CIGNA-1

Enabling Ubiquitous Personal Health Device Enabling Ubiquitous Personal Health Device Integration through Open StandardsIntegration through Open Standards

Steven A. Demurjian and Maifi KhanComputer Science & Engineering Department

The University of Connecticut371 Fairfield Road, Storrs, CT

Thomas P. Agresta and Michael BlechnerFamily Medicine & Pathology Departments

University of Connecticut Health Center263 Farmington Avenue, Farmington, CT

steve@engr.uconn.edu, mok11002@engr.uconn.eduagresta@nso1.uchc.edu, mblechner@uchc.edu

CIGNA-2

Today’s Applications and Systems Built around Today’s Applications and Systems Built around Multiple TechnologiesMultiple Technologies APIs, Cloud Computing, Web Services, Data

Mining, etc. Alternative Data Structure StandardsAlternative Data Structure Standards

XML, RDF, JSON, OWL, etc. Meta-Systems that Share, Use and Exchange Meta-Systems that Share, Use and Exchange

Information to fully functionInformation to fully function XML as de-facto Standard

What are the Key Challenges?What are the Key Challenges? Information Interoperation from Multiple Sources Integration of Today’s and Emerging Technologies

IntroductionIntroduction

CIGNA-3

Interplay of Information in HealthcareInterplay of Information in Healthcare

PHI

Secure PHI

Local Security Policy/Control

XML Converter

MeSHXML DTD

SNOMEDXML

Schema

RxNormXML

Schema

RxTermsXML

Schema

LOINCXML

Schema

Standards

HealthInformationExchange

UMLSXML DTD

GlobalSecurity

Policy andControl

SecureXML

XML-C

PHA Patient App

Mobile

PHA Provider

Mobile App

SMARTSync App

USE

S

USES

MS Health Vault

ASP.NET API

C# D

ataHarvard SMART

EHR

REST API

JSO

N-L

D

Open mHealth

JSO

N

EPIC LucyPHR Server

JAVA APIs

XM

L

OpenEMREHR Server

Java APIs

XM

L

GE Centricity

EHRServer

WSDL

CC

R

SecureCDA

SecureCDA

SecureXML

SecureXML

SecureXML

XML-C

XML-C

CIGNA-4

PHA:PHA: Mobile App for Medication and Chronic Disease

Management iOS/Android Versions hooked to MS Healthvault Patient Version to Enter Data/Authorize Providers Provider Version to View Authorized Data

SMARTSync (Harvard SMART Platform)SMARTSync (Harvard SMART Platform) SMART EMR and MS Healthvault Medication Reconciliation Identify: Overmedication, Adverse Interactions,

and Adverse Reactions Uses Standards and Online Resources NDR-RT

and RxNorm

Personal Health Assistant PHAPersonal Health Assistant PHAand SMARTSyncand SMARTSync

CIGNA-5

PHA and SMARTSync ArchitecturePHA and SMARTSync Architecture

CIGNA-6

PHA – Patient VersionPHA – Patient Version

CIGNA-7

PHA – Patient VersionPHA – Patient Version

CIGNA-8

PHA – Patient VersionPHA – Patient Version

CIGNA-9

PHA – Provider VersionPHA – Provider Version

CIGNA-10

SMARTSync and InteractionsSMARTSync and InteractionsYellow: Significant Red: CriticalYellow: Significant Red: Critical

CIGNA-11

Leverage and Extend our HIE ArchitectureLeverage and Extend our HIE Architecture MSHV SupportsMSHV Supports

Medical Devices: blood pressure monitors, glucose meters, scales, medi-watches, pedometers

Exercise Data Types and API: Allow Information to be Stored – fitbit can download into MSHV

Objective: Support Clinical Decision Support on:Objective: Support Clinical Decision Support on: Medications, Observations of Daily Living Chronic Disease Management, Exercise/Diet Logs Aim for Trending and Potential to Alert

Stakeholders (Patients, Insurers, Providers)

Proposed ApprachProposed Apprach

CIGNA-12

Interoperation Architecture Facilitates Communication Interoperation Architecture Facilitates Communication Across Multiple Formats (XML, JSON, REST API)Across Multiple Formats (XML, JSON, REST API)

Our Approach Consistent with Current Personal Our Approach Consistent with Current Personal Health DevicesHealth Devices fitbit, withings, and bodymedia all Use REST API

and Oauth withings uses JSON to Return Responses iHealth stores information in Cloud

Compatibility of our ApproachCompatibility of our Approach

CIGNA-13

Expand HIE Architecture to Wide Range of SourcesExpand HIE Architecture to Wide Range of Sources Personal Health Records (MSHV, WebMD) Personal Health Devices (fitbits, withings, etc.) Electronic Health Records CIGNA Data Sources

Propose and Analyze Other Possible Architectural Propose and Analyze Other Possible Architectural AlternativesAlternatives Focus on Current and Emerging Platforms Rapid Changes in Mobile Technologies Identify Relevant Analytics for CIGNA

Stakeholders

Planned ApproachPlanned Approach

CIGNA-14

Steven DemurjianSteven Demurjian Software/HIE Architectures, Access Control

Maifi KhanMaifi Khan Cloud Computing, Real-time Health Care

Monitoring, Wireless Sensor Networks Thomas AgrestaThomas Agresta

Clinical Practice, Analyzing Clinical Data, HIE Michael Belchner Michael Belchner

Pathology Info Systems, HIE, i2b2/Data Analytics

TeamTeam

CIGNA-15

S. Demurjian BMI Research InterestsS. Demurjian BMI Research Interests

Collaborative Extensions to NIST RBAC Collaborative Extensions to NIST RBAC Model When and How Interactions Occur Support PCMH and Collaborative Care

Security for XML Security for XML Medical Standards (HL7 CDA, CCR, etc.) Customize XML Instances Delivered to Users

Health Information ExchangeHealth Information Exchange Architectural Solutions for Interoperability

Medication Management & ReconciliationMedication Management & Reconciliation Android/IOS Apps Linked to MS Health Vault Reconciliation via Harvard’s Smart Platform Working with openMhealth.org

CIGNA-16

M. Khan BMI Research InterestsM. Khan BMI Research Interests

Real-time Monitoring and Preventative HealthcareReal-time Monitoring and Preventative Healthcare Real-time Access of Patients’ Sensor Data Cloud-based Storage Architecture Identification of “Early” Symptoms

Reliability and Troubleshooting of Edge ClientsReliability and Troubleshooting of Edge Clients Troubleshooting Low-power Sensor Devices Real-time Failure Diagnosis

Software Architecture for Self-powered DevicesSoftware Architecture for Self-powered Devices Fail-safe Energy Management Algorithms Energy Harvesting Algorithms

CIGNA-17

Thomas Agresta BMI Research InterestsThomas Agresta BMI Research Interests

Optimal HIT Solutions for Primary CareOptimal HIT Solutions for Primary Care Clinical Decision Support, Patient engagement Health Information Exchange for Care Transitions Organizational structures for supporting Primary Care

Informatics Clinical Informatics Education Clinical Informatics Education

Informatics Educational Methods and Strategies Use of Simulation in Primary Care Education

Virtual patients, families & EMR use in clinical care High- Tech, High-Touch Primary Care

Informatics Tools for Collaboration in Clinical Research Informatics Tools for Collaboration in Clinical Research InformaticsInformatics Secondary Use of Healthcare data for analysis and Secondary Use of Healthcare data for analysis and

researchresearch

CIGNA-18

M. Blechner BMI Research InterestsM. Blechner BMI Research Interests

Health Information ExchangeHealth Information Exchange ““Leveraging An HIE Infrastructure To Build A Leveraging An HIE Infrastructure To Build A

Clinical Research Data Warehouse”Clinical Research Data Warehouse” CICATS pilot grant for system development to capture CICATS pilot grant for system development to capture

clinical data from a Health Information Exchange (HIE) clinical data from a Health Information Exchange (HIE) into a research data warehouse.into a research data warehouse.

Intelligent Tutoring System DevelopmentIntelligent Tutoring System Development Collaborative e-learning environment leveraging Collaborative e-learning environment leveraging

natural language processing and medical ontologies natural language processing and medical ontologies (UMLS) to facilitate concept relationship discovery(UMLS) to facilitate concept relationship discovery

Clinical PathologyClinical Pathology Data warehousing for business and clinical Data warehousing for business and clinical

intelligence in the clinical laboratoryintelligence in the clinical laboratory