Healthcare Information Virtual Environment System (HIVES)

Healthcare information systems have a vast array of various equipment, clinics, labs, governmental agencies, manufacturers, doctor offices, and innumerable other organizations providing, collecting, and processing information.  Classic issues of stove piping or 'Silos' have emerged causing inefficiencies in the industry such as multiple lab test and/or diagnostics being prescribed. The advent of a nationalized health records system increases the complexity of these networks as well. In order to gain management and control over these information systems, the American National Standards Institute (ANSI) hosts the Healthcare Information Technology Standards Panel, (HITSP). This is one of several cooperative efforts, between industry and government to create standards. However, all too often the standards result in a highly complex architecture and system design. This is because early standards and architectures often focus on resolving major issues with little forethought into the broader architecture. Many argue that little information is known or that the project is far too complex. Years later, this results in an effort to simplify and streamline the system again.

Allowing a Frankenstein architecture to emerge would be a travesty when our initial objectives are to streamline the healthcare processes removing redundancies and latencies in the current system. The planners should design the system for streamlined performance early. Large scale projects like these are not new and history tells us many good things. The evolution of complex systems such as the computer, the car, and the internet have emerged out of a democratization of design. Literally, tens of thousands of people have contributed to these systems and those models are one approach to resolving the large scale complex information systems involved in healthcare. What we have seen emerge out of the democratization of design is a standardization of interfaces in a virtualized environment. For example, the headlamps are nearly identical for every car with standard connectors and mounts even though the headlight assemblies are artfully different on each car. The computer has standard hardware and software interfaces even though the cards and software perform different functions. The virtual computer is independent of vendor product specifications. Instead, the vendor performs to a virtual computer standard in order for their products and services to function properly.

Let us take a moment to explain that virtualization is the creation of a concept, thing, or object as an intangible structure for the purpose of study, order, and/or management. The practice is used in across a breadth of disciplines to include particle physics and information science. Within the information realm, there are several different virtualization domains to include software, hardware, training, and management virtualization. My interest is not in the use of any specific virtualized technology but instead in exploring healthcare virtualization management.

I propose a need for a Healthcare Information Virtual Environment System (HIVES), Figure 1, which is essential to reducing complexity and establishing a standard for all those participating in the healthcare industry. The virtual environment is not a technological system. Instead it is a management system or space in which medical information is exchanged by participating objects within the virtual environment. Real things like clinics, offices, data centers, and equipment sit on the virtualized backplane or space.  HIVES would have a set of standards for participating equipment, clinics, hospitals, insurance agencies, data centers, etc... connecting to the environment in order to exchange information. Many may remark that these standards exist. I am able to locate dozens of vendor products and services supporting hardware, software and even service virtualization which are not a standard virtualized management of the overarching healthcare environment that is what the nationalized healthcare system is attempting to manage. I have reviewed HITSP and noted there is no clear delineation of a virtualized managed environment.

Figure 1: HIVES

In such an environment, I envision data being placed into the environment would have addressing and security headers attached. In this way, data is limited to those listening and who have authorization to gather, store, and review specific information. For example, a doctor prescribes a diagnostic test. An announcement is made in the environment of the doctors request addressed to testing centers. Scheduling software at a testing facility participating in the environment picks up the request then schedules the appointment. It announces the appointment in the virtualized environment in which the doctor's office software is listening to receive the appointment data. Once the patient arrives the machines perform the diagnostics placing the patient's data back in the environment. A analyst picks up the record reviews it and posts the assessment in the environment. In the meantime, a data center participating in the environment that holds the patient's record is listening and collects all new information posted in the environment regarding the patient then serves those records to authenticated requests. The patient returns to the doctors office which request the patient's record from the data center through the environment. 

The advantages to having such an environment whether called HIVES or something else are astronomical. The patient's records are available to all participating in the environment, security levels and access can be administered in the environment efficiently to ensure HIPPA and other security compliance standards, bio-surveillance data is more readily available with higher accuracy in the data centers, the environment can be an industry driven standard and managed through a consortium, and the government could be an equal participant in the environment.  

Moreover, to be a participant, the manufacturer, clinic, lab, hospital, doctor office, data center or any others have to meet the clearly defined standards and become a consortium participant at some level. Thus, complexity of the architecture and systems interfacing can be tremendously reduced achieving the stated objectives of healthcare reform and streamlining.

Commentary:  Please feel free to comment and dialogue on this concept. I would especially enjoy commentary regarding the standards and any efforts at virtualized management of health care information.