1. Collaboration Network in Healthcare E-RISE 2011 By Yudistira Asnar, Federica Paci (UNITN) May 13, 2011

2. This scenario is adapted from the IBM case study Redbooks - Healthcare Collaborative Network Solution Planning and Implementation http://www.redbooks.ibm.com/abstracts/sg246779.html eRISE 2011 - Yudis(c)2May 13, 2011

3. Challenge: Provide reliable and accessible patient medical records to improve patient health outcomes Involving many actors/organizations with various goals Effective sharing of information to allow them to develop a care management system that effectively manages treatment plans and delivers eRISE 2011 - Yudis(c)3 Healthcare May 13, 2011

4. We have no monitoring system to identify bio-terrorism in a timely manner, to identify potential epidemics at an early stage Experts predict that another influenza pandemic is inevitable subsequent to three that occurred in the twentieth century: There are several health events that might affect a population Pandemic – e.g., Avian Flu, SARS Adverse Drug Event eRISE 2011 - Yudis(c)4 Trends May 13, 2011

5. eRISE 2011 - Yudis(c)5 Healthcare Record May 13, 2011

6. Regional Healthcare Authority “We need to be able to monitor endemic diseases within the region; and alert the citizens when there is an epidemic or a pandemic. Well coordinated actions are also required to monitor, control, and treated such events”  Public Health Alert eRISE 2011 - Yudis(c)6 Story in CityVille May 13, 2011

7. eRISE 2011 - Yudis(c)7 Collaboration in Present Time May 13, 2011

8. Complexity of interconnectivity increase the cost slow setup for a new collaboration Data interoperability across various healthcare organizations Integration of clinical data involving n-parties organizations Controlling Information Security and Privacy eRISE 2011 - Yudis(c)8 Challenges May 13, 2011

9. Regional healthcare authority decides to implement HCN Managed by the authority involving other organizations (e.g., healthcare providers, insurers, national agencies, independent labs) It is setup to function as part of an Epidemic & Pandemic (E&P) preparedness and response program eRISE 2011 - Yudis(c)9 Healthcare Collaboration Network in CityVille May 13, 2011

10. eRISE 2011 - Yudis(c)10 Collaborative Network to-be May 13, 2011

11. HCN Architecture EHR May 13, 2011eRISE 2011 - Yudis(c)11

12. Broker/Hub is managed by the HCN center (healthcare authority) Information sharing based on the Clinical Topic with attached clinical/medical data Participating organizations: CDC, Healthcare Authority, Hospitals, Labs, Pharmaceutical Companies, Health Insurers See Chapter 1 for more details eRISE 2011 - Yudis(c)12 How it works May 13, 2011

13. How it works (cont.) eRISE 2011 - Yudis(c)13May 13, 2011

14. Surveillance in the epidemic/pandemic alert stage and following the onset of a epidemic/pandemic Notification of sentinel events (events results in death or comma) related to diagnosis of public health concerns Notification of medical events which are as precursors of outbreaks Communicate medical data across the network in response to outbreaks eRISE 2011 - Yudis(c)14 HCN in Public Health Alert May 13, 2011

15. Things in the IBM Redbooks IGNORE the privacy levels that has been defined in Chapter 1.3 Chapter 6 gives you some ideas how IBM has implemented this technology on their setting Comply with HIPAA eRISE 2011 - Yudis(c)15 Information Security and Privacy May 13, 2011

16. [from wikipedia] Information Security is defined as protecting confidentiality, integrity, availability of information. It also includes protecting information and information systems from unauthorized access, use, disclosure, disruption, modification, perusal, inspection, recording or destruction and non-repudiation Information Privacy is defined as managing the collection and dissemination of personal identifiable information eRISE 2011 - Yudis(c)16 Information Security and Privacy (cont.) May 13, 2011

17. WHAT is the riskiest THREAT to the information security and privacy in the context of “Public Health Alert” WHAT and HOW to ensure that HCN protecting the information security and privacy Especially medical records of a patient or a class of patients eRISE 2011 - Yudis(c)17 Information Security Concerns May 13, 2011

18. Learn some security methods and Try to apply the method to analyze and design several security methods to protect the information security and privacy of HCN in the context of “Public Health Alert” eRISE 2011 - Yudis(c)18 What to do for TODAY May 13, 2011

19. THANK YOU Question? eRISE 2011 - Yudis(c)19May 13, 2011

20. EXTRAS eRISE 2011 - Yudis(c)20May 13, 2011

21. Enables monitoring groups (e.g. Local health jurisdictions, FDA, CMS, CDC) to improve detection and response time for bio-surveillance, adverse drug reactions, quality of care, and disease outbreaks Enables rapid ability to aggregate and share data Enhances ability to judge quality of care Facilitates and improves efficiency of mandatory reporting and collaboration with business partners Provides a secure environment for clinical data transmission using SSL and the highest level of encryption Leverages existing applications minimizing barriers to implementation eRISE 2011 - Yudis(c)21 Summary of HCN May 13, 2011

22. Hospitals - Internal collaboration for : Research/ Outcomes Analysis/ Quality Improvement Studies Adverse Event Detections Hospitals and Payers Improved coordination for case management Improved identification of disease management candidates Support for quality incentive programs Hospitals and Pharmaceutical Researchers Identification of candidates for clinical trials Post market population analysis Compliance observation for outcomes analysis States (and Local) - Public Health Reporting Bio-surveillance/ Situational awareness Health/disease management program candidate evaluation, outcomes analysis and resource planning Population monitoring eRISE 2011 - Yudis(c)22 HCN in Multi-Stakeholder Context May 13, 2011

23. Clinical Data Repository Population (EHR) Aggregate electronic health records from multiple sources for patient care For intelligent data warehouse population Quality of Care Analysis Prompt identification/notification of patients for whom care departs from established care paths Development of best practice guidelines for specific patient populations facilitated through easier aggregation and analysis of outcomes across disparate systems Evaluation of the practices pattern for specific patient population to support outcomes assessments Detection of Adverse Drug Events Evaluation of drug effects relative to outcome indicators like lab values Patient with prescription for Coumadin exhibiting International Normalized Ratio (INR)/ Prothrombin Time lab result greater than 8 Monitoring across larger populations for lower frequency adverse events Specific examples of HCN in practice give a picture of how organizations can benefit May 13, 2011eRISE 2011 - Yudis(c)23