With the pandemic upon us I believe the value of NonStop is paramount. As many are aware GE Healthcare, the NonStop healthcare solution partner, existed the enterprise side of the business, relinquishing that market to their competitors Cerner and Epic. However NonStop has done more in healthcare and I wanted to tell an older story that becomes very applicable to today’s environment.
Back in the summer of 2005, the National Center for Health Care Informatics (NCHCI) engaged in discussions to create a Regional Health Information Organization (RHIO) for the state of Montana. As a non-profit corporation, the NCHCI recognized the important role it might play as an independent, neutral entity to help facilitate data exchange among highly independent, and competitive, healthcare facilities.
Recognizing the promise of Crossflo DataExchange (CDX) software as a possible solution for Health Information Exchange (HIE), in May of 2007, the NCHCI joined forces with Crossflo and (at that time) HP to develop the Montana Health Information Exchange Pilot Project. The stated purpose of the project was to demonstrate interoperable health information exchange using Crossflo software running on HP NonStop servers.
Criteria and requirements were established to help guide the project. The participant pool needed to include a minimum of four hospitals with electronic emergency department systems geographically dispersed across Montana.
In evaluating the criteria for the Montana HIE Pilot Project, the project team selected Syndromic surveillance as the use case because it represented a highly defined data set that could be de-identified (i.e., not containing identifiable personal health information as defined by HIPAA). Four hospitals, geographically dispersed across Montana and each with electronic emergency department data systems, were chosen to participate (see Figure 1).
Since the objective of syndromic surveillance is to detect diseases in their pre-epidemic phase, the Montana HIE was designed to aggregate diagnoses data from the participating emergency rooms at the four participating hospitals and then electronically publish the data to a syndromic surveillance application already in place at the Montana Department of Public Health and Human Services. The data would be examined at regular intervals to identify symptoms and diagnoses patterns that may indicate the presence of a naturally occurring or bioterrorist pathogen in the population. At that time, infectious disease diagnoses were typically made only after physicians had examined patients and obtained cultures to determine the types of organisms, a process that usually took several days. From a practical standpoint, diagnoses are actually made at an interval that is later than optimal. The best possible time to detect diseases is in the patients’ symptoms phase.
Crossflo Systems and HP were chosen for this initiative because Crossflo DataExchange (CDX) software integrated on HP NonStop servers offered an institution’s existing staff, systems and infrastructure very rapid and relatively inexpensive data sharing. This feature of using each facility’s existing personnel and data systems was an imperative given the disparate nature of the many hardware and software configurations found in hospitals, medical offices and public health entities.
The HP/Crossflo team worked with NCHCI and hospital IT managers to coordinate the implementation activities, and subsequently with the hospital network and database analysts to complete the mapping and transformation processes. In addition, the team worked with the DPHHS management and technical team on the syndromic surveillance system data load implementation, and testing.
The hospital data mapping and transformation process included the set-up of the individual hospital environment, and the mapping and transformation of the data to the syndromic surveillance system format. Some hospitals allowed the CDX application to access the production patient information system directly. Other hospitals opted to create a separate staging environment where the data specific to the project was stored
All processes were tested end-to-end, from data extraction to loading into the Syndromic surveillance system. The data was validated in the Syndromic surveillance system using an existing user interface.
The team evaluated all aspects of the project and shared lessons learned from the project as part of the project close-out process. The updated documentation deliverables were submitted to the customer, and final project sign-off was completed.
Well the project was a complete success but the funding from Homeland Security disappeared so it never went into production. Now as we wrestle with the Covid-19 pandemic I am reminded of the real-time syndromic surveillance done by NonStop and Crossflo back in 2007 and think that solution could still be a timely answer to intra and interstate emergency information. And given the integration capabilities of both the Crossflo software and the NonStop system, an interface to the TSA would seem likely in an effort to backtrack a patient and who they may have exposed. It’s certainly worth reinvestigation. For now:
Clean your hands often
Avoid close contact
Stay home if you’re sick
Cover coughs and sneezes
Be well my friends!
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