What do Data Provenance, Disruption Tolerant Networking, and Healthcare Directories have in common?

What do Data Provenance, Disruption Tolerant Networking, and Healthcare Directories have in common?

All 3 are valuable assets in every sector of health care, but their usefulness becomes even more pronounced when performing an exchange with rural and extremely remote locations as well as during Emergency Medical Services (EMS) care. And perhaps, most importantly, they represent the framework for a new generation of highly adaptable Health Information Exchange.  A model of HIE that will begin to open up HIE resources for rural and underserved urban populations.

Lets take a look at these 3 Core Framework resources for a new Health Data Exchange:

Data Provenance provides a low cost and easy to integrate solution for improved data Security and reliability.  Provenance, which tells us the Who, Where and When and provides a digital signature, for a Patient’s Health Record.  This allows Doctors, working with that patient in the future, to determine the reliability of the information.  And for the Patient, having the Who, Where and When that data provenance provides allows for greater trust and a better understanding of their health data.  With the growing importance of telemedicine, where the distance between patient and doctor can be very large, it is essential that physicians be able to verify the origin and history of a patients record.  Rural telemedicine is a prime example of this need: when a patient receives care both from a local physician and a remote specialist via telemedicine, it is vital that both physician and consulting specialists, be able to access the provenance of each part of the patient’s record.

Delay Tolerant Network (DTN) protocol was developed by NASA to permit Internet communications in Space and in very remote or low resource terrestrial areas.  DTN is a computer networking model and a system of rules for transmitting information, often referred to as a protocol suite, that extends connectivity where conventional Internet resources do not work well. These environments are typically subject to frequent disruptions, possibly long delays and high error rates, especially will cellular based tele-consulting.  When DTN is designed in as part of the exchange network structure it adds an assurance of data integrity and provides a tool for Networks which are exchanging medical data or telemedical consults and surgical assists to guarantee that Network data is accurately exchanged, even in instances of Network outage or wireless connection loss. As telemedicine sees increasing use clinical encounters between patient and doctor via cellular connection will become common and at that point DTN becomes an essential part of Network planning.

HealthCare Directories are the third part of this new Health Information Exchange model. Making use of HL7 FHIR standards, the Directory provides the Data Exchange tool that enables HIE functionality in regions not served by HIE Networks.  HealthCare Directories enable data exchange across organizational boundaries and integrate with existing systems to facilitate automatic document retrieval from disparate repositories.

These new tools add strength to medical record management and exchange across the entire spectrum of care and are especially beneficial to Emergency Medical Services (EMS), very remote rural and low resource urban populations as well as for Field Medics.  Patients receiving emergency medical treatment are often away from home and unable to share their medical history. Additionally, mobile treatment, which in many cases sees a patient taken to a facility where they have never previously received care, adds barriers to smooth exchange and retrieval of medical records. Such emergency cases are also time sensitive, requiring rapid care which necessitates fast, accurate document retrieval, possibly from multiple facilities. Data Provenance allows EMS workers to trust the source of medical records and better determine the ideal course of care in emergency situations; DTN provides Network data integrity and HealthCare Directories.

The data provenance component which is part of this new suite of exchange tools allows the end user to manage, add and export provenance, ensuring both patient and Doctor will be able to access and use reliable provenance.  With the combination of Disruption Tolerant Networking, FHIR enabled healthcare Directory services and Data Provenance, a powerful Health Information Exchange Framework begins to take shape with added integrity control and resiliency both at the document and transport levels, reducing exchange errors and smoothing the flow of data between remote facilities and between healthcare workers during emergencies situations.

 

 

FHIR and Data Provenance

We are beginning an ONC funded Data Provenance research and development  project which we invite you to learn more about.  Data Provenance is one of the most important and least discussed parts of Health Data Exchange.  Affecting security, trust and research and payor usability, data provenance must not only follow HL7 standards but also be accessible and readable, by providers, patients, payors and emergency or field personnel.

We will implement a new FHIR based health systems data provenance API (toolkit) that will improve standards compliance in the provenance generated during the exchange of patient data between EHR systems, HIE Networks and Patient Generated Health Data from a variety of medical devices.  The primary goal is to present readable, actionable data provenance consistently.  Using a mix of CCD-A and full, de-identified patient health records from each participating system, we will start with a sample of 10,000 records per site.  We will identify areas where HL7 provenance standards are not fully or correctly implemented to provide a baseline for gauging the usefulness of the new provenance API.  Where necessary we will have the new API integrated and then run analytics on the same systems after the API is in place to demonstrate successful generation of consistent provenance with a high level of readability.  The readability of the provenance in CCD-A’s and EHR records is potentially important, for trust and for actionability, at the patient, provider and payor levels.

We will be using records from a wide range of systems including Cerner, Epic, Mirth, Nextgen, several cloud based EHR systems used in the field by telemedicine devices and a hybrid EHR in use by one of our rural project areas.  We include in this study one of our USDA-funded rural telemedicine projects which serves the Pacific Region, including the Northern Mariana Islands, Guam and American Samoa.  This region will allow us to sample provenance generated by mobile diagnostic devices used for telemedicine in remote areas and in the field.  This use case for telemedicine involved instances where patient health data must pass through multiple hops to get to a consulting physicians EHR system.