Appendix A. Project Description, Management and Implementation Plan
A.1. Detailed Project Description
The development of the proposed Interactive Consumer Health Portfolio (iCHP) services system encompasses many different areas of concern in this request for proposal, namely, health, education, public service and community networking. iCHP is essentially a 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 service 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 utilizes their health records. From a simple recording of a journal of symptoms for a particular instance of illness or a checklist of health indicated based on provided to the creation of a comprehensive long term personal health and medical record, the proposed services suits consumers at many different classes.
2) The iCHP system will be electronically linked with the 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 can wellness as described below.
3) It channels filtered and customized healthcare information/data to consumers with specific needs. Based on the stored or dynamically created consumer/patient profile, iCHP guides its user to relevant factual, educational, training health contents provided the healthcare provider.
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/experience to their physicians or 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 details the proposed system in diagrammatic form.
Access to the system will be made possible through the Internet and a user interface will be developed that makes using the system 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 chosen health clinics in their neighborhoods. We will design the system that requires different levels of security clearances for appropriate people to access an individual patient’s information.
Figure A-1. The proposed interactive consumer health portfolio (iCHP)
The proposed iCHP will bring tremendously benefits to the people in South Florida, including those belonging to underserved population. Moreover, the services proposed here is not limited to regional applications but represent a model that can be and should be expanded to the national scale.
n Timely healthcare for the participants.
The iCHP services will improve communication between the 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 timely healthcare available to them. Two possible scenarios are described below.
When a person goes out-of-town and falls sick, he can give permission to the local doctors to access his health portfolio. It will contain the patient’s history of that ailment, medications being taken at the time, allergies experienced, etc. The patient sometimes is not in a position to convey this information or is not conversant of the medical description of the ailment. Accurate medical information will allow the doctors to make more informed decisions about him.
Suppose a woman observes a lump in her breast during the regular exam at home. The 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 was available to the patient, she could access it and input this information which will be available to the doctor instantaneously. Appropriate care could then be provided in a timely fashion, and who knows, but a possible future tragedy might have been avoided.
n Better education for the patients.
If a person is suffering from a particular sickness that has many types, like diabetes, it is not easy for the patient to acquire the relevant knowledge from among a lot of available information. The doctor could convey this information very easily by placing a pointer to the approved and validated health literature on it available 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 result in greater awareness on the part of the patients.
n 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.
n 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 the emergency room. Another example is when 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 might save some lives.
n 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 provides a good support to 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 the Fortune Magazine. Last year, the American Nurses Association named it one of the 11 “Magnet Hospitals” in the United States for Excellence in Nursing. The success of the project with this high quality partnership between two leading entities in the region excelling in their own spheres should not be doubted at all.
Figure A-2. Project Personnel Organization Chart.
A.2. Project Management 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 B. Figure A-2 shows personnel organization for the project.
The management structure of the project is organized as follows and summarized in Figure A-2.
· 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 architecturing, and program evaluation.
· 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 BHS 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. Together with Steven Luis, he will also participate in iCHP interface design.
· Steven Luis, Systems Manager in School of Computer Science at FIU, will be in charge of system development, the design of XML-based consumer health record structure and information views, as well as patient-provider interactions. Maribeth Rouseff, Assistant Vice President on 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.
· 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 program evaluation plans and in conducting program reviews.
· Dr. Robert A. Zolten, M.D., Co-PIs, senior physician of Internal Medicine at BHS' Homestead Hospital, 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 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, (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 BHS CPR.
Figure A-3. Project Task Allocation Chart
A.3. Community Involvement Plan
A look at the investigators involved in developing and implementing this proposed healthcare information network should convince everyone that the level of community involvement in this proposal is very high. 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 end-users of this project will be served through a number of clinics established in the city, as well as through Internet access. Currently, plans call for establishing these clinics at three existing clinics of Baptist Health Systems at Homestead, Pinecrest and Kendall. A fourth clinic will be established at Florida International University campus for the use of the system by the students. FIU is a Hispanic serving institution with almost 56% of its student population comprising Hispanic students. Thus we expect that there will be a substantial Hispanic population’s participation in this project from the very beginning. The Homestead clinic of BHS is located in an area with a large minority population comprising of African-Americans as well as migrant population. Thus, the project will be in close contact with this under-served group also right from the very beginning.
Many government agencies are extremely interested in the success of this project. Letters of support by Senator Bob Graham, Governor Jeb Bush, and Congresswoman Ileana Ros-Lehtinen clearly indicate that there are many advantages that will be derived from this project in the future. As Governor Bush writes: “the use of the Internet as an information highway for personal medical information will open a new horizon in the care and wellness advising for the citizens of this state.” There is no doubt in our minds that there will be a substantial involvement of various government agencies in this project in the long run.
The targeted end-users will not all have to be sophisticated in the usage of computers and the information highway. At each clinic site, we will provide training facilities to train the consumers of this healthcare information network to use it effectively. The system will be developed such that novice computer users will be appropriately guided to interact with the system. BHS will be responsible for marketing this system for use by under-served population available at some clinic sites stated above. Increasing community awareness about this healthcare information system is part of our plan to increase the number of users of the system.
A.4. Project Implementation Plan and Schedule
In this section, we describe the implementation plan and schedule for the proposed project as shown in Figure A-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/sustain 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 phrases and the time table associated with them.