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					Event Reporting: the Tension Between
   Accessibility & Confidentiality
           AHRQ IT Portfolio
               6/9/05
                          H Kaplan
                          Columbia University
                                 InCHOIR
                                 Pathology
                          NYPH
 "To conceive of knowledge as a
collection of information seems to
 rob the concept of all of its life...
Knowledge resides in the user and
       not in the collection."
   West Churchman, in The Design of
          Inquiring Systems
NYPH Participating Hospitals
– Milstein Hospital
– Morgan Stanley Childrens Hospital
– Weill Cornell Hospital
– The Allen Pavilion
– Ambulatory Care Network
– Westchester Division of Psychiatric
  Hospital
          MERS-TH Features
• Standardized reporting form for the entire
  hospital network
• Web system that is accessible to reporters
  through any web browser
• Central database of reports for process
  improvement with on-line query tools
• Automatic routing of reports to all relevant
  hospital personnel
   Push: Event report forms are
distributed to all relevant parties in
              real-time
        Empowering the End User:
        Conjunctive Query by Field
End user able to build queries without understanding
database design or table relationships.



            3.                        1.
              Records,
              sorted to       User builds query
            custom report.    by selecting fields
                              from linked forms.



                             2.
                  Query selects records
                 from tables in database.
Discovery Form – Expanding sections reveal
   detailed questions for each event type
MERS-TH Workflow
Weekly, monthly and quarterly sets of data
may be downloaded in Excel spreadsheet
                format
Interactive Charting Tool
 Tension Between Accessibility and
          Confidentiality
Good News re automation
• Reducing the number of paper report forms
• Improved access and availability
  -decrease dead ends
• More timely
Bad News
• (Still need someone to look at it)
• Increased need to control access
  -HIPPA and medical/legal
 Controlling Information Access
Organization Tree
• Roles
• Privileges
Overarching Access Rule Set (derived from
  organization tree)
• Location
• Service line (e.g. cardiac surgery, oncology)
• Types (falls, meds, transfusion, equip, etc.)
  MERS-TH Adapts to Institutional
           Changes
• Built-in lists of hospitals, services and locations
  can be changed with an on-line “location tree
  editor”
• Role/location/service-based access control makes
  it easy to reassign user roles.
• Backup users may be specified for each account to
  temporarily assume another user’s role
• A choice of centralized login mechanisms allows
  centralized institutional password and account
  management
“Ability is the art of getting the
  credit for all the home runs
     somebody else hits”
           -Casey Stengel, baseball manager

 International Center for Health Outcomes and Innovation
                 Research (InCHOIR) CUMC:
A. Gelijns, A. Moskowitz, R. Levitan, N.Egorova, G. Greco
                Department of Pathology CUMC:
                  Barbara Rabin Fastman
Thank You For Your Attention

				
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