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The Mason HIT Center has identified five major challenges that need to be addressed in order to transform the current healthcare system.  Our approach is to create an evolutionary architectural framework that takes the current silo-based transaction-oriented system, and complements it with open-source, patient-oriented, standards-based data and knowledge sharing environment. 

Challenge 1: Create an open-source, service-oriented architecture consisting of modular, discoverable, and compose-able software and data services in support of healthcare.

There are many challenges to creating service-oriented architecture for healthcare systems: proprietary data formats, conflicting standards for electronic health records, semantic heterogeneity in the data elements comprising a health record, text annotations associated with physician interpretation of images, etc.  Rather than envisioning a monolithic single system, we envision a modular approach that allows a system to be configured from a collection of software and data services. 

The challenge is to create tools that allow the domain expert to specify high-level functional, quality-of-service and data requirements and then automatically generate a system from those components. Data integration and interoperation present great challenges for healthcare, and more flexible integration/interoperation frameworks are needed.  The concepts of pay-as-you-go integration and data aggregation via “dataspaces” hold promise in meeting these challenges.  With the advent of mobile devices as sensors, our systems will have to handle continuous data streams of health data.

Challenge 2: Create novel decision support tools to improve the quality of care.

The flood of data that will be streaming into our healthcare system will have to be organized and analyzed to produce value-added knowledge to assist: 1) policy makers in assessing healthcare outcomes, 2) physicians in determining best evidence-based treatments, 3) scientists in the discovery of new knowledge from the data, and 4) patients who are searching for answers to their questions.  We plan to leverage the concepts, tools and techniques in the areas of intelligent semantic search, decision guidance systems, recommender systems, and knowledge discovery from data.

Challenge 3: Create a Federation of Health Information Partners to break down the barriers that impede data sharing and interoperation.

In order to move from the current system to an open, standards-based, service-oriented architecture, we plan to create a Federation of Health Information Partners.  We will initially draw upon our partners in Northern Virginia healthcare community, then expand it to the Washington D.C. Metro region, and if successful, propose to deploy it nationwide.  The idea is to bring together a cross-section of healthcare stakeholders, understand their specific information-sharing needs, and formulate policies, standards, and methods for the secure and trustworthy sharing of information. 

Once the shared information becomes available to federation members, it can be used to support the following:  data liquidity of EHR, prescriptions and images; the creation of new information products; and the mining and analysis of large data sets to support evidence-based medicine.

Challenge 4:  Promote Consumer-Provider Participation in Health Information Exchange Systems

Health information exchange (HIE) systems are designed to promote sharing of relevant health information across diverse organizations, users, and settings. However, there has been a pronounced provider bias in the development of HIE systems, where physicians and other health care providers have been the primary intended audiences for health information.

There is a tremendous demand to develop health information systems that will promote information sharing.  Moreover, there is the need to empower consumers to participate actively in their health care by providing them with full, relevant, accurate, timely, and understandable health information that will enable them to make informed decisions about health risk prevention, health promotion, early detection/screening, and health care services.

Challenge 5: Analyze and compare competing Healthcare Systems Architectures.

We support an integrated vision that will facilitate the shared usage of electronic patient data and broaden the architecture standardization efforts essential to the broad applicability of the National Health Information Network (NHIN) in delivering consumer-centric and information-rich healthcare.  And, while there are a number of sophisticated technical architecture solutions available, currently, there are insufficiently validated health architectures with which to draw comparative conclusion on the benefits and flexibility of the implementations to support the NHIN and Office of the National Coordinator for Health Information Technology (ONC).

Drawing upon our previous experience with the NASA Independent Architecture Study for the Earth Observing System (EOSDIS), we intend to evaluate competing healthcare system architectures using a multi-faceted approach consisting of:

  1. a collection of Use Cases showing both data push- and pull scenarios on how data would be captured, stored and used;
  2. a data/information architecture showing the system data and knowledge structures;
  3. a software architectures showing the interaction among software systems and modules, and
  4. a hardware architecture showing the workload, scalability, and quality-of-service tradeoffs on major systems and network components.

The Mason Independent Architecture Study recommended a federated approach to the creation, sharing and interoperation of data/knowledge products.  NASA eventually sponsored the creation of the Earth Science Information Partners (ESIP), which is a federation of stakeholders that create value-add information products.  The ongoing success of ESIP Federation motivates and informs our proposed federated approach discussed in Challenge 3 above.

Last Updated on Wednesday, 24 February 2010 19:55