1. Patients Health Information
Translator (PHIT)
Team: Caramez-
Karkhanis-Yeramreddy
Faculty: Daniel Ries
Key Standards in Health Informatics Systems

2. Overview
Meaningful use aims to improve:
 Quality, safety, efficiency
 Maintaining privacy and security of patient health
information
Three Stages:
 Stage 1 : Implement and use certified Electronic
Health Record
 Stage 2 : Health care providers can exchange the
information, Improves efficiency and patient care.
 Stage 3 : Achieve Outcome

3. Overview(2)
Information exchange
systems must be:
Compatible
Must meet standards
Must be certified
Exchange information
helps Clinical
Decision Support

4. The Real Problem
Clinical Settings
 In the cases of emergency, unplanned care is
delivered at the Emergency room.
 Physicians are not able to provide efficient care
because they lack critical information about the
patient.
 Lack of Interoperability is hindering the exchange of
data in todays healthcare.
 Situation is explained further by taking a case
example.

5. Case Example
Situation
 85 years old female, falls at home and informs
911.
 Patient is rushed to ER at MGH(uses EPIC).
 Unable to provide information about her.
 CT scans reveal that patient has a Subdural
Hematoma resulted from a serious head injury.
 The Hospital needed more information but it
was not available.

6. Patient Details
Prior Medical History
 Followed by a Geriatric physician at Carney
Hospital outpatient clinic (Cerner)
Conditions
 Atrial Fibrillation (Cardiac arrhythmia)
Probable Medication
 Warfarin sodium for a long time (is the active
ingredient of CoumadinR)

7. Warfarin
Anticoagulant (blood thinner)
Indications: used to prevent harmful blood clots from
forming or growing larger on the legs, lungs, or clots
associated with Irregular, rapid heartbeat called atrial
fibrillation
Warfarin increases your risk of bleeding, which can be
severe or life-threatening:
 Patients 65 years old or older
 History of trauma, such as an accident or surgery
 Take other medicines that increase your risk of
bleeding, including
must be monitored carefully with blood testing

8. Clinical and Technical Gaps
Interoperability problem
 MGH has a certified EHR as well
as Carney Hospital, but they
can’t share health care
information.
 Both hospitals use systems
which use different standards to
store clinical Information.
 The problem is not the systems,
but rather the difficulty of data
exchange between systems.
 Hospitals are ready to share but
how to communicate?
 We need is Syntax and Semantic
Interoperability between
systems.

9. The Massachusetts Health
Information Highway (Mass HIway)
 Statewide health information exchange (October2012)
 Offers providers a way to secure sending of health
information from one User to another
 This meaningful exchange of information can enable the
Commonwealth’s care community to:
 Positively influence care coordination and delivery
 Avoid readmissions and medical errors
 Reduce administrative costs and duplicative testing
 Enhance communication among providers

10. Proposed Design
Hospital 1 Hospital 2
Mass HIWay
Service
provider
PHIT App
Translator
Data
Transfer Data
Transfer

11. Proposed Solution
Automated process - Three use cases have been
identified
Hospital 1
PHIT
Dashboard
Hospital 2
PUSH patient
information on
request
Standard
structure
Query
Request
Query
Request
Case 1: With EMR Vendor conformance

12. Proposed Solution(2)
Case 2: Independent of EMR vendors
Case 2: Independent of
EMR vendors
Hospital 1
PHIT
Dashboard
Hospital 2
Capture
Information while
viewing the
Records
Standard
structure
Query
Request
Query
Request

13. Proposed Solution(3)
Case 3: PHIT Portal on the State HIE
(MassHiWay)
Hospital
1
PHIT
Portal
Hospital
2
Query
Request
Query
Request
State HIE
DB
Fetch/
store

14. Standards to be used
 The idea is to make the
application capable of
handling multiple standards.
 Some of the major
standards which can be
incorporated are HL7,
DICOM, FHIR and text
encryption
standards/protocols.
 Standards can be selected
based on the situations or
cases.

15. Real Time Examples

16. Lets Consider Hospital 1 (MGH) uses HL7 FHIR,
the patient encounter discussed would look
something like this:

17. MGH
HL7 FHIR
Carney Hospital
HL7v.2.5.1
Mass HIway
Service provider
PHIT App
Translator
Data
Transfer
Data
Transfer
Modeled Workflow

18. Hospital 2 (Carney Hospital) uses HL7V2.5.1,
thus using PHIT we could translate FHIR into
HL7V2.5.1.
MSH|^~&|REGADT|MCM|IFENG||200301061000||ADT^A05^ADT_A05|||0
00001|P|2.5.1|||
EVN|A05|200301061000|200301101400|01||200301061
PID|1||191919^^^MALLOE ||WHITEWOMAN^SNOW^E||19560129|F|||1
MAIN^^BOSTON^MA^02116^""^||(900)485--‐5344|(900)485--
‐5344||S||10199925^^^MALLOE^AN|371--‐66--‐9256||
NK1|1|WHITEWOMAN^ELLA|DAUGHTER|1MAIN^^BOSTON^MA^02116^""^|(
900)485--‐5344|(900)545--‐1234~(900)545--
‐1200|EC^EMERGENCYCONTACT
PV1||O|||||0148^EVE,SNOW|0148^EVE,SNOW|0148^WHITEWOMAN,
SNOW|AMB|||||||0148^EVE,SNOW||1|

19. Semantics(LOINC/SNOMED)

20. Allergy Example
 Incase of Allergy and Drug Adverse effects:
 The SNOMED-CT codes for the allergy reaction and the adverse
reactions of the drug will be stored in the data repositories in the
MassHIWay State HIE.
MGH
NDC Codes,
RxNorm.
Carney Hospital
EMR.
MassHiWay
Allergy reaction, poisoning,
adverse effects, etc. in
SNOMED-CT codes
PHIT App
Translator
Pharmacy
codes
Data
Transfer

21. Potential Impact
 Brings lots of benefits during the decision-making
process.
 Can save lives especially at the ER when you need
to act quickly.
 Enhance communication among providers.
 Improve quality of care.
 Can prevent or avoid patients critical/life
threatening condition.

22. Questions??

23. Thank You!