Mastering Data Management

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Bill Klaver assembles the pieces, systems and process of an HIE

Now that we’ve covered each of the aspects of an HIE – including standards, registries, repositories, PIX/PDQ Managers, security and more – it’s time to put it all together. Let’s walk through a quick high level example.

Say that William Johnson has a history of heart problems. Lately, he’s been having mild chest pains. William is not alarmed – he’s had this pain before – but he does call his primary care physician to make an appointment for later that week just to be safe.

When he arrives at the physician’s office his medical records, like in many physician’s offices, are stored in paper format locally in the office and are readily available to the doctor. The doctor has a pretty complete history of William through the years and begins to ask some episodic questions.

After the exam and because of William's age the physician orders an Isotope Stress Test at a local outpatient facility affiliated with the local hospital.

William travels to the outpatient facility for his tests and gives his basic demographic information to the registrar, who creates a new record and admits William for his test. William has the procedure and the test results are captured and stored locally by the outpatient facility, where his name is recorded as “Bill Johnson.”

Without our HIE environment this would be an issue: how would William's physician review the results or even know they are available? How would the physician know William's records are really referenced in the outpatient clinic by Bill instead of William?

With an HIE solution, this is no longer a problem as all systems will share their representation of William with the hospital’s PIX/PDQ Manager, which will resolve all the ways William is represented.

Remember, the PIX/PDQ Manager accepts all patient identities from all creation systems via HL7 messaging, then links those identities to a higher order identity or global identifier, and then answers questions about the person's identity (i.e. what William’s global ID is).

Additionally, behind the scenes, the outpatient facility's systems are tied to the rest of hospital's HIE environment. What this means now is the echocardiogram's and the echocardiograph images can be captured and shared by facility with the hospital's HIE.

The systems at the facility will query the HIE PIX/PDQ manager to obtain the global ID for William, add the GID to the sharable content (note images are not moved around the network but a KOS/Manifest document is generated and shared), and then submit that content to the repository.

Remember, the repository then tells the registry that it has sharable content for William. The XDS registry, which serves as the yellow pages of the hospital, knows which repositories have which information for William.

Hence, when William's family physician calls in a cardiologist to help review the test results, the physician and/or the cardiologist can log into the HIE system (via an EHR), search for William, get his global ID, ask the registry what content is available for William with his global ID, and then locate the that Isotope Stress Test results in the outpatient facility.

Additionally, other data about William may also be available in the XDS registry so, the cardiologist looking for William’s records might get a more complete history of William's health history, depending on his permissions.  Note that, throughout the process, privacy and security are ensured through authentication, encrypted data, auditing and other measures.

So, when William’s primary care physician and cardiologist agree that William should have an angiograph (an x-ray technique where dye is injected into the chambers of the heart or the arteries that lead to your heart to see if the coronary arteries are blocked) they know the content will again be shareable, immediate, and specifically related to William because all the systems are tied to the hospital HIE.

All-in-all, this means that William gets better treatment, at the right time, with more responsible care givers.

This is part of Bill Klaver's series, Building a Health Information Exchange Through International Standards. For other posts in the series, visit the Table of Contents.