Electronic Health

E
Records - EHR as a
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Electronic Health Records:

Where Do We Go From Here?

New York City

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John A. Clendenin
Distinguished Visiting Professor
Instituto de Empressa
Madrid. Spain

# 15 La Grange Frederiksted
PO Box 3171
Saint Croix, USVI 00841
1.617.480.0001
jaclendenin@profesor.ie.edu
 © Inner Circle Logistics, Inc.

Electronic Health Records - EHR as a System of Systems

The Demands on the Health Care Industry are Growing, and It Needs Supply Chain and
Logistics Solutions to Meet the Challenge...

Abstract

The demands on the Health Care industry are growing, and it needs innovative supply chain and
logistics solutions to meet the challenge of e-enabling the process of sharing Electronic Health
Records (EHR) for future collaboration. The tested ICLogistics’ process (US Patent 07155455)
can enable collaborative solutions for data and document exchange among trading partners,
analysis by governmental agencies, and shared between countries that employ ICT
infrastructures of varying sophistication.

This Network Science approach for EHR is examined where multiple interrelated electronic
domains are integrated using the dynamic network analysis of components as a System of
Systems (SoS). The importance and challenges of gathering and exchanging core, common and
unique information among multiple countries and global trading participants are presented along
with the methodology for successful analysis of EHR information contained in the diverse ICT
components of participants.

Introduction

The US population is aging and living longer, placing increased demands on the health care
system. The amount of regulated information, such as patient data, and products, such as
pharmaceuticals, that the Electronic Health Records (EHR) system must handle is on the rise,
creating its own unique set of requirements. Monitoring performance is more important than
ever. As advancements in the science surrounding human health continue to make great leaps
forward, so to must the technological capabilities required to ensure that the human population
efficiently, effectively, and affordably is made the ultimate beneficiaries. In the midst of the
great policy debate surrounding health care that currently dominates the domestic policy agenda,
a major question is the cost of providing viable health care to an increasing population that feels
the “crunch” of trying economic times. No matter the outcome of the current health care debate,
it is clear that the current trend in e-enabling medical records and administrative health care
requirements will be the dominate mechanism to gain efficiency and effectiveness in the 21st
Century. For example, in 2006 the market for electronic medical services was at $1.8 billion in
2006. This market is anticipated to reach $3.2 billion by 20131

1
Electronic Medical Record Market Opportunities, Strategies, and Forecasts, 2007 to 2013. WinterGreen Research, Inc. (2007).

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Challenges in e-Enabling Health Solutions
 © Inner Circle Logistics, Inc.

System-of-Systems (SoS)

One way to look at the health care vertical is as a complex system of networks where dynamic
interactions between overlapping networks form a System-of-Systems (SoS) of integrated health
supply chains that adhere to core principles of business process management. Inner Circle
Logistics, Inc. (ICLogistics), a “Net-Centric” solutions company that specializes in international
trade facilitation strategies using Internet based software and data hosting solutions, offers
integration solutions in data and document management for both large corporations and their
Small and Medium Enterprise (SME) trading partners. The company has developed a suite of
proprietary (Business Process Patent - US07155455 "System and method for making data
available for supply chain integration") software products and services that allow business
partners to search and share critical information seamlessly and in real-time regardless of
software platform or technical sophistication in a secure and reliable infrastructure. The paper is
using this technology innovation to address the complex SoS chaos in the EHR diaspora, we
employ intuitive Internet procedures to express the structural relevance and interchange of data
by means of a tertius gaudens business process methodology. This involves a comparative
analysis of specific data formats and structures and the deductive analysis - or reconstruction - of
the relations, connections, and dynamics of Virtual Relational Databases (Vrdb) that can be
positioned among facially disparate decision support systems.

Within this system of entities there are primary care providers, specialized medicine, hospitals
(public and private), emergency response technicians, insurance providers, pharmacies, and
associated suppliers of medical products that cross the spectrum of goods and services within the
medical industry. Each of these entities represents multi-node networks with multiple linkages
(multi-plex) that penetrate economic sectors outside of the health care vertical. In addition, the
movement of materials, organs, and persons across and within the System add a layer of
complexity that few other integrated systems can replicate. This reality is further exacerbated by
the fact that each network and node contains multiple data types and structures through which
information is disseminated. The challenge of this complex SoS is that data, documentation and
records in multiple data structures, schema, and ontologies have to be submitted in Core
(Unanimous agreement), Common (Agreement among a sub-group), and Unique (Required in a
distinct format and structure) information sets across multiple entities and that this disparate
electronic information must be interfaced and integrated across the various decision support
systems and applications of the multiple entities involved.

Worldwide, the Internet and web-based technologies fundamentally change the way that business
and governments operate by lowering transaction costs and counteracting the limited
standardization of data and documents. These outcomes lead to reductions in risk, price
elasticity, and marginal cost by reducing cycle times, communication costs, redundancy errors,
and asset utilization. Health care professionals must be able to receive reliable information in a
timely manner to ensure optimal patient care and administrators require patients’ insurance

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Challenges in e-Enabling Health Solutions
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records in usable formats to ensure appropriate benefits allocation. In addition, this system must
minimize the potential of identity theft, critical breaches in data and virus infiltration. Due to the
“human element,” there is a small margin for network failures due the sensitive nature of
paradigm making it critical that these solutions are robust.
SoS ~ Solutions

The SoS approach has wide applicability across a number of fields including international trade
facilitation. Core to gaining deeper understanding of the linkages between large scale networks
has been the evolution beyond static analysis of compartmentalized networks to a systems level
approach incorporating dynamic models that exhibit multiple interdependencies across multiple
nodes and networks, also known as Dynamic Network Analysis (DNA). A great example of
DNA is the use of a SoS approach to organize the interdependencies inherent in the international
trade system. In June, 2008, Inner Circle Logistics linked multiple, cross-border governmental
entities and private sector participants along Europe’s Corridor X by creating a networked
communications infrastructure that provided real-time visibility and analysis capability using
data from distributed virtual relational databases to link multiple country “single window”
architectures. The design of this multinational supply chain system allows diverse, stand alone
databases and applications systems that vary in sophistication to “communicate” through the use
of Core, Common, and Unique information sets and a patented business process approach (US
07155455). This simplified web-based process complied with international data harmonization
efforts by using ‘core’ electronic document formats as well as ‘common’ regional requirements
and ‘unique’ country and business partner ICT structures to exchange trade documentation in the
multiple languages and formats required by participants.

The web-based solution resulted in unprecedented access to data and information by creating
seamless integration with each country’s Core data entry system and allowing for business-to-
business (B2B), business-to-government (B2G), and government-to-government (G2G)
information exchange. Real-time connectivity allows for shipping visibility using improved ICT
infrastructure that integrates AIDC, RFID, and GPS components with trade documentation to
improve security and transparency. At each step, supply chain data was made available prior to
arrival at required verification points using a transmission portal that has Department of Defense
(DoD) level security. The web-based tool kit provides seamless data transmission and allows for
real-time upload of documents to Virtual Relational databases (VRdb) by required authorities
and company representatives. Each VRdb accumulated data in real-time from multiple sources
(Shipper, Customs, Border Police, Phyto-sanitary, RFID, GPS) throughout the movement of
goods and stored the data elements that populate reports and analysis systems. This trade data
was linked and combined to create web-services reports originating from multiple legacy
systems and web-based relational databases that presented data in a multitude of useable formats
for real-time decision making capability. The data can be pre-populated with any type of data
elements, updated in real-time, and shared across multiple nodes and networks for an unlimited
combination of data flow and analytical possibilities.

Conclusions

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The core process architecture that allowed for this successful trade system solution has wide
applicability in the health care vertical where there are multiple agents, entities, data types, and
legacy systems. The middle-ware solution allows for stand-alone communication infrastructures
such as found in hospitals, insurance corporations, pharmaceutical companies, and medical
manufacturing entities and retailers to exchange critical data without changing fundamental,
internal processes and procedures. Further, it seamlessly allows for departmental requirements
within the nodal structure that defines each integrated network while simultaneously allowing for
secure, real-time information exchange among emergency units (EMT, Life Flight, etc. using
mobile devices), medical personnel and administration and international “Responders” that
provides mission critical speed, response and effectiveness in crisis and disaster management
applications.

The power of network effects has become ubiquitous in the 21st Century. Increasingly producers
and consumers compete for consumption and production in a complex system of global supply
and demand. As this global system continues to expand there will be an increase in the quantity
and type of products affected by information networks. Producers, consumers, intermediaries,
and governments each represent multiple networks with diverse multi-node substructures
creating a complex trade system that flourishes through the transmission of information. This
reality poses compelling questions for today’s nations to answer as the complexity of EHR, the
increasing number of diverse niches and participants offering just as diverse solutions and
network structure and linkage becomes almost proportional to one’s overall economic position in
the global Health and Medical industry’s commerce system.

The growth, evolution and infiltration of the “network phenomenon” across the global
community create an imperative for improved understanding of complex systems and evolution
of the tools capable of multi-functional analysis. As Jeannette M. Wing, Assistant Director of
the Computer and Information Science and Engineering Directorate stated, “I believe that if we
understand the complexity of our networks better then we can evolve them in ways that can
unleash unimaginable creativity and innovation—from new technologies, to new applications, to
new users—and hopefully at the same time improve the overall security of our networked
systems.”

Core to fostering this type of understanding in the Health industry is the ability to leverage
current trends in e-Commerce to incorporate new web-based tools and methodologies for
systems integration and analysis that move from theoretical hypothesis to the use of empirical
data on medical network structures and information flow that result from designed application of
solutions across the industry’s complex system of systems environment.

The ICT architecture, which has already been developed, would allow the exchange in multiple
formats and structures of the individual medical systems. The resulting SoS will allow for the
successful exchange of data and documents along with the associated reporting. The effects of
this capability have far reaching implications for overcoming the challenges of linking multiple
health systems into a truly adaptive and collaborative SoS for global EHR and Global Health
supply chains. This architecture and business process innovation provides insights into the
future development of a wide range of complex, 21st Century EHR network applications.

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Inner Circle Logistics, Inc.

ICLogistics is a “Net-Centric” solutions company that specializes in international trade facilitation strategies using
Internet based software and data hosting solutions. The firm offers integration solutions in supply chain data and
document management for both large corporations and their small and medium enterprise (SME) trading partners.
The company has developed a suite of proprietary (Business Process Patent - US07155455 "System and method for
making data available for supply chain integration") software products and services that allow business partners to
search and share critical information seamlessly and in real-time regardless of software platform or technical
sophistication in a secure and reliable infrastructure.

Contact:
John A. Clendenin
President & Chief Executive, Inner Circle Logistics, Inc.
+1.340.244.4362 #15 Estate LaGrange Frederiksted, Saint Croix USVI 00841

www.ICLogistics.com Sport@ICLogistics.com

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Challenges in e-Enabling Health Solutions