Seygen Technologies partnered with a US Firm (HITS Partners) to build a Healthcare Information Service Provider (HISP) platform that could connect to the Nationwide Health Information Network (NHIN) platform.
A HISP provides a platform for various healthcare entities like Hospitals, Pharmacies, Emergency services, Insurance companies and Labs to connect and share information on patients. This provides the hospitals and these companies to provide enhanced care by ensuring patient information is shared quickly in an electronic format v/s the traditional paper reporting.
Privacy being an important aspect of the data being shared, data is encrypted and sent between providers to ensure it is only accessed by providers who have the necessary authorization to see and use the information.
We have implemented a solution for domino kidney matching using the “Blossom” algorithm for multiple donor-recipient combination. This solution was the first of its kind used by the public health system in India. The primary functionality was to help physicians get the best match for matching donors and recipients for swapping kidneys based on a number of parameters including medical (blood type, HLA antigen etc.), logistical (location) and other factors (like time of registration, age difference between donor and recipient etc.). The features implemented include:
- Central database where multiple nodal agencies can enter and manage records
- Ability to edit/update records (probably not delete) - maybe de-activate older records to remove them from matching pool.
- Ability for an authorized user to run a match at Centre level, City level, State level or National level
- Ability to review reports that are generated at scheduled intervals
- Ability to run an instant report when a new user is added or schedule a run which would result in the report getting sent back to the requester
- Ability to de-activate data (once the swap is performed and the data is no longer valid)
- Tabular report with Donor-Recipient and Score. On clicking on score, it should give details of a donor and the related recipient and give their details.
In this phase, ST implemented the Direct protocol to allow encrypted email mechanism between providers.
A web-based application provides access to health-care providers ability to register (including bulk-register) and setup the Users and their Digitally Signed Certificates over Microsoft Certificate Server. Their emails are setup on a Microsoft Exchange platform.
Underlying Technology: Microsoft Active Directory, Exchange Server, Certificate Server and a Custom ASP.net application
The Web application lets
- Providers login and view their custom email box
- Providers can set-up referrals for their patients to specialists and attach related documentation (lab reports, images etc). This is encrypted and emailed out to the recipient(s) using their public keys. The recipient may open the email using their private key.
- Providers can view the data sent to them from other providers in the custom views provided
- The Underlying engine decrypts the data using the private key of the Provider
- Multiple data formats supported: HL7 V2.x, HL7 V3.0 and CCD.
- Patient demographics, history of ailments, visits, referrals are all stacked up along with reports and views to let the provider have a 360-degree view of the patient.
- Providers can search referrals, diagnostics and generate / schedule reports.
- Integration with a pharma retailer (Surescripts) to let providers place referral prescription for patients.
In this phase, ST implemented the HISP functionality that enables various providers to connect to an authorized HISP which in turn connects to the NHIN platform.
Functionality and Technologies used:
- MDM - Master Data Management - Mural from Sun Microsystem
- HISP Edge Server Client - An Edge Server that would be deployed on the Provider side to enable roll-up of data on a nightly basis built on Java + Mysql/SQL Server
- NHIN Patient based services (Search Patients, Get Patient Details, GetPatient Documents and related services) on Java + SQL Server
A Patient registry built that integrates with an MDM application (Sun Mural). This provides
- A Unique ID for a Patient within the HISP domain
- MDM → A list of all the Patient names, aliases and related addresses and a link of various IDs (SSN, Driving Licence #, TIN etc) and with the Unique ID
- Patient Registry → Provides Patient v/s ID for each of the Providers (Hospitals and other entities) registered with the HISP and a link back to the MDM
- A Patient Lookup service that gives back a list of matches and the HISP Unique IDs
- A Patient Lookup service based on the HISP Unique ID
The HISP platform is an integration of the Direct Protocol, Edge Server and the Patient and Document registry. It is a complex Gateway with Authorization Workflows and User interventions for requests from internal and external providers. It provides
- Services to external providers on NHIN to perform
- Patient lookup and return back a list of Patients
- Retrieve documents lists (after authorization process) and documents for a Patient
- Register documents by a Provider for a Patient
- Invokes a Patient Lookup on an external Registered HISP
- Patient lookup and return back a list of Patients and the same functionality as provided by the said platform
- Integrates the Web application and lets Providers perform the above activities on the HISP or an external HISP via NHIN
This is a gateway that performs the following functions that ensure that the Actual EHR system is not impacted by Service Requests
- Scheduled/Nightly process to find all the patient records updated and generate CCD records for the same and patient registry document update with any new documents
- A registry containing a list of all the patient’s documents registered
- API to return a list of available documents for a patient searched by Patient ID
- API to return the document (health record, referral information, diagnostic information) for the patient by Patient ID and Document ID