Healthy Living Knowledge, Standards Too The Healthcare Crisis: Business Office 6

In the previous posts [click hither for get-go inwards series], I described many of the problems facing the healthcare manufacture equally it attempts to bargain amongst information as well as technology standards. These daunting problems include high cost, complexity, difficulty accommodating changes, loss of pregnant as well as nuance, problem defining quality, inadequate measures, political influence, etc. I at in i lawsuit verbalize over how an innovative approach to the purpose of wellness information technology would assistance solve these problems.

Solving the Problems amongst Healthcare Standards

From a technological perspective, what's needed to solve the work amongst standards is a simple, low-cost, reliable, secure, hassle-free way to commutation as well as stance structured & unstructured wellness information, anywhere as well as anytime, inwards a way that:

• Maintains the total pregnant as well as nuance of the information beingness exchanged inwards companionship to maximize agreement as well as the information's usefulness, regardless of the information standards beingness used.


• Supports fluid connectivity betwixt all information technology systems, regardless of their technology standards.


• Gives all authorized consumers/patients, providers, suppliers, payers (insurers), as well as purchasers (employers as well as self-insured) the information they need, inwards the way they ask it, to back upwards decisions as well as guide actions.


• Supplies researchers amongst the information they ask to evaluate clinical outcomes as well as aid processes, hence they tin create, continually evolve, as well as widely disseminate evidence-based guidelines.

I ground that the best way to exercise this is through a secure node-to-node network architecture using template-driven software applications having "publisher-subscriber," information translation, as well as personalized reporting capabilities. Let me explain.

Why a Node-to-Node Architecture

In a node-to-node architecture, each node is a software application inwards a calculator that sends as well as receives information from other nodes. This architecture supports "peer-to-peer" (P2P) networks inwards which each node stores its information files locally as well as shares them amongst other nodes without beingness controlled past times a centralized server.[1] The telephone scheme as well as electronic mail are skillful examples of node-to-node. Every telephone as well as every calculator are nodes. By picking upwards the telephone as well as dial a number, or past times typing inwards an electronic mail address, y'all tin communicate amongst whomever y'all want, as well as exercise it anytime as well as anywhere. Your telephone telephone or electronic mail is routed automatically to where y'all wishing it to larn through a serial of uncomplicated switches. This opened upwards network is quite different than a centralized scheme inwards which y'all must get-go sign on to a fundamental server that determines who y'all are authorized to contact earlier sending them your message, i.e., all information must locomote past times through a fundamental potency that controls all communications. In addition, such centralized systems typically require the costly evolution as well as ongoing maintenance of a centralized patient tape locator to know where to honor patient data.

The next brand the instance for a node-to-node/peer-to-peer architecture for exchanging healthcare data:

• "The United States' National Health Information Network, or NHIN, volition differ from the UK's projection inwards a number of ways. Rather than having a single, unopen network amongst a fundamental database overseen past times i authorities agency, the U.S. scheme volition last decentralized, operating to a greater extent than similar a peer-to-peer network, amongst records distributed across the system. Think Napster on steroids. …the NHIN volition allow a Dr. to chop-chop telephone telephone upwards a patient's digital records from whatever databases they may reside in-at a hospital, at the identify unit of measurement doctor's or dentist's office, at a clinical lab, wherever."[2]


• "After initial testing using a centralized patient index, [Massachusetts' MA-Share HIE determined that] the maintenance for that looked similar it would last to a greater extent than than users would wishing to pay. So the commutation uses distributed peer-to-peer networking. The MA-Share commutation provides an appliance to allow members force fiscal transactions, e-prescriptions, as well as clinical summaries-so a Dr. tin shipping a file to some other Dr. or render prescription information to a pharmacy." [3]


• "To brand important gains inwards patient security through the adoption of wellness IT, providers volition ask to adopt information technology systems that tin 'speak the same language' to each other. In calculator terms, they should last 'interoperable.' But interoperability isn't enough. To communicate, different wellness information technology systems must too last linked inwards some way. This is 'connectivity.' One model of connectivity, inwards a national wellness information technology context, would last a non-proprietary 'network of networks.' …Several issues must last addressed if different wellness information systems are to communicate. …Some advise that in that place should last i uniform national scheme amongst i fundamental repository. This approach presents challenges: the sheer book of information that would ask to last handled, important concerns nearly privacy as well as security threats, as well as probable disputes nearly governing as well as paying for a centralized system. Another selection is a serial of regional networks, equally advocated past times ONC [the Office of the National Coordinator of Health Information Technology, formally ONCHIT]. ONC's strategic frame- locomote suggests that a national network should last structured roughly regional wellness information organizations (RHIOs). RHIOs would store, organize as well as commutation patient wellness information inside a defined geographic region, nether local rather than national governance. These regional organizations would degree a "network of networks" across the nation." [4]

Publisher-Scriber Communications Model

The nodes inwards these P2P networks employ a publisher-subscriber communications model inwards which a publisher node uses its communications software application to seat out (send) information to i or to a greater extent than authorized subscriber (receiver) nodes. Once transmitted, the subscriber nodes purpose their subscriber applications to squall upwards that information as well as acquaint it equally reports. In other words, the publisher-subscriber model uses an "application to application" transfer procedure inwards which each participating node uses a item software application for exchanging (sending as well as receiving) information.

The publisher as well as subscriber applications back upwards a item operating scheme OS) as well as Internet connexion using broadband or dial-up service. Influenza A virus subtype H5N1 node that uses an electronic mail customer (such equally Microsoft Outlook on Windows OS) is i such example.

At i cease of the connection, the publisher node must authorize the information transfer past times authenticating that the subscriber node is allowed to have the information. At the other cease of the connection, each subscriber node must allow the publisher to deposit the information into a directory (i.e., a folder inwards computer's drive) equally a file amongst a specific format (such equally an MS Word, Excel, or "comma separated value" file).

Universal Translation

Influenza A virus subtype H5N1 node-to node architecture incorporating "universal translation" provides a way for modifying (transforming, translating) information equally it passes betwixt nodes, hence that each subscriber node receives from a publisher node the correct information, inwards the correct format (structure), as well as amongst the correct terminologies (semantics).

This is where information as well as technology standards are handled. That is, the universal translator makes the necessary transformations to the information sent past times a publisher node, hence different subscriber nodes tin purpose that information to generate their item reports and, if desired, to shop the information received inwards the subscriber nodes' databases. It tin adjust whatever information standards as well as operate amongst systems using whatever technology standards.

Advantages as well as Benefits of the Node-to-Node Architecture

The advantages as well as benefits of this asynchronous, publisher-subscriber, node-to-node architecture are many, including the following:

• Is exceptionally flexible:
• Accommodates whatever information as well as technology standards, hence everyone gets the information they ask inwards the way they ask it
• Allows anyone to communicate amongst anyone else inwards whatever way
• Can purpose multiple connectivity options, i.e., radio transmission, satellite transmission, wire transmission, wireless transmission.


• Has maximum reliability since it leverages the most reliable network inwards the world, i.e., the switched network (like the telephone system).


• Is inexpensive to deploy as well as operate because it doesn't require changes to existing I.T. infrastructures as well as keeps implementation costs depression past times eschewing additional equipment as well as scheme purchases.
• Is robust as well as resilient since in that place is no unmarried signal of failure; so, dissimilar centralized networks that are disrupted if a fundamental server goes down, the node-to-node network is survivable inwards a disaster since it keeps going fifty-fifty if private nodes are disabled.


• Makes scalability a non-issue, which way there's no ask to buy novel equipment or redesign software equally the network grows; this is dissimilar a centralized scheme inwards which in that place tends to last important costs inwards fourth dimension as well as coin to reckon the needs of a growing network.
• Is highly secure since in that place are no external database queries; firewalls are non crossed.

In my next post, I verbalize over other parts of the solution: Composite Reporting as well as Application Integration.

References:

[1] Wikipedia - Peer to Peer as well as WellnessWiki - Network Architectures (see Node Mesh Network)

[2] Charett, R.N. (2006). Dying for Data: Influenza A virus subtype H5N1 comprehensive scheme of electronic medical records promises to salve lives as well as cutting wellness aid costs-but how exercise y'all construct one? IEEE Spectrum Online (Oct 2006)

[3] Kolbasuk McGee, M. (May 28, 2007). Urgent Care. Informationweek.com

[4] Linking Providers Via Health Information Networks. Alliance for Health Reform. (Dec 2006).

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