Monday, February 1, 2010

Front-end Web Application for use in the Human Workflow used to Disambiguate IDs in an Electronic Healthcare Record (or other) Automated System

From December 14, 2009 post

Disambiguation is a process through which multiple potential identification matches are further parsed until the patient can be matched with his or her data with sufficient certainty to allow for the delivery of a health service with reasonable confidence. The complexity of disambiguation varies according to factors such as the number of potential matches and the type of information available for further analyses. When sufficient digital data are not available to further differentiate potential matches, automated disambiguation may not be possible and may require human involvement.

Disambiguation entails implementing significant new workflows and may require substantial time and resources. When human involvement is required, many of the potential benefits of automation are lost. For example, at the point of care, disambiguation is often done by asking the patient further questions regarding personal characteristics and/or health care history. In some situation, disambiguation may not be possible, as when the patient is not present and information needed to further facilitate matching may not be accessible.

From December 7, 2009 post:

Disambiguation of IDs is the process of resolving multiple potential matches into a match with the correct person. In general, statistical matching algorithms are likely to require substantially more-frequent disambiguation compared to that required by a system that uses theoretically perfect universal IDs; often, disambiguation is done by human intervention. Such disambiguation imposes significant costs and operational inefficiencies, particularly if, for example, a physician must resolve the ambiguities.

Note 1: Many of the efficiency and safety benefits theoretically possible with health information technology (HIT) systems depend on eliminating such human involvement and its concomitant slowness, expense, and propensity for error.

Note 2: What follows applies to IDs in general, even though I’ve chosen the healthcare industry for much of this discussion.

When the business process can’t be completed by automation alone, the business process incorporates human workflow. Manual disambiguation of an uncertain ID is one such human task. The form shown in the figure below illustrates a Web app created with Visual Studio 2010 [Beta 2] that a user employs to carry out part of a human workflow.

Please note: This post is presented in early draft form.

Communication between the client (user interface shown in the figure above) and the application services is performed by using proxy classes that run in the client and that represent the application service. In practice, a Web reference is a generated proxy class that locally represents the exposed functionality of an XML Web service. The proxy class defines methods that represent the actual methods exposed by an XML Web service. When your application creates an instance of the proxy class, your application can call the XML Web service methods as if the XML Web service were a locally available component.

At design time, the proxy class enables you to use statement completion for the XML Web service methods. At run time, a call to a method of the proxy object is processed and encoded as a SOAP request message. If the XML Web service does not support SOAP, the proxy class uses HTTP GET and POST. The message is then sent to the target Web Service for processing. If the service description defines a response message, the proxy object processes this message and returns a response to your application.

Note: To make XML Web services outside a firewall available to the Web browser, when creating the Web reference in Visual Studio, you must explicitly specify the address and port of your network's proxy server.

{ click the figures for a larger view }

Click here for more on Microsoft Visual Studio 2010

Click here for more on Oracle BPEL and Human Workflow

Note: If patients cannot be unambiguously identified via a computer-based process, machine-level interoperability will be hampered significantly.