Appendix A - School of Computing and Information Sciences



APPENDIX - A

DETAILED PROJECT DESCRIPTION

Project functionality and benefits:

The development of the proposed Interactive Consumer Health Portfolio (iCHP) services system addresses many different areas of concern in this request for proposal, namely, health, education, public service and community networking. The iCHP essentially provides health related content integration, presentation and distribution services. Users will be able to access it easily from a variety of clinic sites in the Greater Miami area as well as from any computer from which the Internet access is available. In particular, the iCHP services system provides several functions that can significantly promote consumer health wellness.

1) It provides a user-friendly way for consumers to create, maintain and effectively utilize their health records. The proposed services serve consumers at many different levels, from a simple recording of a journal of symptoms for a particular instance of illness or a checklist of health indicators provided by the system, to the creation of a comprehensive long term personal health and medical record.

2) The iCHP system will be electronically linked with a Computerized Patient Record (CPR) where healthcare providers store clinical data about the patients. By doing so, we make certain patient-oriented aspects of medical record, e.g. patient discharge information from the hospital, medication prescribed, their medical diagnosis, and other special instructions, available to consumer. Consumers will then be able to retrieve their confidential electronic health portfolio in a timely fashion which in turn should increase the level of their wellness. Such information can be used in many valuable ways to promote consumer health care and wellness as described below.

3) It channels filtered, approved and validated healthcare information and data to consumers with specific needs. Based on the stored or dynamically created consumer profile, the iCHP allows the healthcare provider to guide the patient to relevant factual and educational information.

4) It provides a vehicle for consumers/patients to interact and communicate with physicians and healthcare providers. Through the iCHP services, consumers can chat with physicians about their health conditions, can report their medical condition and experiences to their physicians and other healthcare providers.

Therefore, iCHP services make it possible for patients to have a control over their health care. It also improves the communication between the patient and the healthcare providers, and makes appropriate health care available in a timely fashion. Figure A-1 gives the overview of the proposed system.

Access to the system will be made possible through the Internet and a user interface will be developed that makes using it extremely simple even for novice users. We expect that there will be many consumers who have computers at their homes, and hence, access to the system will be very easy for them. For consumers who do not fall in this group, we will provide computers at

Figure A-1. The proposed interactive consumer health portfolio (iCHP)

Selected health clinics in their neighborhoods. We will design the system to encompass differing levels of security clearances for access to an individual patient's information.

The iCHP system will be very beneficial to the people in South Florida, including those belonging to under-served populations. Moreover, the services proposed here are not limited to regional applications but represent a model that can and should be expanded on a national scale. Some of the benefits derived from the system are described below.

■ Timely healthcare for the participants.

The iCHP services will improve communication between patients and their healthcare providers. Availability of up-to-date information about the medical conditions of their patients will allow the doctors to provide timely and accurate instructions to them, thereby making personalized healthcare available to them in a timely manner. Two possible scenarios are described below.

When a person becomes sick at an out-of-town location, permission can be given to the local doctors to access the health portfolio that will contain the patient’s history of that ailment, medications being taken at the time, allergies experienced, etc. The patient may not be in a state to convey this information or may not be knowledgeable of the medical description of the ailment. Accurate medical information will allow the doctor treating the individual to make more informed decisions.

When a woman observes a lump in her breast during a routine exam at home, general tendency of most people will be to postpone telling their doctor about it and not call him/her at that instant. However, if the iCHP system were available, the patient could immediately input this information making it available to the doctor instantaneously. Appropriate care could then be provided in a timely fashion, and possibly avoid a future traedy.

■ Better education for the patients.

If a person is suffering from a sickness that has many types, like diabetes, it is not easy for the patient to acquire the relevant knowledge from among the general information available. The doctor could convey this information simply by placing a pointer to the approved and validated health literature on the world-wide-web in the patient’s record in the iCHP system, thereby making it available in a very timely fashion. This additional information would increase the patients’ knowledge about their specific problem.

■ Greater control of their healthcare on the part of the consumers.

Increased awareness about their wellness along with timely information about their health available to the consumers will result in providing a higher degree of control to them over their own health.

■ Potentially, automatic notification about an emergency situation.

The iCHP services will have the current as well as historical medical information of an individual available electronically. Some of this information will come from the CPR with which the iCHP system is appropriately linked. The healthcare professionals will be able to program the system to trigger automatic generation of clinical alerts to the patient and the doctor based on occurrence of a particular event. For example, an increase in blood pressure of a heart patient to a particular level may cause the system to notify the patient to contact his doctor immediately or go to an emergency room. Another example is if the weight of a pregnant woman increases to an unacceptable level, a clinical alert will be generated advising the patient to contact her doctor immediately. Once again, health care provided in a timely fashion can save lives.

■ Decrease in health care costs.

It is common knowledge that an ounce of prevention is better than a pound of cure. For all the reasons explained above, the iCHP system will be able to provide wellness information to individuals in a timely manner that will result in patients receiving medical care early in the game. It is always cheaper to treat an ailment early than later, and hence, this system will reduce healthcare costs in the future.

The system will be developed by a team of professionals from Baptist Health Systems of South Florida (BHS) and Florida International University (FIU). FIU, a Hispanic Serving Institution, is the largest university in the region with approximately 32,000 students. The School of Computer Science is a designated Program of Excellence and the university administration is very supportive of this program. BHS has been one of the most respected medical centers in South Florida for 39 years. In January 1999, it was included in the list of “100 Best Companies to work for in America” by Fortune Magazine. Last year, the American Nurses Association named it one of the 11 “Magnet Hospitals” in the United States for Excellence in Nursing. This high quality partnership between two leading entities in the region excelling in their own spheres will guarantee the success of the project.

iCHP Usage Scenario:

A typical iCHP usage scenario is illustrated in the figure A-2. This usage scenario will first be presented from an enterprise viewpoint, describing the functional aspect of iCHP. Appendix C will review the iCHP in terms of the technologies and the open standards used in designing the architecture of the system, including security considerations.

The usage scenario depicts a consumer, as an actor (the stick figure), interacting with a use case (circle). In Figure A-2, a use case is the process of accomplishing a specific task within the scope of the iCHP functionality. In this scenario, the iCHP case utilizes many other cases in reaching its goal of placing the consumer in the personalized context of relevant healthcare information.

Figure A-2 iCHP Usage Scenario

Placing the consumer in the personalized context of relevant healthcare information

Definitions

The usage scenario introduces the notion of a Health Agent, which is a collection of closely related processes that manage the consumer’s context information. Use cases are labeled using the notation . There are four types of labels; iCHP, CPR, BHS Web Site and External Content Sources which denote the system where the process is executed. The use cases of the type iCHP are within the scope of the project, the other types of use cases are provided by BHS for use within iCHP.

Heath Agent Technology

The iCHP "intelligence" is represented by a set of processes that, based on the CPR and consumers' self proclaimed interests, will exactly place the consumer in an information context that is meaningful, useful and empowering. This set of processes is collectively called a Health Agent (HA).

CPR Services

Note that the CPR services, although a part of the iCHP integration architecture, are not within the scope of the iCHP project. BHS is independently implementing these services as a part of its strategy of constructing a CPR. iCHP will integrate into these CPR services.

Use Case: iCHP: login

The iCHP login process initiates two other use cases. First is the authentication process where the identity of the consumer is established and which produces other credentials of the consumer that are utilized in the iCHP:Construct Session Profile use case which is the second process initiated by iCHP:Login.

Use Case: iCHP: Health Agent: Construct Session Profile

The Construct Session Profile combines information about the consumer from a multitude of sources. In interacting with the CPR, the session profile outlines the consumer's basic demographic information (such as date of birth, postal address, medical record number and email address), the clinical conditions of the consumer, the consumer’s relationship with healthcare providers, and so on. Other interest areas defined directly by the consumer also augment the session profile.

Use Case: CPR Service: PIDS

The Person Identification Service (PIDS) is an OMG (Object Management Group) standard for identifying a person based on a number of traits. In this use case, demographic information would be obtained through the PIDS.

Use Case: CPR Service: HDS

The Healthcare Demographic Service (HDS) will be used to gather additional demographic information from the CPR.

Use Case: CPR Service: SLiMS

The List Management Service (SLiMS) provides a mechanism to query the CPR for clinically identified healthcare problems, allergies and the current set of medications consumed by the consumer.

Use Case: CPR Service: HRS

The Healthcare Relationship Service (HRS) establishes the consumer’s relationship to healthcare providers and insurance companies.

Use Case: CPR Service: COAS

The Clinical Observation Access Service (COAS) represents a set of standardized interfaces for accessing clinical data, such as transcribed reports or laboratory results. The use of this service within the iCHP system will require the use of the OMG Lexicon Query Service. Clinical terminology used in the CPR would correspond to coded concepts and would be mapped to English descriptions for presentation to the consumer (not shown in Figure A-2).

Use Case: iCHP: Health Agent: Consumer Interests

The iCHP provides an interactive feature that allows the consumer to register interest (at different levels) about particular health topics.

Use Case: iCHP: Health Agent: Determine Health Plan

The process Determine Health Plan evaluates the consumer’s Session Profile and identifies the corresponding pre-defined workflow that relates to the Session Profile. A workflow describes the related consumer health information, CPR information and interactive services on a timeline for a particular clinical condition.

Use Case: iCHP: Health Agent: Determine Workflow State

The Session Profile also allows the Health Agent to place the consumer of the workflow timeline, for each workflow, within the Health Plan.

Use Case: iCHP: Presentation: Create View

The Create View use case utilizes the completed Session Profile to initiate the workflow processes that are to be activated, including gathering the corresponding content. The information gathered is organized for presentation.

Use Case: iCHP: Health Agent: Gather Consumer Information

Based on the Workflow State, information is gathered from pre-defined sources.

Use Case: iCHP: Health Agent: Gather CPR Data

Based on preferences and access rights, this process gathers clinical data from the CPR, via the COAS interfaces on clinical systems.

Use Case: iCHP: Health Agent: Construct Interactive Services

Based on the Workflow State, interactive services are initiated.

Use Case: BHS Web Site: Gather BHS Services & Procedure Information

Information about BHS Services & procedures are gathered.

Use Case: BHS Web Site: Gather BHS Wellness Education Program Information

Information about BHS educational wellness programs is obtained here.

Use Case: External Content Sources: Gather Consumer Health Content

Consumer health information is provided by sources external to BHS and to iCHP.

A Walk-Through of the Usage Scenario

In order to illustrate the iCHP usage, let us walk through a specific instance. Jane Doe, a 25 years old female, is logging into iCHP. Supplying her private username and password authenticates her into the iCHP, including establishing her credentials. The login process also initiates a use case of creating her session profile. This is accomplished in part by querying server CPR services to obtain demographic information (postal address, email, religion, etc), healthcare provider relationships (e.g., identification of the primary care physician, the dermatologist, etc.), and current problem or conditions (allergies, diagnosis, medications) for Jane Doe as recorded by the clinical professionals. In addition, the interests defined directly by the consumer augment the session profile (for example, the consumer might be interested in a topic that is a health condition of a relative).

The session profile is supplied to a use case dedicated to determining the corresponding workflow, which becomes the consumer's iCHP Health Plan. Each attribute of the session profile may guide the selection of the Health Plan. Furthermore, the Session Profile refines the Health Plan by exactly defining the consumer's position in each workflow.

Let us assume that the session profile for Jane Doe indicates that she is a few weeks into her first pregnancy and has asthma. It also includes the list of medications Jane is taking for her asthma. Jane has also recently declared an interest in breast cancer, and indicated that it is a common illness in her family. The Health Plan includes the pregnancy workflow as well as the asthma workflow and a high-risk breast cancer workflow. The session profile aids in positioning Jane within these three workflows. Jane has informed her obstetrician (as it was a planned pregnancy) but she has not pre-registered for the maternity program with the health system yet. She has is not yet registered for any child birth classes. Her medication list has not been altered. And she has not seen a physician in regards to being identified as a potential high-risk candidate for breast cancer as it is not in the clinically managed problem list.

The completed session profile and the health plan are the key components in creating the presentation to the iCHP. The health agent is instructed to initiate the three workflows and set the state. The workflow state drives the gathering of the consumer health information, such as presenting Jane Doe with a big "Congratulations, we heard you are expecting!! " banner, including pictures of the clinical staff related to Jane's wellness. Jane is also prompted with pointers to registration forms for the maternity program. The health system has maternity wards at four hospitals, but given Jane's postal address, she is most likely to select one of the two hospitals closest to her home. The maternity programs at these hospitals are primarily featured on the interactive web site, including virtual tours. Jane can also register for upcoming "what to expect when you are expecting" classes and other child birth classes. A generic timeline of events is provided. A consumer health story on the potential risks of using certain asthma medications during the pregnancy is also presented with an encouragement to see the obstetrician and her respiratory physician. An electronic message is auto-generated to both physicians, which would be sent instantly, with Jane's consent (hit the send button). The last healthcare issue in the health plan is the potential high risk for breast cancer. Jane is encouraged to fill-in some more information about the family history and iCHP asks for permission to have a clinician review her responses along with other pertinent information in the CPR. A set of related consumer health articles are provided if Jane is interested in reading more about early detection techniques. If it is also the topic for one of the upcoming wellness lectures, Jane is invited.

The project entails defining how to describe the session profile, the health plan and identifying a number of workflows. The rules for intersecting or merger of workflows within a health plan needs to be defined. Potential workflow candidates with women's wellness, the selected focus area, includes:

- hormonal environment

- menopause

- hormone replacement therapies

- women's medication

- pregnancy

- gestational diabetes

- child care

- what's new in woman's wellness

- breast & ovarian cancer

The iCHP will use commercially available products based on open standards, as described in Appendix C. The technological solution is primarily based on XML and CORBA.

APPENDIX – B

MANAGEMENT AND IMPLEMENTATION PLAN

The proposed project is to be managed and executed by a group of highly qualified and competent principle investigators, including Dr. Yi Deng, Dr. Jainendra Navlakha and Steven Luis of FIU, and Kent Wreder, Dr. Henry Glick, Dr. Robert Zolten and Maribeth Rouseff of BHS. The credentials of the PI team is presented in Appendix C. Figure B-1 shows personnel organization and the management structure for the project.

Figure B-1. Project Personnel Organization Chart.

Figure B-2 gives the descriptions of the task allocations for the project to individual PIs.

• Dr. Yi Deng, project PI and Director for Center of Advanced Distributed Systems Engineering at FIU, will be responsible for overall project management and coordination, system architecture, and program evaluation. Project evaluation is a very important part of our proposal and as described in Appendix-B, it will be carried out in conjunction with each phase of the project.

• Kent Wreder, Co-PI and Corporate Director in Information Technology Division of BHS, will serve as the coordinating PI for the BHS side. Wreder, together with Dr. Deng, will be in charge of project coordination, integration of iCHP with CPR, and the designing of consumer health services.

• Dr. Jainendra Navlakha, Co-PI, Professor and former Director for the School of Computer Science at FIU, will be in charge of project evaluation, community involvement and documentation. It will be our goal to evaluate the involvement of under-served people in the Homestead clinic as well as Hispanic students at FIU in the project from the very beginning. Together with Steven Luis, he will also participate in the iCHP interface design.

• Steven Luis, Systems Manager in School of Computer Science at FIU, will be in charge of the system development, the design of XML-based consumer health record structure and information views, as well as patient-provider interactions. As needed, appropriate training session will be designed to educate participants, particularly the under-served consumers who will not be proficient in technology use.

Figure B-2. Project Task Allocation Chart

• Maribeth Rouseff, Assistant Vice President of Wellness at BHS, will serve as the Corporate Liaison for the project to promote the proposed services to physicians and other medical practitioners and staff. She will also be responsible for selecting the congregation, in consultation with the Baptist Pastoral Care Department, where access to the iCHP system will made available. This will ensure the participation of an under-served group in the project.

• Dr. Henry I. Glick, M.D., Co-PI, Corporate Vice President of Medical Affairs at BHS, will oversee and provide medical advice for the design and application of the proposed iCHP services with the target consumer groups. He will also provide expert advice in developing and implementing program evaluation plans and in conducting program reviews. These evaluations and reviews performed at the end of a phase will provide improvements in the system that will be implemented in the subsequent phase.

• Dr. Robert A. Zolten, M.D., Co-PIs, senior physician of Internal Medicine at the Homestead Hospital of BHS, will share the above mentioned responsibilities with Dr. Glick.

• One (1) IT Staff member will participate in the proposed project on full-time basis. This system developer will be able to handle different aspects of system integration required to fuse iCHP and CPR. Relevant tasks will include: (a) integration of Internet Workflow Engine with the iCHP presentation layer; (b) integration of the Internet Workflow Engine with the CPR, and (c) integration of the iCHP presentation layer with external consumer health information contents.

• One (1) BHS Public Relations project manager will spend 2 months/year for 3 years on this project. This person will coordinate the BHS web presentation and representation, from a marketing perspective. This coordination includes the selection and procurement of consumer health information as well as the public relations and marketing efforts for iCHP.

• One (1) BHS staff acting as a Wellness and Clinical Information Project manager will spend 2 months/year for 3 years on the project. The responsibility for this position is to coordinate the BHS Wellness programs that will be featured in the iCHP and to coordinate the correlation or mapping between the clinical iCHP content and the CPR.

The team involved in developing and implementing this proposed healthcare information network demonstrates the high level of community involvement in this proposal. Our plans to set up clinics at Homestead clinic of BHS and FIU, along with another clinic at a congregation identified by the Baptist Pastoral Health Care Department will guarantee inclusion of under-served populations in the project. The project is certain to serve not only the under-served but also the not-so-well-served people. BHS and FIU are completely committed to the success of this project. BHS has been instrumental in providing high quality healthcare in the local community, whereas FIU is the largest university in this region providing high quality education to this community. The highest levels of administration at both entities have shown their enthusiastic support for this project as evidenced by their letters of support attached in Appendix F.

The Schedule

The implementation plan and schedule for the proposed project is shown in Figure B-3. This plan is based on an incremental approach of system and service development and deployment that is driven by feedback and evaluation generated in the process. The system and service development and deployment is divided into three phases, followed by a project evaluation and sustenance phase. A major milestone is reached at the end of each phase, where formal project evaluation and review will be performed. In the following, we discuss tasks to be performed in these phases and the timetable associated with them.

1) Phase I. (Month 1 – 6)

The primary objectives of this phase are project preparation, consumer profiling, system prototyping and infrastructure development. The idea is to make a quick initial iCHP service

Figure B-3. Project Implementation Plan

offering to a small consumer focus group for the purpose of evaluation that will be used to guide the next phase iCHP development.

Primary tasks to be performed in Phase I include the following:

• Personnel hiring (month 1-6)

• Equipment purchase and installation at FIU, BHS and remote sites (month 1, 3, 6)

• Internet connection and network setup (month 5)

• Requirement definition (month 1-3)

• Selecting provider focus group from BHS (month 1)

• Soliciting iCHP service requirements from provider group (month 2)

• Selecting consumer focus group from the selected sites (month 2)

• Consumer focus group profiling (month 3-4)

• Phase I iCHP system prototyping (month 1-6)

• Participants (consumer and provider) orientation and training (month 6)

• Initial iCHP service offering (month 6)

2) Phase II (Month 7-18)

This phase lasts one year. Following the initial iCHP service offering, a major project evaluation and review will be performed. The results of the review will be used to guide the Phase II iCHP system and services. The goal of this phase is to complete a Limited Feature iCHP system, and begin providing the basic but stable iCHP services to a larger user group. Primary tasks to be performed in Phase II include:

• Portfolio server purchase and installation at BHS (month 7)

• Project evaluation (month 7-9)

• Select second (and larger) consumer focus group and group profiling (month 12 - 15)

• Consumer group orientation and training (month 17)

• Limited feature iCHP system and service development (month 7-18)

• Phase II iCHP service offering (month 18)

3) Phase III (Month 19-30)

The objective of this phase is to provide full-scale iCHP services to the mass population. At this scale, person-to-person training is no longer feasible. Consumer training is therefore moved to the Internet by offering Web-based-training on demand. Integration between the iCHP and CPR will be completed, so that iCHP will be able to offer comprehensive consumer profiling service and health portfolio workflow functionality. Major tasks to be performed include:

• Clinical participants evaluation to support iCHP and CPR integration, as well as for iCHP workflow engine development (month 19-22)

• Consumer group evaluation and survey (month 19-20)

• Full-feature iCHP system and service development (month 19-30)

• ICHP and CPR integration (month 25-30)

• Web-based training offering (month 29)

• Full-scale iCHP service offering (month 30)

4) Final Project Evaluation and Planning for Sustaining iCHP Services Beyond the Project Period (Month 31-36)

The major objectives of this phase are to put in place a sound plan that can sustain and expand the iCHP services beyond the project period. An important element of this plan is to integrate the iCHP services with the professional BHS wellness services. Major tasks include:

• Final project review and planning for sustaining iCHP services (month 31-32)

• Integration of iCHP service with BHS wellness program (month 31-36)

• Seek additional funding to expand iCHP usability and functionality (month 31- )

• Final project report (month 35-36)

APPENDIX – C

TECHNICAL APPROACH AND FEASIBILITY

We have designed iCHP to deliver health related content to consumers and to allow consumers to use iCHP as a means to improve the relationship they have with healthcare provider as well as their own heath. To deliver these services to the community a Metropolitan-wide network will be constructed to support the services we have described. The proposed iCHP network uses the latest communications technologies to insure reliability and security between remote sites and will employ the use of new communication service offerings such as Asymmetric Digital Subscriber Line (ASDL) to provide high speed connectivity to remote sites. Several features of iCHP will require the integration of both well established and cutting edge technologies. We have selected these technologies based on their ability to meet the requirements of the designed system. These technologies use open standards to interoperate seamlessly with other systems iCHP will use to gather and distribute content to.

Features like a on-demand video, interactive “health agents”, and wellness history require an open-standards based framework to integrate the variety of software technologies successfully. The types of content include CPR, health news and other clinical or wellness information. For example, electronic access to this content is achieved through the use of open standards interfaces like those describe in the CORBAMed programming application programming interface (API). More complex data types such as video streams are captured and archived by dedicated video server software can be accessed by using open APIs. The iCHP system and networking components are implemented using commercially available products from major software and hardware vendors. By using off-the-shelf technology the main focus of our effort will be the assembly of the different technologies to provide a content integration, storage, distribution and presentation system for our participants. Content for iCHP will be provided by BHS and will not be an activity of the planned project.

Other equally important requirement is that participants data is keep confidential by the use of secure encryption techniques. Since the system is designed to stored thousands of records and allow hundreds of users simultaneous access the system must be responsive. The design of the user interface and other user interactions will be developed with the use of focus groups and will be very user friendly. Registered participants can access iCHP from any Internet based system that meets our software and hardware requirements making system is very accessible.

The design approach we are pursuing is superior over other approaches because we are using the “best of breed” to manage information. The technologies are distributed and scalable. The system is designed and provisioned for system and networking upgrades to maintain the services to our participants. All systems will be managed and maintained by project personal and supported by BHS and FIU. Overall we believe the approach we have chosen is portable to other communities across the nation.

Network Architecture

A local Internet service provider will be selected to provide the main connectivity needs for all iCHP remote, BHS and FIU sites. By using a single provider network we will reduce the number of gateway hops and inevitably the amount of network latency between each site. Latency is a serious consideration since remote site users will be requesting video streams as well as interactive content which will not present itself effectively if latency is to great. Interaction with participant’s stations from homes or other off-site locations will be able to interact with the system but may be required to download certain content if their Internet connectivity is poor.

The ASDL (1.5MB downstream 256K upstream) or ISDN (128K) bandwidth requested at each remote site will allow each station access to the content requested, 33.6K to 128K for each video stream depending on size and resolution. Initially both BHS and FIU will have installed a DS1 (1.5MB) connection and with BHS upgraded to 10Mbps in the third year to support increased user utilization and system capability. We believe that network connectivity speeds greater than today’s analog modem service is needed to support clinic sites since there will be several

Figure C-1. iCHP Metropolitan Network Architecture

systems accessing the networking simultaneously. System responsiveness is an important factor since most users will be computer novices and may become impatient when, due to the shared architecture of Internet topology, are delayed due to network congestion. We do not anticipate any integration problems using the variety of networking technologies. Our team and both organizations have experience using such networking technologies and the equipment necessary to support the service. Both organizations have existing Internet connectivity to the campuses but intend to dedicate the requested service for the project purposes only. Where possible we will use our existing relationships with our mutual Internet provider, BellSouth to obtain further discounts on connection costs.

Since the confidentiality of the iCHP participants is imperative we envision a secure Virtual Private Network (VPN) will be created between FIU and BHS to allow for the migration of integrated components develop at FIU to the BHS production servers. The VPN will encrypt data leaving the FIU development and BHS production sites before the data is delivered to the ISP. At all iCHP sites integrated firewall and network router products will be used to provide security from unauthorized access to iCHP equipment. All data interactions with iCHP service will occur via web browsers enabled Secure Sockets Layer (SSL) communications.

System Architecture

The iCHP system we envision will distribute several services amongst a pool of production servers. Each will be responsible for intercommunications and coordination either with internal databases, video server or CORBA based interfaces to services located in the CPR.

Participants will use low cost, high performance computers located at the remote sites to request information and interact with a variety of services iCHP will provide. The software used will be a Java enabled web browser and a streaming video player. The user will connect to a high performance web server with SSL extensions and establish an encrypted and authenticated connection to the iCHP service.

As described in Fig. C-2, the web server will utilize common gateway interfaces to access a web applications server who will coordinate database queries and information storage and retrieval. The web application server will use a workflow engine to establish a session profile for the user to help them navigate through different predefined health and wellness services. A comprehensive XML DTD library will be used to describe incoming content from BHS and store as XML documents for later retrieval. The web application server will process questionnaires, tables, and forms storing and retrieving them from the XML document server. The web applications server will invoke CORBA and Java APIs to retrieve relevant content for the participant.

Templates used to describe the mapping of information to and from BHS CPR and iCHP systems. The mapping templates will be used to gather specific information from the CPR and the user so that there will be a common taxonomy for portfolio information. Templates will also help filter information to and from the portfolio and the CPR. The templates will run on the web application server. Video content received from BHS will be stored in a video server that will provide video-streaming capabilities.

Figure C-2. iCHP System Architecture

Our distributed architecture will help load balance services provided by database and workflow servers like Oracle Application Server and Vignette StoryServer. Popular web server software like Apache with its myriad of web extensions creates flexibility for design features. Emerging technologies like BlueStone’s XML document server will allow use to fully describe portfolio information. All products have extensive features to manage a variety of information types, are extendable to allow definition of new interfaces or capabilities and provide several open standard interfaces including CORBA compliant interfaces. Security will be maintained between CPR and iCHP via CORBA defined security services that require layered credentials before information can be transmitted between systems.

Applicants Qualifications

BHS and FIU are uniquely qualified to serve the communities proposed in Miami-Dade County (see appendix A). The staffs assembled from each organization represent a diverse group of clinical, managerial, and technical expertise. Each member’s background and experience is presented below to show how each will contribute to the success of the project. Both organizations have for the past several years collaborated on several projects that benefit members of the local community. The proposed project builds on this relationship by allowing us to provide a new set of community information services based on advanced networking technologies.

Dr. Yi Deng, is Director of CADSE and leads a staff of over 30 researchers and assistants in several research tracks including systems architecture and design, software engineering, and their application to industry and training. In the second year of collaborative work with BHS he and his researchers have advanced many CORBAMed open standards being deployed at health care facilities around the nation. He and his staff continue to have had significant impact on BHS goal of a comprehensive CPR.

Kent Wreder, as the Corporate Director of Object Technology, is responsible for BHS effort to create a service-based healthcare enterprise system architecture. Kent is a leading member within the healthcare domain task force within the Object Management Group (CORBAmed) within which interoperability standards for distributed healthcare computing are produced. His efforts research and standards building efforts have been recognized at OMG and he is considered a leading authority of healthcare information architecture.

Dr. Jai Navlakha

[Demonstrate your ability to conduct project evaluation tasks by showing your expertise in scientific methods exemplified by the research you have conducted in the past. Show how your past experiences in software engineering methods will be used to facilitate interface design. Discuss your awareness of community issues and any examples of where you interact in community affairs.]

Steven Luis, Systems Manager for the School of Computer Science at FIU has for the past six years overseen the development of several databases that are used to maintain the School’s financial and administrative information services. His work with faculty researchers has allowed him to participate in the design and implementation of multi-user platform systems and distributed systems. He currently chairs the University’s Internet 2 Networking Development Team and was the proposal manger for the NSF awarded “High Performance Connection for FIU” grant “. He has extensive networking expertise and has developed networking solutions in from ATM to wireless. He oversees a computing support staff of two full-time and 15 part-time staff. He has developed several workflow techniques, supported by information systems that are used to streamline operations and provide quality service to over 1000 users.

Dr. Glick and Dr. Zolten,

[Demonstrate how in their current capacity they can serve beneficial to both the development of patient-provider interaction and evaluate it’s effectiveness. Mention these responsibilities will fit nicely with their existing duties at BHS.]

Maribeth Rouseff

[Show how in her current capacity she will be capable of promoting services to physicians, BHS clients, and consumers.]

APPENDIX – D

CURRENT AND FUTURE IMPACTS OF THE PROPOSED PROJECT

The development of the iCHP system that will store and retrieve confidential health portfolio electronically in a secure environment with the capability of interacting automatically with the Computerized Patient Record is going to be an extremely important tool for the healthcare industry in the future. We believe that it will have a tremendously positive impact for the general population in the future. Some of the benefits of the project to society are stated below.

TIMELINESS OF THE PROJECT:

This is evident from the fact that many important people in the healthcare industry have been engaged lately in conceptualizing such a system. Examples include:

■ A free web-based Personal Medical Record for all Americans was recently announced by a leading consumer healthcare network, , led by former U. S. Surgeon General Dr. C. Everett Koop. This personal health management tool will allow consumers to develop a private, lifelong health record for themselves and their families.

■ HealthMagic, Inc. has developed HealthCompass, an Internet based personal health management tool that allows consumers to develop a lifelong health record for themselves and their families.

Thus it is evident that there is a substantial interest in the topic of the proposed project, and the time is ripe for such an undertaking.

EXTENDING THE STATE-OF-THE-ART IN THE FIELD:

The above mentioned efforts are geared towards consumer-controlled maintenance of a web-based Personal Medical Record for consumers. Our proposal goes much further than these efforts. It allows for the information about a consumer’s health created and stored by not only the consumer, but also by other healthcare providers like doctors and nurses, and having an active interaction with the computerized patient record of the consumer. Availability of clinically precise data, record of physician interpretation, results of tests performed for that consumer, hospital discharge information, special instructions relating to medications, etc. makes this system greatly superior healthcare information network as compared to the other such efforts. This is a very innovative approach for handling this problem, and will certainly extend the state-of-the-art in the field of healthcare information network.

REDUCTION OF HEALTHCARE COSTS IN THE FUTURE:

The current practice in the healthcare industry does not allow for continuous and timely exchange of information between the patient and the healthcare providers. There is generally speaking, no easy way to track the wellness of a patient by the doctor. This system with its consumer health portfolio not only eliminates this deficiency but also empowers the consumer and the healthcare providers to identify possible health related implications in the future from current symptoms in a timely manner. This will allow their treatment before it becomes impossible or at least, very expensive. Thus we expect this system to reduce the overall healthcare costs in the future.

TIMELY HEALTHCARE TO THE UNDER-SERVED POPULATION:

Referring to the availability of the healthcare to the general populace, the Governor of Texas, Mr. George Bush said very recently [Miami Herald – March 3, 1999], “ We do have a segment of our population that is clearly being left behind. I fear this division will grow wider.” For a very large population that lives in rural and/or underdeveloped areas of the country where healthcare providers are not easily accessible, this system will prove to be a major boon. Not only will the consumers in these areas be able to communicate their health-related information to their doctors easily from the comfort of their homes or from the local libraries, but also get a response from them in the form of simple instructions to follow. Instantaneous health-related information available for all concerned parties when they need it, where they need it, and with no dependence on geographic boundaries will result in providing timely healthcare to this under-served population.

POTENTIALLY IMPROVED HEALTHCARE SERVICE FOR MINORITIES:

It has been feared for quite some time that the quality of healthcare available to minorities is not the same as that available to non-minorities. Akilah Monifa, a freelance writer based in Oakland, California reports [Miami Herald – Opinion Page – March 4, 1999] that “if you are black or female, you get inferior healthcare. That’s the distressing, if not surprising, conclusion of a recent study in the prestigious New England Journal of Medicine.” She further states that the researchers were unable to determine the exact reason for the discrimination but wrote: “Bias may represent overt prejudice on the part of physicians or, more likely, could be the result of subconscious perceptions rather than deliberate actions or thoughts.” We firmly believe that a healthcare information network like that proposed will go a long way in addressing this ‘discrimination in healthcare’ problem. Better communication with minority patients in a timely fashion along with more detailed information about their life-styles available through the patient-healthcare provider dialogue will allow the doctors to reduce and possibly eliminate, their subconscious perceptions about the minorities.

TRAINING END-USERS OF THE SYSTEM:

One very important aspect of the proposed system will be to provide relevant information to the consumers without overloading them with incomprehensible text. For example, if a consumer is suffering from one particular form of diabetes, then the healthcare provider will be able to point him to the information about that particular type of ailment on the Internet by providing an appropriate link to the available approved and validated literature on the web. It will be an impossible task for most consumers to search for this information themselves because of the plethora of information available on the Internet. Thus information dissemination without overwhelming the consumer is definitely an advantage offered by this system. Greater awareness about their health and better interaction with healthcare providers will give consumers better control over their health-related decisions.

LONG-TERM IMPACT OF THE PROJECT:

We sincerely believe that the chances of our success in developing and implementing this healthcare information system are very good. We are technologically ready, our technological approach is sound and the team of investigators from both, the academia and healthcare industry have worked closely in the past and therefore the partnership is guaranteed to succeed.

Success of this pilot project will have a tremendously positive impact. We expect that the project will be extended to include many new kinds of ailments, including life-threatening ones, beyond those mentioned in this proposal. A more complete system of this kind will obviously be attractive to the government agencies, in-charge of providing healthcare to the masses. Adaptation of the system at the city, county, state and national levels will result in bringing this technology to the citizens of this country resulting in opening up new horizons in the care and wellness advising for them.

It is clear that the long-term impact of this project is limited only by the level of one’s imagination.

APPENDIX – E

RESUMES OF PRINCIPAL INVESTIGATORS

APPENDIX – F

LETTERS OF SUPPORT

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Other BHS Staff

BHS IT Staff

BHS:

Co-PI. Kent Wreder

Corporate Director, IT/BHS

Co-PI. Maribeth Rouseff

Assist. Vice. Pres., Wellness, BHS

Co-PI. Glick, M.D.

Co-PI. Zolten, M.D.

Graduate Research Assistants (GRA) (4)

TBA

Project Coordinator &

Senior Programmer

FIU:

PI. Yi Deng, Ph.D., Director, CADSE/FIU

Co-PI. Jai Navlakha, Ph.D., Professor, FIU

Co-PI. Steven Luis, System Manager &

Faculty Coordinator

BHS Wellness and Clinical Information Project Manager

• Correlation and mapping between iCHP content and CPR

Graduate Research Assistants

• Software development

• Consumer health portfolio interface design & programming

• Reports and documentation

• Software/hardware installation & maintenance

• Health information content development & organization

BHS PR Project Manager

• Selection and procurement of consumer health content

• ICHP PR and marketing

Project Coordinator: TBA

• Documentation & reports

• Software Development

• Coordination of consumer groups

• Program reviews

BHS IT Staff

• ICHP/CPR system Integration

• ICHP workflow development

Co-PI. Maribeth Rouseff

• BHS Corporate Liaison

• Community Involvement

Co-PI. Steven Luis

• System Development

• Consumer Health Record Design

• Patient-Provider Interaction

Co-PI. Glick, M.D.

Co-PI. Zolten, M.D.

• Clinical/health service experimentation

• Medical/clinical expert consultation

• Program evaluation and review

Co-PI. Jainendra Navlakha, Ph.D.

• Project Evaluation

• Community Involvement & consumer relations

• iCHP interface design

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PI. Yi Deng, Ph.D.

• Overall Project Management

• iCHP Architecturing

• Program Evaluation

Co-PI. Kent Wreder

• BHS Side Project Coordination

• ICHP-CPR Integration

• Consumer Health Service Development

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