Needham Heights, MA, USA
Bernard P. Wess, Jr. mail
A person's health and safety cannot be divorced from the their experiences, whether at home, work or play. Creating a wholeistic approach to person- and family-centered care requires combining and normalizing personal healthcare data, occupational healthcare data, clinical and personal attributes and methods of analysis that result in the creation of complete picture of a person and their state of care and health.
The National Academies Institute of Medicine has recently created a panel to study to examine the rationale and feasibility of incorporating work history information into patient electronic health records1. NIOSH seeks to ensure meaningful use of occupational information in electronic health records by 2015.
In the 1990s, Jim Palmer from The Procter and Gamble Company (P&G) put together a team of engineers, nurses, physicians, group health and occupational health and safety (OH&S) experts. The charge was to level-off and then control healthcare costs for approximately 1 million P&G employees in 100 countries. The program called CareNet was very successful, having reduced healthcare costs, total procedures and increased the quality of care and employee satisfaction for more than seven years. How was this done?
The program was successful because Jim combined all the lines of business at P&G, from group health and worker's compensation to OH&S into one integrated care and research information system built around two fundamental engineering concepts at P&G — total quality management and the center of excellence.
The Center of Excellence
The approach to integrating data was the same as the approach to total care management — combine everything we could determine about the employee and their family and use the information to manage care and drive insurance research to bring down healthcare, worker's compensation and self-insurance costs.
Since then, we have expanded the sources and uses of integrated social, clinical, health, disability and safety information to include:
- Occupational Health
- Risk Management
- Events, Cases, Protocols, Studies, Notes etc
- Provider information
- Case/Person/Event management
- Enrolled and non-enrolled services
- PHR/CDR/LAB etc information (self-reported and attested)
- Group and personal health information (clinical, administrative and financial)
- Worker's compensation (clinical, administrative and financial)
- Benefit and Policy information
- Social networking, mobile health data, medical home data
- Electronic collaboration
- Security, audit and control data
- Requirements and design information
- Real-time device management
This approach—total data integration—is the foundation of integrated care and case management and an important step forward in creating true patient- and family-centered care, regardless of the person's role as an employee, patient, and family-member in society.
A Systems Solution
Since the P&G experience, we have looked beyond claims data to merge additional critical data sources into an architecture that creates a uniform health & care information system that is vocabulary driven for global flexibility, is rule-based and makes no distinction between sources of data and lines of risk in insurance.
These concepts are very important for integrated occupational and health information systems. No code set includes the complex set of clinical, administrative, occupational, safety and financial terms and conditions that a complex corporation or organization will require, particularly in a global health and safety environment. As a result, the clinical and occupational team of experts must be able to define local codes and terminology, often on a country basis and make the clinical, administrative and financial information applications immediately aware of the new term and its associated rules.
This integration results in a uniform conceptual and information "space" that allows immediate expansion and ease of reporting for clinical and financial metrics. Moreover, it allows the rapid development of global applications in:
- Group health
- Worker's Compensation
- Occupational health
- Center of Excellence
- Care and Case Management
The Life Sciences Universe product is enabled to design, build and operate simple or complex insurance, clinical and financial applications for all lines of business and risk and to create and monitor patient "watch" or "surveillance" groups by diagnose or treatment category. Patients can use cell phones, smartphones, home computers and receive PDF documents created by personalized follow-up rules. These are not time consuming to create and they can be quickly designed and attached to a patient by a care or case manager.
Information Model Architecture
To enable enterprise-scale systems implementation, the entire product is written in Oracle and supports Oracle cluster processing, 64-bit architecture and full, secure Internet processing using Oracle Sun Web Services. Advanced transaction processing, audit and control is implemented using Oracle Advanced Queues for clinical, administrative and financial transaction processing that guarantees delivery of web transactions to secure queues for immediate processing.
Numerous tools are provided to balance real-time, clinical and analytical processing of patient rules. Full audit trails are created for all patient communications both sent and received.
1 Occupational Information and Electronic Health Records, National Academies Institute of Medicine, http://www.iom.edu/Activities/Environment/OccupationalHealthRecords.aspx
keywords: clinical rule engine, integrated care, medical home, no shows, clinical rule engines, life sciences universe, medicare, medicaid, patient compliance