VeriWrite Compliance for clinical data

Aim: Add VeriWrite compliance to sensitive clinical data or patient data, so the effort for clinicians to record, organize, maintain and protect collective details is reduced

Comment

Hackathon: FHIR @hack 2021

Problem statement:

Healthcare providers regularly collect sensitive medical information about their patients. This forces clinicians to spend excessive amounts of time on data entry, and burdens hospitals with the responsibility of organizing, maintaining, and protecting a massive database of confidential patient records. Develop a solution that prioritizes patient/clinician experience.

Inspiration

Scope of solution: Practitioner / Healthcare Provider related patient data

Vision: Verisafe Healthcare URL: http://www.venkataoec.wixsite.com/verisafenhealth

Description: A Medical Record is defined as: A clinical, scientific, administrative and legal document related to patient care in which is recorded sufficient data in the sequence of events to justify the diagnosis and warrant the treatment and its end results.

The Medical Records Department: It is the department responsible for collection, safe storage, preservation and analysis of medical records.

The problem solving is to add a VeriWrite Compliance section to the department, where this new section looks at the underlying liability and/or continual improvement needed in medical records collection, safe storage, preservation and aims for veritable, sustainable and accurate analysis.

What it does

The solution VeriWrite involves the recording of details to help reduce complex or collective data issues. It expects to help simplify records keeping and maintenance where there is compliance for evaluation of performance such as

a. Evaluation through Statutory Requirements

b. Evaluation for Medico-Legal Requirements

c. Evaluation of Progressive Patient Care

d. Evaluation for Provision of Health Information (morbidity and mortality statistics)

e. Evaluation for Periodic Reports*

f. Evaluation for Universal Work Precautions

g. Evaluation for Environment Control

h. Evaluation through the Statistical Approach (essential for utilization studies and administrative decisions for future programmes and allocation of resources)

i. Evaluation through Medical Audit

j. Evaluation through Nursing Audit

k. Evaluation through Equipment Audit

l. Evaluation through Patient Satisfaction Survey (IPD)

m. Evaluation through Patient Satisfaction Survey (OPD)

n. Evaluation for Provision of information for Medical Insurance Agents

How I built it

VeriWrite Compliance: The insight is to record details important for a patient in a Companion Card format, where vital details are included to help understand the person’s or patient’s health condition.

Beyond the vital, the Companion Card will also permit the practitioner, or consultant or clinician to record confidential or sensitive data with the use of a VeriWrite No.

The VeriWrite No. will not permit inappropriate / non-audited people to see the confidential / sensitive information. This could mean using the @sign to control access.

It will permit review of the manner in which this information is recorded during consultations /diagnosis, but will not permit viewing of the confidential/sensitive information.

The VeriWrite No could be a combination of alphabets and digits that codify the official Healthcare provider name or practitioner's name or consultant's name and medical record Master Index serial number.

If there is no Master Index serial number in this provider’s organization, or practitioner's or consultant's business/clinic then a specific serial number could be part of the VeriWrite No.

The Password associated with the C & S details would generally be an automatically coded form of the VeriWrite No itself, as this would help regulate access but reduce the chances of password issues like wrong password, forgotten password or old password etc

Explain the use of the @ Platform and/or FHIR resources

  1. The @sign can be used to control access or recording of VeriWrite data

  2. The @wavi page for a person can be used to refer to the new Companion Card or include Companion Card details

  3. The @mosphere can be used to transfer Companion Cards,
    Prescriptions (scanned or converted to KML) and Diagnostic Summaries (scanned or converted to KML)

A Plan to Prevent and Control (P2PC) oversight bot: On identifying the location to which these files are transferred using @mosphere, it is recommended to implement an if_file_transferred_handler that scans the folder for files of a particular extension or format and tweets updates that a prescription, or diagnostic summary or Companion Card has been received to a Twitter account.

As common expectation there will be enhancements to the @mosphere implementation to also send out notifications using the @Platform to the @sign of the recipient of the files being transferred.

  1. The @buzz can be used to regulate/delete access to transferred Companion Cards, Prescriptions (scanned or converted to KML) and Diagnostic Summaries (scanned or converted to KML)

A Plan to Prevent and Control (P2PC) oversight bot: On identifying the location to which these files are transferred, it is recommended to implement an if_file_deleted_handler that scans the folder for files of a particular extension or format and tweets updates that a prescription, or diagnostic summary or Companion Card has been deleted to a Twitter account.

At the idea level: The VeriWrite Persistence Key Store

As SMART Phones may be preferred by practitioners and clinicians in independent clinics or businesses, the problem solving could be extended to

  1. Create a separate @persistence keystore that can be used by practitioner or clinician to prescribe and share diagnostic summaries with a patient

  2. Create a separate @persistence keystore that can be used to read, write, update, delete “Companion card data” where this data may be complete card information or may be key hole specific card information

  3. Create a separate @persistence keystore that can be used to read, write, update, delete “Health Policy data” where this data may Health Policy information or may be Claim information

  4. Associate Data sharing and privacy with these keystores, where the access to each data record could be

(a) public: keystore data (like LineIcon card data) that can be read by anyone without need for authentication

(b) shared: keystore data (like Prescriptions, Diagnostic summaries and Vital health data + Confidential & Sensitive card data) that the owner has explicitly granted the right to some entity to read it after proving they are who they claim to be

(c) private: keystore data (like Healthcare Policy data) that is only accessible to the owner (requires authentication)

  1. Add a notification verb for the keystores containing “Prescription”, “Diagnostic Summary”, “Line Icon data”, “Vital health + C-S data” to alert the @Platform VeriWrite application when new data shared by others is available

  2. Incorporate the monitor verb to create a persistence connection to the keystores to access / update data

  3. Enable new Vital HealthCare Applications that are certified as @protocol compliant (@pps) to access and diagnose data stored in the @persistence keystores for prescriptions and diagnostic summaries .

  4. Enable new VeriSafe Healthcare Applications that are certified as @protocol compliant (@pps) to access and infer data stored in the @persistence keystore for Companion Cards like protected Vital health data + Confidential & Sensitive card data or public LineIcon data

VeriWrite Compliance and Companion Card details:

Name:

Sex:________Age:____________________Blood Group:

Medical history with record of immunization:

Medical history Details:

Immunization Details:

Whether on prescription medicines? Yes/No
Details:

Whether under treatment? Yes/No Details:

Any adverse drug reactions:

Serum protein recording (for COVID-19 interpretations):

[ ] Normal [ ] Evaluation needed [ ] Unknown

Any life changing condition (if relevant):

Any sensitivity to priority infections or pathogens:

Any Anti-microbial resistance incidences (if relevant):

COVID 19 (status):

[ ] Normal [ ] Family incidence [ ] Quarantined

[ ] Treated and Recovered [ ] Recovering

[ ] Not appropriately Tested

Last COVID/respiratory illness incidence:

Last major complaint (keeping in mind C & S regulations):

Last bacterium complaint:

First-aid or Emergency services (medication, medical equipment registration for emergency admission & need for treatment details, whom to contact numbers):

Linked AADHAAR/ Social Security/ Seamless Care No:

Linked with Healthcare (Claim): Yes/No Policy No:

Line-Icon specific Details:

The Line Icons associated with this card are

[+] Selective First-Aid details

[+] Food sensitivity and allergies

[+] Drug allergies

[+] Risk differentiator / Physical disabilities

[+] Wear-ons details   C & S details that could be added as a sheet to prescriptions / diagnosis summaries

C & S sheet (As guided by the VeriWrite Compliance circular)

VeriWrite No.:_______________________________________________ Dated:

(+) Records Confidentiality & Sensitivity (C & S) Index

Select mode of recording Confidential & Sensitive details:

[ ] Recorded or entered by the practitioner into database

[ ] Written down as diagnosis summary in C & S format for confidential access

[ ] Written down in prescriptions in C & S format for confidential access

[ ] Recorded officially by the record keeping department

  1. Select Confidentiality & Sensitivity (C & S) level of access:

[ ] Not to be disclosed without permission (Sensitive information)

[ ] Exclusively confidential (available only to Patient – Practitioner)

[ ] Normatively confidential (available only to Patient – Practitioner – Provider)

[ ] Not confidential

  1. VeriWrite Compliance

(a) Clinical data Details (that are considered Confidential and/or Sensitive):  

(b) Disease details (that are considered Confidential and/or Sensitive):  

(c) Procedures / Operations details (that are considered Confidential and/or Sensitive):

Card Information Storage provisions (to store data transferred or recorded):

[ ] Prescription Data logger (NEW, VeriWrite infra, a “prescription with card information” reader with enabling storage mechanism)

[ ] Diagnostic Summary Data logger (NEW, VeriWrite infra, a “diagnostic summary with card information” reader with enabling storage mechanism)

[ ] Healthcare Policy Data logger (NEW, VeriWrite infra,a “healthcare policy with card information” reader with enabling storage mechanism)

[ ] VeriWrite Data services (NEW, VeriWrite infra, a “card data” read, write, update, delete mechanism where data may be complete or key hole specific)

[ ] GPS Card KeyHoleData loggers (NEW, OGC KML Standard, a “card information” storage mechanism or a “card information” transfer mechanism)

Card Information Transfer provisions:

[ ] VeriWrite Dashboard services (NEW, VeriWrite infra)

[ ] @mosphere using @sign (NEW, @ infra)

[ ] Whatsapp using mobile number

[ ] VeriWrite Email

In this sheet the fields marked by * are mandatory and need to be filled almost always.

The following details are important for the records keeping department/systems The section can also design database pooling or clustering of clinical data with the help of different databases such as the Master DB, Physicians DB, Practitioner/Consultant DB, Disease DB, Procedures/Operations DB, Department wise DB, Location specific DB, Quality Indicator DB, Machine Learning Algorithm DB.

This will regulate what is normally implemented today as a Normatively confidential to Exclusively confidential as relevant to the case.

Proposed selections/settings Also the "Not to be disclosed without permission" setting will need a “not to disclose without permission policy” to be followed, by all practitioners/records keeping personnel.

If there is a "Not-applicable status" in the C & S section then the records keeping department need not implement any database pool or cluster for the data being recorded.

If there is a "No status" in the C & S section then the records keeping department need not use any database pool or cluster for the data being recorded.

If the records management database is simple or conventionally old, then the C & S section can help plan activation of selective databases as on a need basis, that is, if the records management database is incorporated with the VeriWrite solution, then the Required status in the C & S section can enable activation of a selective database as on a need basis.

If the records management database is incorporated with the VeriWrite solution, then the Yes status in the C & S section identifies that a VeriWrite No & some Companion Card and Line-Icon data will be recorded in a selective database with indexing.

Proposed Clusters for Practitioner-Provider services

(Priority 1) Master Index Details

System activated: Yes/No/Required/Not applicable

  (Priority 2) Physicians Index Details

System activated: Yes/No/Required/Not applicable

  (Priority 3) Practitioner / Consultant Index Details

System activated: Yes/No/Required/Not applicable

(C & S Priority 4) Disease Index Details

System activated: Yes/No/Required/Not applicable

(C & S Priority 5) Procedures / Operations Index Details

System activated: Yes/No/Required/Not applicable   (Priority 6) Department wise Index Details

System activated: Yes/No/Required/Not applicable

(Priority 7) Location wise Index Details

System activated: Yes/No/Required/Not applicable

  (Priority 8) Records Quality Indicator Index Details

System activated: Yes/No/Required/Not applicable  

(Priority 9) Records Line Icon and Machine Learning Algorithm Index Details

System activated: Yes/No/Required/Not applicable

Proposed Practitioner / Consultant Services:

(Priority 1) Practitioner / Consultant Index Details

System activated: Yes/No/Required/Not applicable

(C & S Priority 2) Disease Index Details

System activated: Yes/No/Required/Not applicable

(C & S Priority 3) Procedures / Operations Index Details

System activated: Yes/No/Required/Not applicable

(Priority 4) Records Line Icon and Machine Learning Algorithm Index Details

System activated: Yes/No/Required/Not applicable

Note: (This can extend in scope to VeriWrite problem solving for Line Icon Services)

Line Icon Services (vitals beyond Disease and Procedures):

The Line Icon solution looks at creating data pools for vitals beyond Disease and Procedures, like the ones mentioned in the submission.

These data pools could be accessed by Line Icon platforms that design solutions for these issues or threats.

The solutions could be provided to people either via the provider-practitioner framework, or by the practitioner framework, or by a Secure Your Health network, or Disaster management services network or First Aid services network.

Line Icon Services (vitals beyond Disease and Procedures):

(Priority 1) Selective First-Aid Index details

System activated: Yes/No/Required/Not applicable

(Priority 2) Wear-ons Index details

System activated: Yes/No/Required/Not applicable

(Priority 3) Drug allergies Index details

System activated: Yes/No/Required/Not applicable

(Priority 4) Risk differentiator or Physical disabilities Index details

System activated: Yes/No/Required/Not applicable

(Priority 5) Food sensitivity and allergies Index details

System activated: Yes/No/Required/Not applicable

Line Icon Services (vitals beyond Disease and Procedures):

Secure Your Health networks could rely on Location wise Data and access of any instantiation of Difference To Society (D2S) programmes that help a healthcare provider, or practitioner or consultant use information about the Health, Growth and Immunity (HGI) influencers in a location. Details are included in the document “4 - D2S programme for HGI”.

Disaster management services networks could use Location wise Data to understand whether the Location of interest implements any Relief or Impact Management Model. Details are included in the document “5 - Relief Work Management”.

Clinical data URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/ClinicalData

Requires auto-coded password to create or access information which could be independently recorded or recorded as part of the following indexed (priority specific) information.

The auto-coded password and associated level of access would then disable or enable the access to particular links for information to be created or recorded. The links with C & S priority 4 and 5 are regarded as confidential and sensitive details at the highest level.

(Priority 1) Master Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/MasterData

(Priority 2) Physicians Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/PhysicianData

(Priority 3) Practitioner / Consultant Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/PractitionerorConsultantData

(C & S Priority 4) Disease Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/DiseaseData

(C & S Priority 5) Procedures / Operations Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/ProceduresorOperationsData

(Priority 6) Department wise Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/DepartmentData

(Priority 7) Location wise Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/LocationData

(Priority 8) Records Quality Indicator Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/QualityIndicatorData

(Priority 9) Records Line Icon and Machine Learning Algorithm Index Details URL/Link: http://Web site of preferred hospital or nursing home or healthcare provider/SeamlessCare/MLAData

Revisiting real-world issues:

Now that records may already exist that do not have any indexing or secure access, the new VeriWrite Compliance could integrate a machine learning algorithm that can read the data and index / prioritize the same via the algorithm to identify the (indexed/prioritized) bucket to which the data should be tagged to, where this should help come up with a standard resolution for indexing / prioritizing existing or non-compliant clinical data.

In the proposed solution,

  1. The clinical data in the repository could be clustered using a combination of (a) Text-analytics of “text fields” with select descriptions, (b) the time estimated or taken to resolve each request and (c) a categorization variable that categorizes the nature of data/records

  2. The Text-analytics technique could be based on Word2Vector

  3. The clustering technique could be based on DBSCAN

  4. The Cosine similarity algorithm could be used to classify data to fit within one of the buckets created (where this is based on text categorization)

  5. A skeleton could be then created for the clinical data including the names of buckets that were relevant for the details found. The skeleton is then put across to the record keeping or compliance committee, for them to specifically re-record the same if confidentiality or sensitivity is to be protected, else the skeleton is included as part of a VeriWrite Compliance report in the existing record keeping systems.

  6. For Clinical data written down as prescriptions or as a diagnosis summary, where this detail could be confidential and sensitive, the record keeping procedure will decide whether the originals are issued to the patient or person and whether a copy of the same is created and retained by the practitioner/consultant/department.

Added problem solving for prescriptions: If no copy of certain confidential and sensitive prescriptions is maintained, then this could need to be rectified, where a copy of certain prescriptions is always created by providing counter-foils or carbon-copy sheets to the practitioner or consultant and by having the assistant for the practitioner or consultant enter these details into the records database.

Added problem solving for prescriptions: If records of certain confidential and sensitive prescriptions are maintained, then this will need protection by ensuring the addition of a VeriWrite No that can control access, record keeping and storage of these details.

Added problem solving for diagnosis summaries: Generally all records management solutions would store a diagnosis summary into the records database for later retrieval and review. The new recommendation is to have a practitioner/consultant/assistant tag the diagnostic summary as to whether it contains confidential and sensitive details.

Added problem solving for diagnosis summaries: If records of certain confidential and sensitive diagnostic summaries are maintained, then this will need protection by ensuring the addition of a VeriWrite No that can control access, record keeping and storage of these details.

Challenges I ran into

This idea must satisfy Quality of Service / Quality Assurance for Medical Records. That is the prioritized design for medical records must satisfy

  1. The patients

  2. The VeriWrite compliance panel

  3. The clinicians

  4. The management

  5. The health authorities

  6. The legal authorities

  7. The insurance authorities

Records Quality Indicator:

  1. Number of records found incomplete during random checks by the Medical Records Committee (MRC)

  2. Number of records found damaged during random checks by the Medical Records Committee (MRC)

  3. Percentage of records found missing / untraceable during random checks by the Medical Records Committee (MRC)

  4. Time taken for the retrieval of records during surprise checks

  5. Complaints from the consultants/registration/front desk staff about the delay in retrieval/supply of records for reference

  6. Complaints from patients/relatives about delay/non-availability of documents

  7. Complaints from health authorities about delay/non-receipt of documents/reports

  8. Observations by the courts/insurance agencies

  9. Observations by the Medical Audit Committee / Nursing Audit Committee about the quality of records generated, preservation of records or timely availability of records

  10. Quality and timely availability of the statistics as reported by the users / reviewers

  11. Instances of breach of confidentiality of information

  12. Physical condition of records as seen during periodic inspections, concern about dust, fungal growth, damage by pests or seepage of water

Accomplishments that I'm proud of

Working on problem solving to improve health, wellness and save life itself

ROI insights for this solution: Thinking ahead, the VeriWrite Compliance and Companion Card solution has the following return of investment profile.

  1. It can help Tracer methodology where the Companion Card can help trace a person’s use of healthcare and services. The open-ness is also there for Surveys without restriction.

  2. Helps Priority Focus methodology where surveys or inferencing can be done on unregulated and/or confidential data

  3. Helps unannounced survey of vital health information like blood pressure problems, blood sugar problems, heart health problems and pre-training for drug effectiveness, emergency response and even antibiotic resistance.

Summary of vital information or vital health data: As a card that will need to include clinical data, the effort is to ensure mainstream clinical details are recorded without the intent to record dynamic data such as readings, scanning reports, diagnostic tests etc, as these values can change from time to time.

What I learned

Records are veritable evidence of the safe and supportive healthcare provided by a healthcare provider

What's next for VeriWrite Compliance

Implementation of the VeriWrite infrastructure and framework

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