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Hospital Network Integration of Information

The NISAPP Workbook on Hospital Network Integration follows a similar strategy to that of institutional integration when addressing the integration of data among hospitals in a hospital network. As the figure illustrates hospital networks are based on the various abilities of the institutions within the network to access data. In the case of a hospital network, institutions are accessing data or integrating information among the many institutional healthcare data repositories

Legend for Hospital Network Integration of Information
Numerical Key	Description
1	The entirety of an institution's ability to describe the history of a patient's care.
2	Integration is supported based on accepted standards between two systems. The sending system structures the data based on the form in the defined standard and the receiving system converts this standard data into the form unique to its use.
3	A software program that accepts data in one format and converts that data to another form (i.e., patient name and id are received as the first and second pieces of data from one system and is changed so that id precedes patient name for another system).
4	A software architecture that accesses databases maintained by other systems and presents an integrated view of patient data to a user.
5	Agreements defined by an institution. For example, an agreement that accompanies each patient transfer.

There are at least three approaches to hospital network integration similar to those described when enhancing the integration within an institution. Any number of these approaches may be appropriate when considering hospital network integration.

Standards such as, ASC X12N, Health Level Seven (HL7), American Society of Testing and Materials (ASTM), Medical Data Interchange (MEDIX) and American College of Radiology/National Electrical Manufacturers Association (ACR/NEMA), are pertinent to hospital networks. HL7, MEDIX and ACR/NEMA each include components of the standard that directly address the movement of data among separate providers. Just as with institutional integration, these standards have met with varying degrees of acceptance. Those standards based primarily on the movement of textual data (i.e., HL7) are less likely to be useful in integrating among hospitals because so much of the data to be shared is not in a textual form.
An "interface hub" performs a similar function as an interface engine did in institutional integration. The interface hub takes data from one source, reformats it either to a standard structure or to another system's structure and then communicates the changed data. Generally, an interface hub will include the needed software and hardware to allow several interface engines to convert data among many systems.
A shell can also be used to connect the many systems used within the network just as it can within an institution. The telecommunication and information technology structure is more ambitious than that found in most institutions since systems are interconnected over a large geographical area, or wide area network. Additionally, since the providers within the network may be autonomous, unlike the departments within the same institution, confidentiality and security of each hospital's repository is paramount.

Most importantly, though, the sharing of data and/or information within a hospital network must be governed by the various agreements that govern how the network operates. For instance, all hospitals have identified appropriate agreements that govern how a patient is to be transferred from one institution to another. Any integration among healthcare providers must continue to satisfy these agreements and as the NISAPP Workbook on Hospital Network Integration encourages the integration be based around these documents.

A similar approach is used in the NISAPP Workbook on Hospital Network Integration of Health Information. In fact the Hospital Network Integration of Health Information process is based on the results for each institution from the Institutional Integration of Health Information process. The unique aspects of the hospital network process are related to consideration of agreements among providers within a network and the opportunities to share technologies

The following describes each step in the Hospital Network Integration of Health Information process.

Step	Description
1	Identify the individuals within the hospital network interested in identifying the goals and outcomes for the network that will lead to greater information integration and use.
2	Identify the current agreements among the institutions in the network. Document the form of the agreement, how data is shared on the agreement and the procedures implied in the agreement.
3	Identify the individuals within the network that can assess the current technologies within each institution of the network and can determine the impact on these technologies of the institution's goals and outcomes.
4	Examine the existing uses of technology. Assess the use of information technology including systems, integration among systems, telecommunications, Telemedicine, and management of patient specific data.
5	Define the goals that identify the direction of the network in the context of patient access, resource utilization, regulations, network access and quality and the overall mission of the network.
6	Define outcome measures that can be used to determine the satisfaction of the network's goals.
7	Determine the technology impact of the goals and outcome measures identified. Identify technology responses for each goal and outcome measure.
8	Develop a plan of action for both the network and its use of information technology that allows the network to accomplish it's goals.

For additional information contact Kelli Schneider @ (970) 207-9798 or

E-mail address ptc@socencom.net