KRM Associates Inc - PHR Project Overview

EMR Evaluation
PHR Development
Integration

In performing the evaluation of Electronic Medical Record solutions across West Virginia, surveys were conducted to assess the variations in solutions, and their relative capabilites. It was determined that though roughly half of the providers had some form of computerized system in place, they were often limited in scope to scheduling and practice management. Only around ten percent had an EMR system robust enough to electronically manage patient medical information.

Through the evaluation, it was also determined the most common EMR solutions in West Virginia were open-source installations. The two most prevalant are OpenVistA™ and RPMS; both systems are based on Department of Veterans Affairs software and represent affordable solutions for providers. Currently these are installed in 7 state hospitals and 40 rural clinics. These products were found to be some of the more robust and adoptable EMR solutions, especially when viewed relative to installation and support costs. West Virginia consists of a largely rural and low income population, which meshes well with these commercial alternatives. Following the analysis, the decision was made for KRM to demonstrate their interaction using these two solutions.

In approaching the Personal Health Record component of their proof of concept, KRM’s initial intention was to leverage an existing PHR solution, also developed by Department of Veteran’s Affairs, titled “MyHealtheVet”. This highly successful and award winning PHR provides critical patient services to veterans, and has been lauded as an benchmark for the industry. However, upon a technical assessment of the solution, it was determined MyHealtheVet was too tethered to the VA’s Vista EMR to make a publicly interoperable installation of this solution too difficult to merit the time and effort.

The decision was instead made to develop and deploy an internally created solution. Through this approach, the solution’s interoperability with the open-source community could be assured. Additionally, through working with medical staff, both patient and provider needs could be addressed to assist the project in its relevance and growth.

To provide an adoptable and sustainable solution, KRM recognized that patient and provider feedback in an ongoing manner would be of critical importance. In beginning project design, KRM and Shepherd University reached out to various resources in the state of West Virginia, including prior Veteran’s Administration employees involved in the MyHealtheVet program. Through working with this staff, KRM was able to leverage lessons learned from the MyHealtheVet initiative in their product design. Additionally, by working with clinicians and medical professionals within the state, the product has been developed with their ongoing appraisal and input to guide the project towards meaningful functionality.

To ensure interoperability, KRM examined standards emerging throughout the industry relative to document formats and exchange protocols. By conforming to federally provided guidelines, the solution could exist on a standard capable of interacting with nearly any medical system. In selecting an EMR format to conform to, KRM used the standards set forward by the Certification Commission for Health Information Technology (CCHIT). Within this context and for this specific pilot, the continuity of care record (CCR) standard was selected for its robust architechture and XML-extensible format. For information exchange, this format is also well suited for transfer using the NHIN CONNECT standards.

This product needed to be widely adoptable in order to function in West Virginia, so the decision was made to build this project in non-licensed technologies. Currently, the installation exists with a MySQL database back-end, accompanied by Java-based middle tier and front end. By using widely adopted and low-cost technologies, the solution could provide a more readily distributable and affordable alternative in the healthcare technology market. This project, upon completion, will be furnished to the healthcare community as an open-source solution.

In March 2010, KRM Associates Inc. teamed with Northrop Grumman to demonstrate their Personal Health Record solution interacting with a Health Information Exchange (HIE). The Health Information Exchange was developed by Northrop Grumman, and utilizes the NHIN CONNECT standards. These standards, published by the Office of the National Coordinator (ONC), are guidelines for exchanging health-related information securely through networks.

The Personal Health Record developed by KRM was capable of requesting Electronic Medical Records from the Health Information Exchange. Upon this action, the HIE would request the appropriate records from test EMR installations of RPMS and OpenVistA, retrieve these records, and parse them into a secure personal health record repository. This data can then be displayed and interpreted through the PHR web-interface.

The secure transfer of information using publicly furnished standards represents an innovation in the potential for health information exchange. Through open-source technologies, electronic health information can potentially be captured and displayed at a fraction of the cost of privately developed EHR solutions and exchanges.

Through integrating a Personal Health Record with a Health Information Exchange, the potential for patient involvement in care increases dramatically as well. A patient has the potential to manage access to records not only contained within their Personal Health Record, but also across all distribution and collection points of the exchange; meaning a patient can better interact with their information and how this is used with providers.

Additionally, a Health Information Exchange has the ability to integrate medical information beyond standard medical records; this could mean anything from medications and immunizations to claims information and billing records; the benefits to patients and providers of communicating through these channels are potentially tremendous.