ensure consistency of provenance through the full continuum of healthcare, from patient generated health data to physician and lab data and back to the patient.

The project is coordinating exchange and provenance tracking between diverse health information organizations—both clinical and patient-centric—to implement and test a new Data Provenance tool set. Designed to deliver uniform, system-independent Provenance originating from a variety of sources and able to be read and interpreted at multiple levels of data exchange. The new tool set will be deployed as a provenance management layer within the data systems of health systems participating in the project to minimize the impact on existing workflow.

We have formed a partnership of healthcare providers, telemedicine providers, and patient engagement organizations to take part in this project and to act as dual provenance generators/consumers, demonstrating interoperability of provenance regardless of which exchange connections it is traversing. Each participant will implement provenance-enabled document creation, exchange, and verification. This will expedite the use of exchange data by providing improved trust, increasing patient engagement and making health information more useful to providers and payors by better ensuring data and identity authenticity.

This project will demonstrate consistent data provenance in multiple health information exchange environments. The dProv app will be applied to One-Step EHR-to-EHR data and image exchanges as well as to the larger exchange environment that includes patients and payors.  Exchange settings such as telemedicine where mobile clinical devices are used to send patient data gathered by the attending caregivers, into a cloud-based health record, then to a local clinical EHR and then, via a HIE Network, to consulting physicians HER will take part in the project.

Take a moment to review our Power Point presentation:

RAIN Live Oak Data Provenance introduction of project2