. Copyright 2017 - Michigan Health Information Network Shared Services. 1. Jim Edwards, Director of Development. jim.edwards@mihin.org. Allen Flynn, Pharm.D. ajflynn@med.umich.edu. Agenda. Statewide Health Directory services. ID: 591939
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Using a Knowledge Grid to Enhance Messages in Michigan
Copyright 2017 - Michigan Health Information Network Shared Services
1
Jim Edwards, Director of Development
jim.edwards@mihin.org
Allen Flynn, Pharm.D
ajflynn@med.umich.edu
Slide2Agenda
Statewide Health Directory servicesActive Care Relationship servicesCurrent medication reconciliation workflowLearning Health for Michigan infrastructureEnhanced medication reconciliation workflowPersona storiesEnhanced medication reconciliation demonstration
2
Slide3Statewide Health Directory
Manages organizations, providers and the multiple relationships between themContains electronic addresses used to route information to providers
3
Copyright 2017 - Michigan Health Information Network Shared Services
Health Directory
Name
Specialty
Practice unit
Practice organizations
Related organizations
Delivery
oreferences
…additional attributes
Slide4Active Care Relationships
4
Primary Care Provider
Linkage
Patient
Copyright 2017 - Michigan Health Information Network Shared Services
Declared
active care relationships
between patients and providers
13,535,374 16,466
In Michigan:
Active Care Relationships:
Providers:
Slide5Trusted Data Sharing Organization
(TDSO)
Trusted Data Sharing Organization
(TDSO)
Medication Reconciliation
Current Workflow
Health Directory
1) Patient discharged from hospital,
message sent to TDSO, MiHIN
2) MiHIN checks patient-provider attribution and identifies recipients
3) MiHIN retrieves contact and delivery preference for each recipient
from directory
4) Notifications routed to recipients based on electronic address and preferences
Primary Care
Specialist
Pharmacist
Patient
Health
Plan
Patient to Provider Attribution
5
Copyright 2017 - Michigan Health Information Network Shared Services
Slide6Copyright 2017 - Michigan Health Information Network Shared Services
Can We Make the Workflow Smarter?
6
Slide7Learning Health for MichiganInfrastructure
Slides: Allen J. Flynn, 2017 Charles P. Friedman, 2016, 2017
Connecting Health
for Michigan 2017
kgrid.org
Slide8The Knowledge Grid Infrastructure Approach
Need: Computable Knowledge ‘FAIRness’Why? State-wide Learning Depends on Effective Computable Knowledge Sharing How? Knowledge Grid and Its Components
Learning Health Sciences
kgrid.org
Slide9LH4M & Knowledge FAIRness
Learning Health Sciences
9
F
indable
A
ccessible
I
nteroperable
R
eusable
To Make Computable
Knowledge a
Statewide Resource
It Has to Be “FAIR”
Slide10Rapid, Transparent Statewide Knowledge Sharing
Knowledge Grid
Learning Health Sciences
Digital Library
Digital Library
Digital Library
•
•
•
Slide11Why? Speeding Up Knowledge to Practice
EHRs/eHealth
Learning Health Sciences
Knowledge
Objects
1. Computable Knowledge
2. Knowledge Management
Digital Library
Corroboratory
Mechanisms
3. Maintain Trust
✔
Object
Shelf
4. Connect Knowledge to Practice
Slide12What is Knowledge Grid, by Components?
EHRs/eHealth
Knowledge Grid
1. Knowledge Objects
2. Digital Library
Existing Health IT
4. Activator
Digital Library
Learning Health Sciences
3. FAIRness Mechanisms
or
Analytic Results of Interest
5. RESTful services
Slide131. Computer-Processable Knowledge Objects
Articles
Results
of Interest
Knowledge Objects
Description
Interface
Computer-
Processable
Knowledge
“Payload”
Guidelines
Learning Health Sciences
Slide14Learning Health Sciences
Example Knowledge Object Source from Oncology
Slide15Learning Health Sciences
Here Is the Written Knowledge
Slide16Types of Knowledge Objects
Learning Health Sciences
Type
Input
Service
Output
Calculation
Individual Features
“Do the Math”
Numeric Result
e.g., predictive models
or
dosage calculator
Interpretation
Facts of the Case
Apply Best Practice
Health Knowledge
Written or Verbal Instruction
e.g., computable
guideline
Presentation
Image Parameters
Apply Communication
Best Practice
Knowledge
Visual
Display
or Image
e.g.,
iconarray
Tailoring
Facts & Features About
the Output Recipient
Apply Psychological
and
Communication
Best Practice Knowledge
Individualized,
Evidence-Based
Multimedia Message
e.g., motivational messages of encouragement for an individual who is more likely to respond to them
Slide172. Digital Library to Manage and Share Knowledge
Capability to Curate and Manage
Online Collections
of Knowledge Objects
Digital Library
Learning Health Sciences
Slide183. Mechanisms to support Knowledge FAIRness
Technical Safeguards to Protect Knowledge Objects
Records of Knowledge Object Use
Links to Knowledge Sources
Learning Health Sciences
✔
✔
✔
F
indable
A
ccessible
I
nteroperable Reusable
FAIR means
:
Slide19Learning Health Sciences
4. & 5. Connect Linked Knowledge to Practice
”Request”
”Response”
Shelf
Engine
Activator
Knowledge
Objects
Payloads
eHealth
Applications
EHRs
&
Apps
People
Wanting
to Know
Best
Practices
RESTful
Services
Slide20Knowledge Grid by Components
EHRs/eHealth
kgrid.org
1. Knowledge Objects
2. Digital Library
Existing Health IT
4. Activator
Digital Library
Learning Health Sciences
3. FAIRness Mechanisms
or
Analytic Results of Interest
5. RESTful services
More Info
Slide21Trusted Data Sharing Organization
Trusted Data Sharing Organization
(TDSO)
Enhanced Medication Reconciliation
Workflow
Health Directory
1) Patient discharged from hospital,
message sent to TDSO, MiHIN
2) MiHIN checks Knowledge Grid, enhances
message as appropriate
3) MiHIN checks
patient-provider attribution and identifies recipients
5
) Notifications routed to recipients based on electronic address and preferences
Primary Care
Specialist
Patient
Health
Plan
4
) MiHIN retrieves contact and delivery preference for each recipient
from directory
Patient to Provider Attribution
21
Copyright 2017 - Michigan Health Information Network Shared Services
Pharmacist
Slide22Persona Stories
Christy Munson gets a new opioid prescription which may put her at risk for dependence Alice Vargas gets a new prescription that puts her at risk of respiratory depression
22
Copyright 2017 - Michigan Health Information Network Shared Services
Slide23Christy Sees Specialist for Chronic Lower Back Pain and Fatigue
23
Copyright 2017 - Michigan Health Information Network Shared Services
Christy Munson’s medications are checked A newly started opioid is foundEnhanced content sent with the outbound Medication Reconciliation (Intelligence)
Knowledge ObjectMedications Are CheckedAdvanced Clinical Decision SupportNew Opioid(Alert Message)Respiratory Depression-
Slide24Alice Sees Physician for Insomnia/Anxiety
24
Copyright 2017 - Michigan Health Information Network Shared Services
Alice Vargas’ medications are checkedDangerous combination found that can cause respiratory depression (Triple threat)Primary care physician receives enhanced message and is informed of the potential harm (Intelligence)
Knowledge ObjectMedications are CheckedAdvanced Clinical Decision SupportNew Opioid-Respiratory Depression(Alert Message)
Slide25Enhanced Medication Reconciliation Demonstration
25
Copyright 2017 - Michigan Health Information Network Shared Services
Slide26Thank You
Allen Flynn, Pharm. DDepartment of Learning Health Sciences, University of Michiganajflynn@med.umich.edu Jim EdwardsDirector of DevelopmentJim.Edwards@mihin.org
26
Copyright 2017 - Michigan Health Information Network Shared Services
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