The two main definitions required for understanding the connection within the network are interoperability and security. Comviva (n.d.) describes interoperability as the ability of the networks to consistently send and receive data at the quality level that the end-user expects and to complete this process without affecting the operations of the networks. This is an integral element needed to achieve the end-to-end connectivity between the different networks, which is the ability of these networks to connect and exchange the data. In the case of the Manchester hospital, the connectivity and interoperability will ensure that the different divisions share data, without this process negatively affecting the work of the elements of the network; hence, the departments will still be able to use their personal computers and data systems with the same speed and quality of data retrieval as before. Security simply means that the data that moves through the interoperable system is exchanged only between the HIE parties that have the credentials allowing them to view it (Monica, 2019). The facilitation of security requires using specific strategies to protect the data itself and the process of data exchange.
The categories of interoperability include semantic, structural, and foundational. The semantic one is the highest level of operability that allows the user to utilize the information retrieved from the network actively, and it is based on structuring the data and codifying the vocabulary (Monica, 2019). The structural level is the one at which the recipient is capable of interpreting that data at the data field level. The foundation interoperability is the level at which the system can send the data to another network element of the HIE.
Technologies
The technologies required to facilitate the interconnectivity of the networks in the HIE related to the storage of information and the exchange and retrieval of it within the different systems in this network. According to Monica (2019), Health Level 7 International (HL7) and DirectTrust created a set of standards and classifications for interoperable networks. The first category is the Consolidated-Clinical Document Architecture (C-CDA), which incorporates both the texts that can be read by humans and those designed for machine learning purposes. C-CDA has a template of seven variations for the structured data and one designed for unstructured data. Direct secure messaging, for example, was introduced by DirectTrust as a method of secure information exchange over the Internet (Monica, 2019). Next, the Fast Healthcare Interoperability Resources (FHIR) is a standard introduced by HL7, which is designed to connect discrete data elements (Monica, 2019). FRIH is designed to connect the metadata about the files with the most common use cases, which makes the process of data retrieval easier and more comprehensive.
Legal and Ethical Issues
The primary legal and ethical concern is the issue of sharing the patient’s personal information with the other parties, which requires the hospital to obtain the individual’s agreement that testifies to their understanding that their personal information and data about their condition will be shared across the different divisions of the hospital. HIPPA’s standards are the ones that must be referenced when creating this network and when obtaining the agreements for data collection and storage from the patients. Mello et al. (2018) argue that the federal patient privacy laws have been a barrier to the development and widespread adoption of the HIE networks because some of the regulations are complex.
Compliance
Compliance is achieved by following the standards of how patient information must be maintained and shared among the HIE members. According to Monica (2019). The HIPPA standards require personal health information to remain secure at all times. To ensure compliance with the HIPPA standards, this HIE network will utilize the methods that ensure data security, such as the direct messaging systems where the data exchange occurs with an added layer designed for safety that is described in Direct Standard. Direct Standard is a set of specifications and technologies that the HIE must adopt in order to ensure that the process of information exchange is sufficiently protected.
Information Governance Life Cycle
Information governance lifecycle is the process of managing data from the moment of its creation until it is deleted from the system (“Information lifecycle governance,” n.d.). The elements include “records management, electronic discovery, compliance, storage optimization, and data migration initiatives” (“Information lifecycle governance,” n.d., para. 1). The purpose of these steps is in ensuring that the tremendous amount of data that HIE handle is managed properly, for example, by facilitating the cleanup of the data and by ensuring its maintenance. These elements must be included in the information governance plan because the lifecycle describes the steps through which data moves when it is first introduced to a system and the processes that help clean the massive sets of data. As a result, the inclusion of this information allows the HIE members to share data more effectively.
Data Dictionary
The data that has to be included in a dictionary is the Data Standard, which explains how the information for this dictionary must be collected and stored (“What is a data dictionary?” n.d.). For example, the standards may describe how the physicians should record the symptoms of their patients, such as by using the keyword format. Next, there should be a document that explains the metadata elements, such as the names of the variables, the type of input data, and other relevant elements. According to ScienceDirect (n.d.), a data dictionary may also contain a file with the names and descriptions of the other files stored in the system, such as a file that accounts for all the patient health records in HIE.
The process of management and maintenance of the elements in your data dictionary must be based on the responsibility and self-reliance of the individuals who are responsible for these dictionaries. For example, including the contact information of a person who created data fields or the standards of data may help ensure that the data management is adequately conducted (“Practical data dictionary design and maintenance,” n.d.). Another suggestion is ensuring that only the management team or the analysts can make changes to the structure of the data dictionaries.
Adopting and using vocabulary standards is necessary to ensure that the data dictionary’s updates will be consistent with the initial outline develop for the system, which will also affect the efficiency of the data storage and exchange. For instance, if the standards are not followed, the information in the dictionary will have a different format or will be added using varied approaches, which will make it difficult for the algorithm to manage the retrieval. Moreover, Monica (2019) notes that these standards provide a set of common characteristics applicable for different languages and environments, which helps maintain the efficiency of data management.
The use of a dictionary can support data standardization and exchange by creating a set of rules for all members of the HIE. By following these rules, the individuals who input data into the system and create metadata for it will do this consistently, which will help retrieve the data and make distinctions between patient records, treatment plans, insurance records, and other files.
Stakeholders
According to the Department of Health Care Finance (n.d.), there are three main stakeholders in HIE: the patients, providers, and the government. The providers affected by this change will be members of the HIE network, and they will benefit from the common issues they have faced before, such as the inability to retrieve records from other facilities and ordering duplicate tests. To ensure the buy-in and participation of the stakeholders, it is necessary to communicate the value and purpose of implementing the new data management system and specifically emphasize the issues that this new program will help address (AHQR, n.d.; “What are the benefits of health information exchange?,” n.d.). For the providers, the change will impact their efficiency and costs, allowing these healthcare entities to earn more profits. The patients will be treated more effectively due to enhanced information exchange, and therefore, their buy-in can be ensured by explaining the positive impact on their wellbeing. Finally, the government will also be impacted because its citizens will receive better care, the health of the public will improve, and the HIE data could be used to analyze the population health trends, suggesting an overall positive impact on the health of the population. To communicate these messages and ensure buy-in the organization can create a purpose statement and post it on its webpage.
References
AHQR. (n.d.). Health care stakeholder participation in health information exchanges (District of Columbia). Web.
Comviva. (n.d.). All you need to know about network interoperability. Comviva. Web.
Department of Health Care Finance. (n.d.). Benefits of health information exchange.Web.
Information lifecycle governance. (n.d.). Web.
Mello, M., Adler-Stein, J., Ding, K., & Savage, L. (2018). Legal barriers to the growth of health information exchange-boulders or pebbles? The Milbank Quarterly, 96(1), 110-143. Web.
Monica, K. (2019). How health data standards support healthcare interoperability. HER Intelligence. Web.
Practical data dictionary design and maintenance. (n.d.). Web.
ScienceDirect. (n.d.). Data dictionary. Web.
What are the benefits of health information exchange? (n.d.). Web.
What is a data dictionary? (n.d.). Web.