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Best Conceptual Overview for Setting up a Patient Management application - Noob Level RRS feed

  • Question

  • I'm looking to develop a straightforward application to manage health plans for multiple patients in which the health information entered is then available in the patient's healthvault and also available for care management.

    I have reviewed and was able to get the sample fitness application to run and connect to my beta developer HealthVault account. It is a great start for what I would like to develop and like the idea of having the record be patient-centered. I am a beginning level programmer who has had success in developing asp.net applications, but am not sure I understand the best way to move forward in developing a HealthVault application for managing patients.

    I can see that as a care manager I would be the custodian for someone's HealthVault account, but I'm not sure that I understand the best way to then set-up my application to manage multiple accounts. I'm used to managing these types of aspects through a SQL database connection, but some of the underlying architecture seems to be getting away from this. I've read through most of the documentation, but am not sure if I understand what the most efficient approach would be.

    Is there an example somewhere of what this type of application might look like?

    I know this is perhaps a broad question, but any advice would be appreciated.

    Thanks,

    Nathan
    Tuesday, March 11, 2008 12:24 AM

Answers

  • Nathan,

     

    Essentially you are looking at a Multiple Record capable application. 

     

    In case your application is a custodian of multiple patients,  when the custodian user logs into the the application, your UI should allow to switch between patients (records) and allow him to select a record. For ex while logging in, set the parameter for RedirectToLogin as TRUE in which case the custodian will see the set of records he has permissions for and can choose one to proceed with.  Your application should then always refer to PersonInfo.SelectedRecord (which refers to the record that the custodian selected) for interacting with healthvault.

     

    Unless absolutely required do not store healthvault data directly in your SQL db.  You may want to fetch it from HV when you need it (again, refer to HealthAndFitness application to figure out how to cache data in the application cache so that the Healthvault requests are minimal).  This is more secure and you can avoid numerous sync issues that may arise if the data get changed in either end points..

     

    The other approach that I can think is -  the care manager (the application user that manages all patient records) necessarily need not be the "custodian" of records to access their records. You can get your application authorized for offline access to your patient's records .  Again, depending on your scenario, this may be a good or bad option.  In this case, your application can give a choice to the care manager when he logs in to select the the HV user to interact with and code in your application will access their records in offline mode. In this case you may end up storing some Ids etc in db for future offline access.  Again this is just a thought and I am not very sure of this option since I have not tried it. 

     

    Please go thru

    http://blogs.msdn.com/healthvault/archive/2007/10/26/healthvault-applications-and-offline-access.aspx  

     

     

    HTH

     

    Raj

     

     

     

     

     

     

     

     

    Tuesday, March 11, 2008 6:47 AM
  • Thanks for the additional data - I understand what you are trying to do now.

     

    It would be reasonable for the patient to have their own health record - that is created with the assistance of their health manager - and then have that patient grant read/write access to the care manager. That would then allow the care manager to interact with applications (ie your tracking application or others) using the patient's health record, but without the full abilities that custodial access provides. If you wanted to pass on that access to another institution, that could be done by having the patient grant read/write access to a care manager at that new institution.

     

    I agree that the health information should be in the domain of the patient, even if the bulk of the use is through a care manager.

     

    I'm not sure of the right approach to deal with managing and transferring patients between caregivers. The access would be tied to a specific caregiver account.

     

    I would also encourage you to look at the privacy policy for HealthVault, and the operating requirements for applications:

     

    https://account.healthvault.com/help.aspx?topicid=PrivacyPolicy&rmproc=true

    http://msdn2.microsoft.com/en-us/healthvault/cc268231.aspx

     

     

     

    Tuesday, March 11, 2008 6:24 PM

All replies

  • Nathan,

     

    Essentially you are looking at a Multiple Record capable application. 

     

    In case your application is a custodian of multiple patients,  when the custodian user logs into the the application, your UI should allow to switch between patients (records) and allow him to select a record. For ex while logging in, set the parameter for RedirectToLogin as TRUE in which case the custodian will see the set of records he has permissions for and can choose one to proceed with.  Your application should then always refer to PersonInfo.SelectedRecord (which refers to the record that the custodian selected) for interacting with healthvault.

     

    Unless absolutely required do not store healthvault data directly in your SQL db.  You may want to fetch it from HV when you need it (again, refer to HealthAndFitness application to figure out how to cache data in the application cache so that the Healthvault requests are minimal).  This is more secure and you can avoid numerous sync issues that may arise if the data get changed in either end points..

     

    The other approach that I can think is -  the care manager (the application user that manages all patient records) necessarily need not be the "custodian" of records to access their records. You can get your application authorized for offline access to your patient's records .  Again, depending on your scenario, this may be a good or bad option.  In this case, your application can give a choice to the care manager when he logs in to select the the HV user to interact with and code in your application will access their records in offline mode. In this case you may end up storing some Ids etc in db for future offline access.  Again this is just a thought and I am not very sure of this option since I have not tried it. 

     

    Please go thru

    http://blogs.msdn.com/healthvault/archive/2007/10/26/healthvault-applications-and-offline-access.aspx  

     

     

    HTH

     

    Raj

     

     

     

     

     

     

     

     

    Tuesday, March 11, 2008 6:47 AM
  • Nathan,

     

    I like to think of "custodian" as somebody who has decision-making power for a person. So, I might be a custodian for my child, or for a parent that I'm helping out with healthcare decisions.

     

    Unless I misunderstand what you mean by "care manager", I don't think that person would be a custodian. I think they would be someone who used an application that had been granted access to a specific person's account.

     

    Can you list a few scenarios that you're planning on implementing, and detail what data is either stored or retrieved from the HealthVault record, and who does the storing/retrieving?

    Tuesday, March 11, 2008 3:12 PM
  • Eric,

    Maybe you are right and maybe I don't understand the difference between granting access to a specific person's account and being a custodian of an account. I'm thinking of its use within vulnerable populations (homeless, migrant, lower SES) in which actual HealthVault interaction on their part would be extremely limited and would be most often used in coordination with a care manager/case worker of some sort.

    Patients receiving this type of care would be signing a consent form (HIPPA, etc.) that would allow the care manager to assist them in their medical care and consequently allow them to be a "custodian". Although they technically might not log on and do anything with their HealthVault account, the potential would at least be there.

    I guess this then leads to the next question of whether there is a way to make the custodian an organizational entity versus a personal entity. For example, if I am a care manager who works within a community assisting x number of people and then get a new job, how do I transfer my custodianship of each patient to the new person taking over my community?

    In regards to data I suppose it is not necessarily a matter of storing, but a matter of being able to aggregate and report trend type data across participants and to be able to pull address type data, etc.

    Thanks for your response, this is the "conceptual" aspect of what HealthVault is meant to achieve that I am trying to make sure I understand.


    Tuesday, March 11, 2008 3:54 PM
  • Raj,

    Ok, I will read further into the Multiple Record application documentation. I just wanted to make sure I was understanding how this type of scenario would best be approached through HealthVault.

    I think the second approach sounds more like what would need to be accomplished and what I should follow-up on.

    The problem I see with the first approach is how a new custodian (new care manager for that set of patients) would access the set of patient records without having to reassign permissions for all the patients.

    I did not know of the offline sample discussed in the link you sent and will check that out.

    Thanks for the response.


    Tuesday, March 11, 2008 4:13 PM
  • Custodian access is equivalent to owner access, and I think is different than consent.

     

    A custodian can delete any data from a record, give custodial access to others, or even delete the whole record if they wish.

     

    I have a few options for you, but I'm going to ask some others in our group for their thoughts before I post them.

    Tuesday, March 11, 2008 4:51 PM
  •  

    In regards to data I suppose it is not necessarily a matter of storing, but a matter of being able to aggregate and report trend type data across participants and to be able to pull address type data, etc.

    Can you expand on this a bit? What sort of data are you thinking you will aggregate and report on, and how will that data get into HealthVault?
    Tuesday, March 11, 2008 4:53 PM
  • Some examples of the data that would need to be gathered might include reporting overall priority conditions (i.e. what are the top five conditions that patients within the population are suffering from) and overall care management success (percentage of patients who successfully followed up with appointments, maintained some level of a prescription regiment or lowered their blood glucose levels).

    General demographic type data will want to be gathered and aggregated as well to assist in identifying applicable health resources and opportunities for care financing (i.e. which clinics are serving the majority of this population or based on patient information are they eligible for Medicaid).

    When you ask how the data will get into the HealthVault I'm assuming you mean "who" and from this perspective it would generally be the care manager. If the patient was to enter information that would be its own very large sign of success. The end goal would be that specific medical information is entered into an EHR and linked to a HealthVault account. Based on that data a care manager (perhaps outside of the original medical provider system) would devise a management plan for the patient and would be entering further data into a health management/fitness type of application also linked to the HealthVault account.
    Tuesday, March 11, 2008 5:39 PM
  • Eric,

    In regards to custodian access, I didn't note that the custodian could delete the record or data within the record and in general would not want this level of control. Actually, for the population I would be targeting I don't know that I would want the patient to be able to delete the data or record either (I guess that becomes its own ethical question). I suppose that by creating an offline element to the application that would allow me to preserve data up to the point of deletion which might then be fine. I relate this in terms of responsibility not in necessarily wanting to store or own the data.

    In regards to passing access on it does seems of value for the custodian (care manager) to be able to pass on access (with patient permission) to another care management institution.

    Use of the HealthVault within the goals of what I want to accomplish is to provide a record of continuous care for those with highly fragmented care. The healthcare application would most often be interacted with by the care manager, but especially within this population in which there is no common care provider, there seems to be an advantage for the patient in building it so that the overall record and its ownership resides within the domain of the patient (even if they don't personally ever really use it).

    Tuesday, March 11, 2008 6:02 PM
  • Thanks for the additional data - I understand what you are trying to do now.

     

    It would be reasonable for the patient to have their own health record - that is created with the assistance of their health manager - and then have that patient grant read/write access to the care manager. That would then allow the care manager to interact with applications (ie your tracking application or others) using the patient's health record, but without the full abilities that custodial access provides. If you wanted to pass on that access to another institution, that could be done by having the patient grant read/write access to a care manager at that new institution.

     

    I agree that the health information should be in the domain of the patient, even if the bulk of the use is through a care manager.

     

    I'm not sure of the right approach to deal with managing and transferring patients between caregivers. The access would be tied to a specific caregiver account.

     

    I would also encourage you to look at the privacy policy for HealthVault, and the operating requirements for applications:

     

    https://account.healthvault.com/help.aspx?topicid=PrivacyPolicy&rmproc=true

    http://msdn2.microsoft.com/en-us/healthvault/cc268231.aspx

     

     

     

    Tuesday, March 11, 2008 6:24 PM
  • Ok, I think that makes sense and sounds like what I am trying to accomplish.

    Just to be sure...

    1. A HealthVault account would be created for the patient and at that time access would be granted to the care manager at the read/write level ("View and Modify the Person's Information").
    2. Then when the care manager goes to use their local application the care manager's credentials could be used to access information from the patient's HealthVault account until the patient releases their rights.
    3. Any further access would have to be negotiated per patient.

    Thanks again for the clarification, much appreciated.
    Tuesday, March 11, 2008 7:24 PM
  • That is correct.

     

    Wednesday, March 12, 2008 4:46 PM
  • Hi ,

    Are developing this application for your own venture or for an employer or client?

    If its for your own, L'd like to youch base with you,

    Thank

    Mark

    Thursday, March 13, 2008 3:41 AM
  • Hello,

    I'm an action researcher working with an organization.

    Thanks for your interest,

    Nathan
    Thursday, March 13, 2008 6:04 PM