Healthcare IT Transformation: Bridging Innovation, Integration, Interoperability, and Analytics

320 Pages·2016·19.016 MB·\320

by  John C. Dodd (Author)

Healthcare IT
Transformation
Bridging Innovation,
Integration, Interoperability,
and Analytics

Healthcare IT
Transformation
Bridging Innovation,
Integration, Interoperability,
and Analytics
John C. Dodd
CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742
© 2017 by Taylor & Francis Group, LLC
CRC Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed on acid-free paper
Version Date: 20160719
International Standard Book Number-13: 978-1-4987-7844-2 (Hardback)
This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been
made to publish reliable data and information, but the author and publisher cannot assume responsibility for the valid-
ity of all materials or the consequences of their use. The authors and publishers have attempted to trace the copyright
holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this
form has not been obtained. If any copyright material has not been acknowledged please write and let us know so we may
rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or uti-
lized in any form by any electronic, mechanical, or other means, now known or hereafter invented, including photocopy-
ing, microfilming, and recording, or in any information storage or retrieval system, without written permission from the
publishers.
For permission to photocopy or use material electronically from this work, please access www.copyright.com (http://
www.copyright.com/) or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923,
978-750-8400. CCC is a not-for-profit organization that provides licenses and registration for a variety of users. For
organizations that have been granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are used only for
identification and explanation without intent to infringe.
Visit the Taylor & Francis Web site at
http://www.taylorandfrancis.com
and the CRC Press Web site at
http://www.crcpress.com
Contents
Preface: Shift to Patient–Consumer-Centric Health IT with Innovation at All Levels .....xiii
Acknowledgments ....................................................................................................................xv
Author .....................................................................................................................................xvii
1 Wave 2: Integration–Interoperability and Analytics Overview ...................................1
Abstract ..............................................................................................................................1
1.1 Introduction ............................................................................................................1
1.1.1 Do We Really Have to Change to Get Patient–Consumer Engagement? .....5
1.2 Must Change! Current Progress: Shift to Patient–Consumer Focus ........................8
1.3 Government: Medical Providers—Health Information Industry Partnerships ........9
1.4 Years, Not Months..................................................................................................11
1.5 Mixed World: Fitting the Pieces Together from the Middle ..................................12
1.6 Background: Build upon the Accomplishments ......................................................17
1.7 Where is Healthcare Transformation Now? At the Federal Level, within
State Innovation Models, Medicaid Reforms, and CMMI Grants ..........................17
1.8 Integration: Start from the Patient–Consumer Perspective and Use
Information-Centric Content Management Approaches ........................................19
1.9 Interoperability ......................................................................................................20
1.10 Analytics Integrated into Fact-Based Decision Making .........................................20
1.10.1 Reference Model: L Value-Driven Bi-Directional Business-
Knowledge and Integration .......................................................................20
1.11 Creating Integration and Interoperability Solutions and Implementing
Shared Services Projects .........................................................................................22
1.12 Intercloud Framework for Patient–Consumer Linking to Value-Driven SOS
for Government and Community Health Architecture and Shared Services
Analysis .................................................................................................................23
1.13 Building Keystone Shared Services and Ability to Adapt and Extend
with Value Adds .....................................................................................................25
1.14 Information Sharing Services .................................................................................25
1.15 Governance Actions for a Shared Services SOS .....................................................28
1.16 Integration and Interoperability/As-A-Service .......................................................28
1.17 Pilot Bi-Directional and Improvement Networks for a Rare Disease Collaborative .....29
1.18 Building in Protection: Policy-Based Machines, Data Segments, and Layers
of Protection ..........................................................................................................30
1.19 Emerging Trends ...................................................................................................30
1.20 Conclusion ............................................................................................................32
v
vi ◾ Contents
2 Steps Needed to Plan and Design a Patient–Consumer-Driven
Architecture for Wave 2 ..............................................................................................33
Abstract .............................................................................................................................33
2.1 Introduction ...........................................................................................................33
2.1.1 The Big Challenge: Meeting the Needs of Patients and Consumers
Using Health IT and New Innovative Approaches ....................................34
2.2 Challenges, Controversies, Coopetition, and Issues ...............................................37
2.2.1 Challenges: AIMs—Care, Health, and Cost.............................................39
2.2.2 Controversies ............................................................................................40
2.2.3 Coopetition: Defining the Mix of Collaboration and Competition ...........41
2.2.4 Issues..........................................................................................................41
2.2.5 Solutions and Recommendations ..............................................................42
2.2.6 Multiple Attribute Value Analysis and Decision Making ..........................42
2.2.7 Meaningful Use 2 and 3 with a Series of End-to-End Scenarios ...............43
2.2.8 PAUSE Assessment ...................................................................................43
2.2.9 Process for Assessment ...............................................................................45
2.2.9.1 Plan the Strategic Focus of the Healthcare Organization ...........46
2.2.9.2 Assess the Maturity and the Technical Debt ..............................46
2.2.9.3 User Experience Review Based on the Populations Supported ......47
2.2.9.4 SOS Mission Threads and Logical Channels and
Common Integration Steps and Interoperability Services ............47
2.2.9.5 Establish the Baseline Roadmap and Create an
Open Environment with a Phased Incremental
Modernization Approach ...........................................................48
2.2.10 Define Integration and Extension Points ...................................................49
2.2.11 Define Key Value Threads and Shared Services .........................................49
2.2.12 Define Data–Information Subject Areas for Integration and
Interoperability of Administrative and Clinical Information ....................50
2.2.13 Define the UCORE of Identity Information ..............................................52
2.2.14 Logical Channels and Interfaces ................................................................53
2.2.15 Integration and Interoperability Platform: Services
and Capability Models .............................................................................53
2.2.16 Development and Integration of Shared Services and Creating
a Master Roadmap and Negotiation Process ..............................................55
2.2.17 Meaningful Use Reporting and Analysis ..................................................56
2.2.18 Emerging Trends ........................................................................................57
2.3 Conclusion .............................................................................................................59
3 Wave 2: Integration Using System of Systems Health and Human System
Model Integration Process with Integration Maps and Risk Management ................61
Abstract .............................................................................................................................61
3.1 Introduction ..........................................................................................................63
3.1.1 State Innovation Models ...........................................................................64
3.1.2 Medicaid Reform Including IT Updates ...................................................64
3.1.3 Ad Hoc Changes on Annual Basis .............................................................65
3.2 Challenges, Controversies, and Issues .....................................................................67
3.2.1 Integration Challenges ...............................................................................67
Contents ◾ vii
3.2.2 Controversies ............................................................................................69
3.2.3 Issues.........................................................................................................69
3.3 Solutions and Recommendations ...........................................................................70
3.3.1 Process Step for Integration and Interoperability Shared Services .............70
3.3.2 Integration Mapping .................................................................................72
3.3.3 Breaking the Silos with a Keystone Interoperability and Integration
Platform ....................................................................................................73
3.3.4 Define a Reference Model for Key Threads and Services Needed ..............73
3.3.5 Define the Data–Information Subject Areas .............................................75
3.4 Emerging Trends ...................................................................................................77
3.5 Conclusion ............................................................................................................79
3.5.1 A Next Generation of Medicaid and MITA Need an Integration
Approach ..................................................................................................79
3.6 The Practical Stuff .................................................................................................80
4 From Host-Centric to Patient–Consumer-Information-Centric Interoperability
Enabling New Care Coordination and Analytics Building Blocks ............................83
Abstract ............................................................................................................................83
4.1 Introduction ..........................................................................................................86
4.2 Patient–Consumer to Provider B-Directional Information-Centric Analysis .........87
4.3 Emerging Information-Centric Networking ..........................................................87
4.4 Ecosystems Tying Systems to Systems and Information-Centric
Paths of Progress ................................................................................................88
4.5 Issues, Controversies, and Problems .......................................................................90
4.5.1 Controversies, Motivators, Barriers, Moderators, and Issues ......................91
4.5.2 Controversies ............................................................................................93
4.5.3 Motivators .................................................................................................93
4.6 Continuous Stakeholder Engagement and Shared Services Development ..............93
4.7 Patient–Consumer-Information-Centric Interoperability and Continuous
Delivery .................................................................................................................94
4.8 Process Steps: Shared Services and SOS Capabilities .............................................95
4.8.1 Barriers .....................................................................................................96
4.8.2 Moderators ................................................................................................96
4.9 Issues .....................................................................................................................97
4.10 Information Sharing Reference Model: Integrated Views for Improvement ...........98
4.11 Standards Profile and Accelerating Gap Closure ..................................................100
4.12 Information-Centric Network-Software-Defined Networks Aligned
with Patient–Consumer–Healthcare Value Models ..............................................101
4.13 Patient–Consumer-Information-Centric Public APIs: Open APIs
with Governance Process ......................................................................................101
4.14 Shared Services: Design–Development–Deployment and Governance .................102
4.15 Governance Tools: Integration Plan along with the Management
of Shared Services .................................................................................................102
4.16 Patient–Consumer-Information-Centric Pathways and Local, Extendible
Architecture with Integration Points .....................................................................103
4.16.1 Integration Certification and Community-Problem Resolution ...............103
4.16.1.1 Integration Master Plan ............................................................104
viii ◾ Contents
4.16.2 Integration Master Plan and Integration Points........................................104
4.16.3 Creating a Regional or State Transformation Integration Plan .................105
4.16.4 Connecting to the Current Capabilities: Integration and Extension Points......106
4.16.5 CMS Patient–Consumer-Information-Centric Enterprise Architecture
Needs to Extend to the Ecosystem and Communities of Interest .............107
4.16.6 Using Simple Semantics Ontologies Today ..............................................111
4.16.7 Strategy and Principle Agreement and Mapping ......................................111
4.17 Leveraging Emerging Trends ................................................................................113
4.17.1 Fitting the Individual Organization into the Related Networks ...............115
4.18 Conclusion ...........................................................................................................116
5 Using New Medicaid Reform with Next-Generation MITA for Patient–
Consumer-Information-Centric Health and Human Services Interoperability
Architecture and Shared Services in the 2018–2020 Time Frame ............................117
Abstract ...........................................................................................................................117
5.1 Introduction .........................................................................................................118
5.1.1 Background .............................................................................................118
5.2 Challenges, Controversies, and Issues ...................................................................118
5.2.1 Challenges ...............................................................................................118
5.2.2 Controversies ...........................................................................................119
5.2.3 Issues.......................................................................................................120
5.3 Solution and Recommendations ...........................................................................121
5.3.1 New BI Analytics Framework Needed ....................................................122
5.4 Integration Master Roadmap and Negotiation Process ........................................124
5.4.1 Cross Clinical and Administrative Coordination Scenario: Mental
Health and Medicaid Alignment with Integration and Interoperability
Shared Services .......................................................................................124
5.4.2 School Behavior Referral Scenario ..........................................................124
5.4.3 ED Set-Up of Mental Health and Medicaid Connections .......................126
5.5 Emerging Trends .................................................................................................127
5.6 Moving the Medicaid Systems to a Patient–Consumer Focus ..............................127
5.7 Conclusion ..........................................................................................................130
5.8 The Practical Stuff ................................................................................................133
6 Fostering Innovation and Integration, Alignment and Continuous Planning
into Your Evolutionary Life Cycle ............................................................................135
Abstract ...........................................................................................................................135
6.1 Introduction: Fast Smart Ready Technology ........................................................135
6.1.1 Innovation Manifesto ..............................................................................137
6.2 Fostering Innovation and Selecting Ready Technology with Ingenuity
Workshops and Governance .................................................................................138
6.2.1 Moving Innovation and Integration to a Primary Focus and Placing
in Life Cycle .............................................................................................139
6.3 Leveraging Capabilities: Ready Technologies........................................................142
6.4 Challenges, Controversies, and Issues ...................................................................142
6.4.1 Challenges ...............................................................................................142
6.4.2 Controversies ...........................................................................................143
6.4.3 Issues........................................................................................................144
Contents ◾ ix
6.5 Solutions and Recommendations ..........................................................................144
6.5.1 Integration and Interoperability Continuous Delivery
and Integration Process Steps ...................................................................144
6.6 Continuous Integration Process for Health Ecosystem Model
with Patient–Provider Exchanges ..........................................................................145
6.6.1 Managing Based on Health Events ..........................................................149
6.6.2 Continuous Exchange and Alerting between Patient and Provider ..........149
6.7 Creating Health Event Information Hub ..............................................................151
6.7.1 Creating a Patient and Provider Analysis Portal for Specific
Diseases and Communities ......................................................................151
6.7.2 Continuous Pathway Integration Readiness and Risk Scorecard ..............152
6.8 Emerging Trends ..................................................................................................152
6.8.1 An Integration and Interoperability Research Project Needed..................152
6.9 Conclusion ...........................................................................................................154
6.10 The Practical Stuff ................................................................................................154
7 Analytics Framework for Range of Health Services .................................................155
Abstract ...........................................................................................................................155
7.1 Introduction .........................................................................................................155
7.1.1 Leverage Analytics Frameworks and Early Health Analytics....................157
7.2 Challenges, Controversies, and Issues ...................................................................157
7.2.1 Challenges ...............................................................................................158
7.2.2 Controversies ...........................................................................................158
7.2.3 Issues........................................................................................................159
7.2.4 Challenges of Analytics Integration .........................................................160
7.2.5 Challenges of Stakeholder Engagement: Vendors with Abstract
Services Layer...........................................................................................161
7.2.6 Challenges of Interoperability and Analytics ............................................161
7.3 Solutions and Recommendations ..........................................................................161
7.3.1 Analytics Reference Model ......................................................................162
7.3.2 Analytics Data Model: Common Identifiers ............................................162
7.3.3 Predictive Process Models: Immature but Needed Now ...........................163
7.3.3.1 Fitting into the Surrounding Environment ...............................163
7.3.4 Relate Analytics to Needs of Community of Interest, and Ensure
Analytics are Goal Driven ........................................................................166
7.3.4.1 Define a Set of Health Infographics and Their Usage
for Both Patient–Consumers and Providers ...............................166
7.3.5 Analytics Shared Services: From Core Services to Sharing Data
and Processes ...........................................................................................168
7.3.6 Emerging Trends of New Analytics and Big Data ....................................169
7.4 Conclusion ...........................................................................................................169
7.5 The Practical Stuff ................................................................................................170
8 Incremental Commitment Planning, Governance,
and Tracking Value-Risk-Integration .......................................................................173
Abstract ...........................................................................................................................173
8.1 Focusing on Goals and Implementation ...............................................................174