Abstract:
A method and health information exchange system for health and human care providers providing shared community health information records on individuals and their related household members in a secured relational database that is fully HIPAA compliant are disclosed. The system gathers a broad range of medical, epidemiological, and demographic information on individuals and their related household members visiting disjointed and unassociated health and human services providing care in a predefined region. The database is accessible to authorized subscribers via a secure private web site in real time, and allows for the tracking of service utilization of the individuals and their related household members in the predefined region to help ensure that the individuals and their related household members are receiving the necessary care from the variety of disjointed and unassociated health and human services.

Description:
STATEMENT OF GOVERNMENT INTEREST 
       [0001]    An award from the Health Resources and Services Administration of the US Department of Health and Human Services was used in the development of this invention. Accordingly, the invention described herein may be manufactured and used by and for the Government of the United States of America for Governmental purposes without the payment of any royalties thereon or thereto. 
     
     FIELD OF THE INVENTION 
       [0002]    The present invention relates generally to information management systems and, more particularly, to a network-based distributed health information exchange system and method for disjointed health and human service providers in a regionally defined area. 
       BACKGROUND OF THE INVENTION 
       [0003]    For over thirty years there has been a clear understanding that health care in this country would be vastly improved if health care providers had real time access to the comprehensive set of health related information available for each patient. Web based technologies that allow for secure transmissions of protected health information are widely recognized as critical to both quality improvement and cost reductions in the health care industry. However, currently, most health related information for an individual patient is resident, on average, in at least seven different locations within one community. For example, a primary care provider has one set of data, multiple medical specialists have additional sets of data, various laboratories, outpatient procedure and urgent care facilities have additional sets of data, pharmacies, emergency departments, and inpatient facilities have additional sets of data. Although much of the data is duplicative, each provider also has data unique to the record resident in her office. 
         [0004]    Within the health care industry, the estimated 8% of provider/organizations investing in health information technology are focused primarily on inpatient services, and importing legacy data. Most commonly adopted health information technology (HIT) services are practice management systems that maintain electronic appointment books, insurance inquiries, and billing information for a particular provider organization. Larger provider systems have been outsourcing review of laboratory results using electronic health information technology, and implementing enterprise systems that electronically integrate multiple services and documentation within the hospital. 
         [0005]    For the most part, the early adoption of HIT has been in the private sector and has focused on improved quality of care and reduced administrative cost and burden for individual provider systems. There are a plethora of proprietary products being developed or customized by vendors for provider organizations with little to no attention focused on interoperability across products to facilitate the exchange of information from one provider system to another. Additionally, vended systems are typically written on platforms that require purchase of less accessible software and have had multiple layered functionalities requiring extensive programming for interface between systems or previous versions of the same system. Little attention to date has been focused on outpatient services, and even less attention has been focused on health care services provided in the public sector to those patients without health insurance. 
         [0006]    The remaining 92% of the health care industry is still watching and waiting—primarily because there remain very few national standards for products and processes development in the industry, and because of the prohibitive cost involved in the migration from paper to electronic records. Additionally, most potential users are reluctant to purchase proprietary systems developed by vendors and customized for each individual provider or provider network, because there is not yet a strong market incentive for these systems to be able work together, that is, they are not routinely interoperable. 
         [0007]    Health and human services organizations, which provide outpatient services for those lacking health insurance, are required to comply with federal privacy and security regulations under the Health Information Portability and Accountability Act (HIPAA). Currently, there is no standards-based health information technology that is readily adaptable to existing non-compliant systems. In addition, public health and emergency preparedness organizations need to quickly access and map information from health information records related to outbreaks of infectious diseases, or the impact of biohazards as documented through client/patient encounters at multiple public sector facilities. 
       SUMMARY OF THE INVENTION 
       [0008]    It is against the above background that the present invention provides an electronic health information exchange system for disjointed health and human service providers in a regionally defined area, such as a state or county to improve access to healthcare and care management for those individuals and their related household members typically lacking health insurance. The system is implemented over a public network, such as the Internet, through a virtual private network and provides a secure private web site. Via the private web site, the system provides web pages to view and input information in health information records maintained in a relational database. The system permits authorized users to record demographic information at the individual and household levels, as well as services utilization data of the individual and related household members in the health information records. With such records, the system facilitates more efficient and effective enrollment of people into available health and human services in the region, and to help ensure that the participating individuals and their related household members are receiving the necessary care from the variety of disjointed health and human services. 
         [0009]    The above noted and additional advantages and features of the present invention will be apparent from the following description and the appended claims when taken in conjunction with the accompanying drawings. 
     
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]      FIG. 1  is a schematic diagram of an illustrative system with a plurality of components in accordance with an embodiment of the present invention; 
           [0011]      FIG. 2  is a schematic diagram of a representative hardware environment in accordance with an embodiment of the present invention; and 
           [0012]      FIGS. 3-35  are various screen images of a user interface embodiment for accessing, composing and reviewing live health information records. 
       
    
    
     DESCRIPTION OF THE INVENTION 
       [0013]    The following description of the embodiments of the invention directed to a network-based distributed information management system, method, and article of manufacture for managing a health and human services regional network is merely exemplary in nature, and is in no way intended to limit the invention or its applications or uses. 
         [0014]      FIG. 1  illustrates an exemplary distributed regional health information exchange system  100  with a plurality of components  102  in accordance with an embodiment of the present invention. As shown, such components  102  include a public network  104  which take any form including, but not limited to a local area network, a wide area network such as the Internet, etc. Coupled to the public network  104  is a plurality of computers, which may take the form of desktop computers  106 , laptop computers  108 , hand-held computers  110 , or any other type of computing hardware/software. Various computers in the system  100  are connected to the public network  104  by way of a server  112 , which is equipped with a firewall for security purposes. A representative hardware environment associated with the various components  102  of  FIG. 1  is depicted in  FIG. 2 . 
         [0015]      FIG. 2  illustrates a representative workstation  200  by which embodiments of the present invention may be carried out. In the present description, the various sub-components of each of the components  102  may also be considered components of the system  100 . For example, particular software modules executed on any component  102  of the system  100  may also be considered components of the system  100 . The hardware configuration of the workstation  200  illustrated in  FIG. 2  includes a central processing unit  210 , such as a microprocessor, and a number of other units interconnected via a system bus  212 . 
         [0016]    The workstation  200  further includes a Random Access Memory (RAM)  214 , Read Only Memory (ROM)  216 , and an I/O adapter  218  for connecting peripheral devices such as disk storage units  220  to the bus  212 . The workstation  200  further includes a user interface adapter  222  for connecting a keyboard  224 , a mouse  226 , a speaker  228 , a microphone  230 , a video camera  232 , and/or other user interface devices such as a touch screen (not shown) to the bus  212 . The workstation  200  further includes a communication adapter  234  for connecting the workstation  200  to the public network  104  ( FIG. 1 ) and a display adapter  236  for connecting the bus  212  to a display device  238 . The workstation  200  typically has resident thereon an operating system such as, from Microsoft, IBM, MAC, UNIX, or LINUX. Those skilled in the art will appreciate that the present invention may also be implemented on platforms and operating systems other than those mentioned. For example, the workstation  200  could alternatively be a graphical terminal connected to a mainframe, mini-, or super-computer. 
         [0017]    In general, enrolled referring health and human service provider personnel have secure access to the regional health information exchange system  100  according to the present invention via a public key encryption system using Virtual Private Network (VPN) software or hardware or SSL-class security. In one embodiment, the system  100  is implemented and communicates over the network  104  utilizing TCP/IP and IPX protocols, with data transport across the network  104  carried out via Virtual Private Network encryption, or encryption via wavelet compression or other comparable technique. Password access and public key encryption, preferably in accordance with the Health Information Portability and Accountability Act (HIPAA) is used throughout the system  100 . 
         [0018]    As shown by  FIG. 1 , the health information exchange system  100  further provides an internal network or core domain  111  which is protected from the public network  104  by a series of firewalls, namely, a perimeter firewall  113   a,  and a core firewall  113   b.  The perimeter firewall  113   a  protects a perimeter application server  115  by determining what inbound traffic from the network  104  is valid and thus can be passed to the perimeter application server  115  and what is invalid and thus blocked. The perimeter application server  115  acts as the VPN host, public web site server, and email server and is connected to the core firewall  113   b  which protects an internal network or core domain  111  from unauthorized user access. In the core domain  111 , a core server  114  provides further VPN authentication, and acts as the Primary Domain Controller, providing Active Directory services, Internet Information Services, and hosting a .Net framework to authorized users gaining access through the perimeter and core firewalls  113   a  and  113   b  via user and password authentication as explained hereafter in later sections. In addition, the core domain  111  has a database server  116  connected to a relational database  118  which stores all the content of the system  100 , such as health information records  120 . One function of the data server  118  is to use the data in the health information records  120  to automatically fill out a Medicaid application. In addition, all data tables in each of the health information records  120  of the database  118  have been designed to support source and time stamps, as well as associated log tables to audit changes and access operations. This is achieved through a combination of database functions, triggers, and stored procedures which since being conventional, no further discussion thereon is provided. It is to be appreciated that the system  100  has been designed to conform to a scalable multi-tier application architecture built to begin operations with the minimum hardware configuration inside design parameters. 
       Authorization 
       [0019]    To gain access to the internal network or core domain  111  over the system  100 , a user organization must execute a data sharing and business associate agreement with a service provider of the core domain  111  which defines the terms under which authorization to use the system  100  and core domain  111  is granted to both organizations and individuals within organizations. After this organization level agreement is established, the individual user goes to the public website provided by the perimeter server  115  of the system  100  to apply for a password and complete the required information. This information is then transmitted to the system administrator who authorizes access to the core domain  111 . When approved, the user then receives an e-mail provided from the perimeter server  115  that will include the user name, password, and instructions on how to install the VPN client software on the user&#39;s computer. 
       VPN Connection 
       [0020]    The VPN client software is required for connection to the core domain  111  of the system  100 . In one embodiment, there is an installed capacity of 1500 concurrent user VPN connections in the system  100  to the core domain  111 . In one embodiment, there is a special one-time use password to download the VPN Client software provided in the email. In one embodiment, the VPN client software is downloaded from the network  104  via a link provided in the email to the VPN software vendor&#39;s server or the perimeter server  115 . Instructions on how to install and use the software to access the core domain  111  is also sent to the user via the e-mail authorizing access to the core domain  111 . 
         [0021]      FIGS. 3-35  are screen images of software utilized by the system  100  and of various web pages provided by a private web site embodiment hosted by the core server  114  according to the present invention that authorized users use to compose and review live health information records  120  on a workstation  200  in the system  100  such as described in  FIG. 2 . The screen images are a non-limiting series of screen shots, which demonstrate some of the fundamental methodology underlying the system  100  and the health information records  120 . 
         [0022]      FIGS. 3-5  are screen images showing how a user accesses the core domain  111  of the system  100  using a VPN client program  300 . Go to the Start menu on the user computer, click on Programs. In the program list, look for the VPN client program  300 , which in the illustrated embodiment is Cisco Systems&#39; VPN Client software. On the extended menu, the user clicks on the VPN Client program icon  310  as shown by  FIG. 3 . Next, as shown by  FIG. 4 , the user Click on a “Connect” icon  400  in the VPN program  300 . The user will be prompted in a user authentication dialog box  500  provided by the VPN program  300  for the user name and password, such as shown by  FIG. 5 . The user name and password is provided in the e-mail that was sent to the user when the user was authorized to access the core domain  111 . 
       Basic Rules of the System 
       [0023]    In  FIG. 6 , after the user is authenticated by the perimeter server  115 , the user will then get a VPN Client Banner dialog box  600 . After reading the banner information, the user clicks on a “Continue” button  610 . The user&#39;s display screen will then go back to whatever the user was working on before the user connected to a private web site  1010  ( FIG. 10 ) hosted by the core domain server  114  using the VPN program  300 . 
         [0024]    The VPN connection must be maintained during the user session with the core domain  111  in order to allow the transmission of information between any one of the user computer  106 ,  108 ,  110  and the core server  114 . The core server  114  will disconnect if the user connection is idle for 30 minutes. The core server  114  only knows the user is interacting with it when the user makes an action like a submission or a search. If the user is entering data into a form, the core server  114  does not know the user is active until the user sends the data. Therefore, it will not hurt to submit frequently because the core server  114  will update the health information record  120  with each submission. For example, the user may put in a child&#39;s name in a demographic form and submit, but then realize that the user spelled the name incorrectly. The user can then go back to the form, select the field where the error occurred, correct the spelling, and submit the form again to the core server  114 . 
         [0025]    If for some reason the user&#39;s connectivity to the network  104  is terminated before the user log out of the VPN client program  300 , the core server  114  will retain the user connection for about 20 minutes. If the core server  114  is unaware of the network interruption and the user tries to log in again, the user may not be able to get back in until the user original connection reaches its time out limit. The core server  114  remembers everything the user did. The core server  114  is configured so that health information records  120  are never deleted or erased or written over; any changes the user submits are written as a new line of data. The core server  114  is designed to address HIPAA audit trail compliance, which means that the old information can be retrieved, and most importantly, the core server  114  tracks what user has read a record, what user has changed a record, and what the changes were made to a record. 
         [0026]    After establishing the VPN connection using the VPN client program  300  through the firewall  113   a  to the perimeter server  115 , the user now opens a web browser  700 , which in the illustrated embodiment of  FIG. 7 , is Microsoft&#39;s Internet Explorer. In the address bar  710  of the web browser  700 , the user types or selects from a favorites list the domain name address  720  of the core domain  111  of the system  100  and presses “Enter.” If the core domain  111  is up and running with no problems, a start html page  800  will be displayed to the user and, if necessary, provide a system status message  810  as illustrated by  FIG. 8 . To access the core domain  111 , the user then clicks on the HealthLink Information Exchange™ (the system) link  820 , which opens a Network Password dialog box  900  as illustrated by  FIG. 9 . In the Network Password dialog box  900 , the user types the same user name and password the user received with the user authorization email from the perimeter server  115 . 
       General Features of the Core Domain 
       [0027]    A home page  1000  of the private web site  1010  in the core domain  111  is then presented to the user by the core server  114 , which is illustrated by  FIG. 10 . To navigate around the private web site  1010  to the home page  1000  and to other pages or forms in the private web site  1010 , for example, a tab navigation bar  1015  supporting tab browsing is provided across the top of the page. In the illustrated embodiment, the tab navigation bar  1015  provides a HOME tab  1020 , a SUPPORT tab  1030 , a USER INFO tab  1040 , a MY TASKS tab  1050  and a REPORTS tab  1060  are available to persons authorized as client/patient contact professionals. It is to be appreciated, depending on the access level provided to the authorized user various tabs may be hidden or inaccessible to the user in the tab navigation bar  1015 . In addition, the tab navigation bar  1015  dynamically changes to present additional pages that may be tabbed too and viewed from the page in the private web site  1010  that the user is currently viewing. 
         [0028]    If the user wishes to learn or provide information about the system  100 , the user clicks on the SUPPORT tab  1030  to view a SUPPORT page  1100 . On the SUPPORT page  1100 , users will find user and administrator posting area sections as illustrated by  FIG. 11 . A TIPS AND TRICKS posting area section  1110  is provided to give administrators and supervisors a place to post information about developing practices and changes in methods of using the system. An ERROR EVENTS posting area section  1120  is also provided on the SUPPORT page  1100  where health advocates and other authorized users who encounter problems can post error events as illustrated by  FIG. 12 . The noted error events in the ERROR EVENTS posting area section  1120  allow administrators to track problems in both the private web site and database applications. Events are removed once they have been addressed. Errors in the health information records  120  may be recorded also in the ERROR EVENTS posting area section  1120 . Selecting the USER INFO tab  1040  will display the USER INFO page  1300  which lists contacts  1310  and documents  1320  posted to the private web site  1010  for user use and reference as illustrated by  FIG. 13 . The next two tabs—MY TASKS tab  1050  and REPORTS tab  1060 —permit access to client information and data reports. 
       Searching for Individuals and Households in the System 
       [0029]    Selecting the MY TASKS tab  1050  will present a My Tasks page  1400  having a search box  1410  which permits the user to see if there is a health information record  120  on a person having a health care encounter with a health and human service provider in the system  100 . In the search box  1410  the user inputs what is known of the person in a number of various search term fields as illustrated by  FIG. 14 . Such search term fields in one embodiment include: first name field  1412 , middle name field  1414 , last name field  1416 , date of birth (DOB) field  1418 , phone number field  1420 , social security number (SSN) field  1422 , and head of household identification number (HHsID) field  1424 . In the illustrated embodiment, a search result tab section  1426  indicates that no health information records  120  in the database  118  matched the search terms entered by the user in the search box  1410 . At this point, the user two options are to start a new record by selecting a new household record link  1428  provided on the My Tasks page  1400  or to modify the terms search used in the search box  1410 . Starting a new household record is covered in a later section; in the following section, additional search options permitted by the private web site  1010  are discussed. 
         [0030]    If the user is unsure of the spelling of this person&#39;s name, the user can give the search less specific data to produce a larger number of results, for instance. Instead of using the full last name, the user might just include the part of the name that the user is sure about, such as Test, and perhaps just the first initial of the first name. In addition, the private web site  1010  permits advance searching using a variety of filters under a filters section  1430  and options under an options section  1431  which are expanded and shown by  FIG. 15 . 
         [0031]    In the filters section  1430  of the search box  1410  searches can be performed by filtering for a registry agency filter  1500 , a registry sources filter  1510 , a registry statuses filter  1520 , an all records filter  1530 , an assignable advocate filter  1540 , a referral source filter  1550 , and/or a service requested filter  1555 . By default, “all” is selected for each filter to provide the most inclusive search. Selecting the registry agency filter  1500  permits the user to search and view only those health information records  120  that have been “started” or registered by a particular agency of the system  100 . It is to be appreciated that all registry agencies participating in the system  100  will be shown by a drop down box (not shown) for selection. For example, selecting the referral source filter  1550  allows the user to search and track all or a particular source of each patient referral. The available sources which can be selected individually are provided in a drop down box list (not shown) when the referral source filter  1550  is selected. In many cases, individuals come to a community health center (CHC) from one of the hospital emergency departments, and these individuals are subsequently assisted with Medicaid applications. With this data the user can tell which people came from more than one hospital or agency. Accordingly, the system  100  provides a way in which the user may track the service utilization patterns of individuals and their family members that are associated together under a particular household identification number. 
         [0032]    The service requested filter  1555  searches for all or a particular requested service, such as for example, a dental service. The available services which can be selected are provided in a drop down box (not shown) when the service requested filter  1555  is selected. For example, it may be useful when a new resource or agency becomes available in the system  100  to see all health information records  120  intended for that particular service, and to mark the health information records  120  with an indication or message that prompts another health or human service provider who may be seeing the individual to provide such information to the individual and to schedule such an appoint with the new resource or agency. With some of the services for which the users refer an individual it may be also important to know the status of workflow items, which may indicate where there may be potential problems, as in the case where court dockets slow a pro se application process for child custody, or in the case of Medicaid, how many are in a pending status past  90  days. The registry status filter  1520  when selected provides a drop down box (not shown) of such workflow status items, such that a search result of the health information records  120  for such workflow items can be provided to the user to track such problems. The assignable advocate filter  1540  permits the user to search records assigned to a particular advocate, or with an all selection, which provides a filter to delineate all clients assigned to an advocate from those individuals whom have not been assigned to an advocate. The all records filter  1530  w will result in a search of all health information records  120  in the database  118  for individuals on whom demographic data is available and excludes individuals having a “Later” status in their health information record  120  with only contact information. However, in the options section  1431 , the user may select a My cases only option  1560  which will result in a search of only those individuals assigned to the user if a designated advocate, an uninsured only option  1570 , which will result in a search of only the records of those individual identified as uninsured, and head of household only option  1580 , which will result in a search of only those records identified as a head of household. Time periods can also be entered by the user for a registry date range  1585 , a referral date range  1590 , and a follow up date range  1595 . 
         [0033]    In one illustrated example, a search for a first name “Test” in the search box  1410  resulted in 6 health information records  120  being listed on the search page  1400  in a search result main grid  1600 . As shown in the illustrated embodiment of  FIG. 16 , the main grid  1600  lists in tabular format the following information from the queried and returned health information records  120 : action icon(s)  1610 , a first name  1630 , a middle name  1635 , a last name  1640 , a social security number  1640 , a phone number  1650 , a follow-up  1660 , a last update date  1670 , an updated by indicator  1675 , and a contact  1680 . For convenience of the user, by default, the search results in the main grid  1600  are sorted first by the entered sort term, in this case first name  1630 , and then by head of household. Other sorting of the search result however may be selected by the user double clicking on one of the column headings of the main grid  1600 . 
         [0034]    As shown by  FIG. 16 , Developer Test is the designated head of household since listed first and also having a full array of action icons  1610 , and Clinic Test is an individual in the same household as Developer Test. To differentiate who is a head of household and who is an individual, the simplest way to tell is that heads of household have a full array of icons in the search result main grid  1600 . As shown by  FIG. 16A , a close up section view of the main grid  1600 , the following action icons are provided to the user: a Household Express action icon  1690  takes the user to a Household Express summary page ( FIG. 17 ); a Household Members action icon  1691  takes the user to a Household Members section of the Registry page ( FIG. 18 ); a Referrals action icon  1692  takes the user to a Household Referrals page ( FIG. 25 ); a Medicaid action icon  1694  opens an electronic document (e.g., .pdf) providing a Healthy Start/Healthy Families application (not shown) that new individuals filled out during the intake interview, wherein it is to be appreciated that other government program applications may also be provided; a PRC action icon  1695  takes the user to another electronic document (e.g., .pdf) (not shown) also used during the intake summary for the county in charge of the regional health and human services in the health information exchange system  100 , and a Person health action icon  1696  takes the user to an Individual Immunization page ( FIG. 27 ) of the individual&#39;s health information record  120 . 
         [0035]    Returning back to  FIG. 16 , if the user wants to know if there is anyone else in a household, such as for example, with January or Sonny, the user may click the Household Express action icon  1690 , the Household Bikers action icon  1691 , or right clicks on the mouse  226  ( FIG. 2 ) in any cell of the main grid  1600  in a row for the individual and select either a household express hover tab  1682  or a registry hover tab  1684 .  FIG. 17  shows a household express summary page  1700  returned after selecting either household express action icon  1690  or the household express hover tab  1682 . A household express tab  1710  may also be provided which the user may select to view the household summary  1700 .  FIG. 18  shows a household registry page  1800  returned after selecting either household registry action icon  1692  or the registry hover tab  1684 , which provides the user with the complete health information records  120  for a particular HHsID  1620 . A registry tab  1810  may also be provided which the user may select to the household registry page  1800 . In addition, each section in the registry view can conveniently be expanded or collapsed via a display/hid selection  1820  at the bottom of each section. 
       Entering Client Data 
       [0036]    To enter client data into a health information record  120  of the system  100 , the user should first search to see if the individual is already in the database  118 . For example, as shown by  FIG. 14 , a search for “Kinship Test” resulted in no record being found in the database  118 . Accordingly, the user will need to add the individual as a new health information record  120 . To start a new household, the user clicks on the New Household link  1420 , which then presents to the user a new household entry form  1900  for populating the new health information record  120  as shown by  FIG. 19 . The user then enters the available data into the data entry fields provided on the new household entry form  1900 , such as for example, name, address, phone number, number of household members, registry source, period record is valid, follow-up date, and remarks. Then the user chooses among an Express entry link  1910 , a Registry entry link  1920 , a Later entry link  1930 , or Cancel entry link  1940 , which is self explanatory. 
         [0037]    The Express entry link  1910  is selected as a quick way to get basic information of each individual of a household entered into a health information record via an Express entry form  2000 , which is illustrated by  FIG. 20 . It is to be appreciated that the database server  116  will automatically assign a unique HHsID  1620  to the new health information record  120  and to all health information records  120  listed as being a member under the individual designated as “Self(Head)” in a Relation box  2010  provided on the Express entry form  2000 . Using the Express entry form  2000 , the user may also entry into the health information record  120 : a date of birth (DOB)  2020 ; a social security number (SSN)  2030 ; gender  2040 ; self-reported health issues  2050 , such as asthma, hypertension, diabetes, epilepsy, cancer, and stroke; special groups  2060 , such as pregnant, veteran, disable, senior, and non-US citizen; insurance information  2070 ; and income information  2080 . The user may also enter such data for each additional member of the household, such as for example, “Kinkid Test” the spouse and head of household of Kinship Test as shown in the illustrated embodiment. Additional members can be added under the HHsID  1620  via the Add member link  2090 . 
         [0038]    The Registry entry link  1920  ( FIG. 19 ) is selected to enter detailed information known about each individual of a household entered into the health information record  120  via a Registry entry form  2100 , which the various sections thereof are illustrated by  FIGS. 21 ,  22 , and  23 . With reference first to  FIG. 21 , a Household summary section  2110  is provided at the top of the Registry entry form  2100  which displays the data entered from the Household entry form  1900 . Below the Household summary section  2110  is a Household members section  2120 . It is to be appreciated that the Household members section  2120  provides data entry fields in addition to those provided on the Express entry from  2000 , such as for example, expanded demographics  2130  permitting entry into the health information record  120  data on race, ethnicity, education, marital status, and occupation. In addition, the Household member section  2120  provides income and insurance boxes  2140  and  2150 , respectively, which allow the user to add more than one source of insurance or income and the amounts for each. The Household members section  2120  also provides a member remarks area  2160  which permits the user to view information about the health information record  120 , such as when last updated and by whom. 
         [0039]    Additional sections of the Registry entry form  2100  include a Household addresses section  2200  and a Household contacts section  2210  as illustrated by  FIG. 22 . Each of the sections  2120 ,  2200 ,  2210  on the registry entry form  2100  can be expanded to show details, including household ID summary and details for each individual, details for addresses and contacts, by using their respective sections Display/Hide selections  2220 ,  2230 ,  2240 , or for all sections, a Display/Hide all selection  2250  provided at the bottom of the Registry entry form  2100 . In the illustrated embodiment of  FIG. 22 , the Household members section  2120  along with the household summary section  2110 , and the Household Contact section  2210  are hidden, with details regarding the Household Addresses section  2200  being expanded, which are self explanatory, and thus no further details are provided. In the illustrated embodiment of  FIG. 23 , the Household members section  2120  along with the household summary section  2110 , and the Household Addresses section  2200  are hidden, with details regarding the Household Contact section  2210  being expanded, which are self explanatory and thus no further details are provided. 
         [0040]    The “Later” entry link  1930  ( FIG. 19 ) is used when there is not enough time to complete the information collection with the individual at an initial interview or even at a later health encounter with any one of the providers of the system  100 . If selected, the health information record  120  is then later viewable by selecting a Contact Later tab  2400  as shown by  FIG. 24 . On the record display in the Contact Later tab  2400 , the user can record the history of the contacts in a history box  2410 . Typically, this is only completed when the user do not succeed in contacting the individual after the initial intake interview. 
       Demographics Definitions 
       [0041]    With reference again to  FIG. 20 , the check boxes provided under the Health Issues category  2050  are used to delineate those health issues that are eligible for disease management programs or special services. These health issues in one embodiment as shown include Asthma  2051 , Hypertension  2052  (high blood pressure), Diabetes  2053 , Seizure disorder  2054 , Stroke  2055 , and Cancer  2056 . The check boxes under the Special category  2060  relate to the Medicaid application for a state. Selecting pregnant  2061  makes the individual automatically eligible for Medicaid and medical documentation must be provided, which is automatically filled out from the health information record  120  by the data server  118 . Checking veterans  2062 , Disabled  2063 , and Senior Citizens (aged 65+)  2064  will flag the health information record for review for any special service that may be provide to such individuals. Checking Non US citizens  2065  will flag the health information record  120  as not being eligible for Medicaid. 
         [0042]    The insurance box  2140  allows users to indicate more than one source of insurance and the monthly amount it costs. Selectable categories under the Insurance box  2140  include in one embodiment NONE (no health insurance), CareSource (Medicaid Managed care program), Medicaid (for low income and disabled), Medicare (for seniors), Military (CHAMPUS), Anthem (private plan usually through employers), United Health Care (private plan usually through employers), and Other. 
         [0043]    Referring again to  FIG. 21 , the income box  2150  allows users to indicate more than one source and amount of income per person. Definitions for each category are: NONE (no income), Wages (indicate total per month), SS Disability (social security disability), SS Retirement (social security retirement), SS Other (other Social Security programs such as those for disabled children, deceased parents, etc.), SSI (Supplemental Security Income for the disabled), and Child Support. It is to be noted that the payment of child support is indicated by placing the minus sign in front of the amount paid, so for example −25 would indicate a $25 per month payment. In addition, due to variations in parentage among household members, the amount of child support received is included as income for the child for whom it is paid. Non-custodial parents can be recorded under household contacts, see below. Other information includes state specific programs, such as for example, in one embodiment, TANF Temporary Assistance for Needy families is a program of the Ohio, Department of Job and Family Services, Workers Compensation, OWF Child Subsidy, Kinship Subsidy, and other such programs. All amounts are considered monthly and are inputted as whole dollars. 
         [0044]    Head of household is defined as the person who is filing the Medicaid application, if applicable, or the person to whom the Advocate is speaking. For each individual in the household, information collected includes gender and relation to the head of household. Please note that it is acceptable to be speaking to the wife of a male-headed household. She will appear on the top line of the Demographics Summary, but under Relation to head of Household, she would be identified as “Spouse.” For example, as illustrated by  FIG. 21 , the individual “Kinship Test” is marked as the “Main contact” in a main contact box  2162  to indicate that she is the individual who gave the latest information. The husband&#39;s information “Kinkid Test” appears on the second line. As Kinkid Test is the head of the household; therefore, “Self (head)” is selected in a “Relation to head of household” box  2164  for him in the health information record  120 . The selectable choices from the Relation to head of household box  2164  in one embodiment include: Self (head), spouse, aunt/uncle, child, cousin, foster child, friend, grandchild, grandparent, nephew/niece, parent, sibling, significant other, stepchild and other. 
         [0045]    Race is not a required item and choices are configurable. Current options are based on individual state Medicaid application requirements and the selectable choices from a race drop down box  2166  include in one embodiment American Indian/Alaskan, Asian, Black/African American, Native Hawaiian, White, Other, and Missing/Refused. Ethnicity is not a required item and the selectable choices from an ethnicity drop down box  2168  include in one embodiment Hispanic or Not Hispanic. Gender in a gender drop down box  2170  is not required and is based on self-report. Education is sometimes a problem as there is often a difference between those who complete 12 years of high school AND those who got a diploma or a GED. Accordingly, the selectable choices from an education drop down box  2172  include in one embodiment 1-8 years, 9-12 years, HS diploma, GED, Some college, Associate degree, Bachelor&#39;s, Masters, PhD, and other. The selectable choices from a Marital Status box  2174  include in one embodiment Single, Married, Separated Divorced Widowed, and Other. The selectable choices from an Occupation drop down box  2176  in one embodiment is broken down into typical department of commerce categories, and in other embodiment include: professional, technical, scientist, computer programmer, manager/admin, store manager, program administrator, sales, sales clerk, counter help, insurance sales, clerical, administrative support staff, file clerks, typists, crafts, carpenter, plumber electrician, potter, operatives, tool and die makers, machine operators, transportation, cab drivers, bus drivers, service, hotel staff, waitresses, waiters, laborers, day labor, ditch digger, highway worker, farm owner/manager, farm laborer/foreman, unclassifiable, active military, and special categories (not dept of commerce), disabled, retired, and student. 
         [0046]    Referring again to  FIG. 22 , on the registry page  2100 , the user can also change or edit the information provided in the Household Address section  2200  and the Household Contacts section  2210 . The Household Address section  2200  shows an address  2202  for the household. In addition to the standard information on the household address  2202 , the user can indicate dates which this address has been valid, permitting a housing history for those who need it. To do this the user enters a date into “Since” and “Through” fields  2204  and  2206 , respectively. If the user knows that a family is moving, the user uses the Through field  2206  on the old address and the Since field  2204  on the new address. Additionally the user can add directions in a directions posting area  2207 , remarks in a remarks posting area  2208 , and with an address type drop down box  2209  indicate the type of address. In one embodiment, valid types of addresses include: Home, Shelter, Home (owned), Homeless, Home (renter), Jail, Work, Mailing, Relative, Other, and Friend. 
         [0047]    Referring again to  FIG. 23 , in the Household Contacts section  2210  the user can record personal and professional contacts  2212  for the household. The user can also indicate dates which each contact has been valid, permitting a reference history for those who need it. To do this the user enters a date into “Since” and “Through” fields  2214  and  2216 , respectively. Additionally the user can add information from the contact in a contact comments posting area  2217 , remarks about the contact in a contact remarks posting area  2218 , and with a contact type drop down box  2219  indicate the type of contact. In one embodiment, valid types of contacts include: for personal contacts, Guardian, Non-custodial parent, Biological Father, Biological Mother, Relative, and Friend; for Health contacts, Emergency, Guarantor, Primary Care Physician, Clinic home, Hospital, and Pharmacy; for professional contacts, Caseworker, Social Worker, Case Manager, Probation Officer, Payee, and Employer. 
       Referrals 
       [0048]    Referring now to  FIG. 25 , in order to track needs of clients and where they are sent (referred) for services, the user uses a Referral page  2500 . The Referrals page  2500  may be viewed by the user by either selecting the House Referrals action icon  1692  ( FIG. 16A ) from the action icon section  1610  of main grid  1600  on search result page  1400  ( FIG. 16 ) or selecting a Household Referrals tab  2510  when provided in the tab navigation bar  1015 . Referrals  2515  listed in a Referrals section  2520  are tracked by the HHsID  1620  and are used to track the process and progress toward completion of all referrals for the household. From the Referral page  2500 , the user may update an existing referral shown in the Referral section  2520  by clicking on a listed referral  2515  which populates the existing information in the referral details section  2530  for editing or may add a new referral to the referrals section  2520  by selecting the Insert New Referral selection  2535 . 
         [0049]    For example, to add a new referral, the user begins by recording a date requested in a Date requested field  2540 . In one embodiment, clicking on the Date requested field allow the user to use a calendar pop up to select date. Next, the user can list in a Source field  2542  the source (agency) of the referral. The source filed lists in a drop down box all participating members in the system  100 . For example, if a first agency asks the client to contact a second agency to initiate a Medicaid application, them the source is the first agency, or if Juvenile Court asks the client to contact an individual to take care of a child custody issue, then the source is Juvenile Court. Recording the source of the referral permits the user to track beyond the first contact service utilization patterns of the household. 
         [0050]    Next, the user selects the type of service requested from a Service drop down box  2544 . In one embodiment, the selectable choices include: Child Custody, Childcare, Clothing, Dental, Education, Emergency Shelter, Employment, Financial, Food, Furniture, Housing, Income Programs, Legal, Medicaid, Medical, Mental Health, Optical, Other, PRC Application, Prenatal/Maternity, Prescriptions, Transportation, and WIC. For each of the services types, there is a customized list of resources provided in a Resources drop down box  2546  to which the user may select, and which will change by location, specialty, etc. 
         [0051]    As mentioned above in a previous section, the system  100  permits the user to track the progress and process that each referral  2515  takes in order to document problems that may be systemic. The current status of the workflow and outcome for each referral  2515  is shown in Workflow and Outcome cells  2550  and  2552 , respectively, listed in the Referral section  2520 . The user may update the status of the workflow of each referral  2515  using a Workflow History section  2554  which provides a Workflow Status indicator drop down box  2556 , a Workflow Date box  2558 , a Workflow Time spent box  2560 , and a Workflow Remarks box  2562  for recording such information. In addition, the user may update the status of the outcome of each referral  2515  using an Outcome history section  2564  which provides also an Outcome Status indicator drop down box  2566 , an Outcome Date box  2568 , an Outcome Time spent box  2570 , and an Outcome Remarks box  2572  for recording such information. It is to be appreciated that the outcome history of a household tracks what has happened to the referral in the system  100  and the associated dates permit the user to compare this against standards for performance. For example, it is a problem when a Medicaid application is pending more than  90  days. The system can provide reports on pending status over time because these items show the entire history of both workflow and outcome as shown. 
         [0052]    The user may setup a follow up with either clients or other agencies using a Follow up date field  2574  (calendar pop up), and provide a reason in a Follow up reason drop down box  2576 . In one embodiment the reasons provide by the Follow up reason drop down box  2576  includes: Client follow up (suggesting calling the client to check on status); Eligibility check (with either client or agency); Final Attempt (need to make a last attempt to contact the client); Letter needed (final attempt made, letter letting client know status); Other; Outcome Information (checking on what the outcome was. e.g. did the client follow up); Recertification date (to remind the client it is time to apply again so there is no lapse in coverage); and Verifications (calling to inform that more substantiation of their economic or other conditions are required). If the user checks a Set reminder box  2578 , a message will appear on the users My Tasks page  1050  on the date entered in the Follow up date field  2574 . Additional fields include a Validate from field  2580  and Expires on field  2582  to input a time period for the referral  2515 , and a Remarks area  2584  for an other information regarding the referral. 
       Scanned Documents 
       [0053]    Referring to  FIG. 26 , a Household Document page  2600  is shown which lists in a document summary section  2610  any documents that have been scanned into the health information record  120  identified by the HHsID  1620 . The Household Document page  2600  is viewed by the users selecting the House Documents action icon  1693  ( FIG. 16A ) from the action icon section  1610  of main grid  1600  on search result page  1400  ( FIG. 16 ) or selecting a Household Document tab  2620  when provided in the tab navigation bar  1015 . 
         [0054]    Document details are viewable by selecting on any of the listed documents in the document summary section  2610  which populates the fields provided in a Document Details section  2630 . The user clicking on a Add new document selection  2640  will clear the fields provided in the Document Detail section  2630  if populated such that the information regarding the new document can be entered. As the fields shown in the Document Details section  2630  are either self explanatory or function in the same manner as other similar fields in other Details sections of the private web site  1010 , for brevity, no further details regarding are provided. 
         [0055]    It is to be appreciated that additional pages are included in the private web site  1010 , such as for example, an Individual Immunization page  2700  ( FIG. 27 ), an Individual Problems page  2800  ( FIG. 28 ), an Individual Medication summary page  2900  ( FIG. 29 ), an Individual Medication details page  3000  ( FIG. 30 ), an Individuals Procedure page  3100  ( FIG. 31 ), an Individual Note page  3200  ( FIG. 32 ) providing individual notes, as well as an Individual Documents page  3300  ( FIG. 33 ) providing scanned document concerning the individual, an Individual Contacts page  3400  ( FIG. 34 ) providing addition contacts of the individual, and an Individual Referrals page  3500  ( FIG. 35 ) providing the referrals of the individual. As the Individual Documents page  3300 , the Individual Contacts page  3400 , and the Individual Referrals page  3500  provide the same information and detail section functions as the Household Document page  2600  ( FIG. 26 ), the Household Contacts page  2400  ( FIG. 24 ), and the Household Referrals page  2500  ( FIG. 25 ), respectively, except pertaining to the individual and not the household, for brevity, no further discussion on these pages  3300 ,  3400 , and  3500  is provided. 
         [0056]    Referring to  FIG. 27 , data such as shot, medication, and prescription for each household member is recorded via the Individual Immunization page  2700 . As mentioned previously above, the Individual Immunization page  2700  is viewed by the user by selecting the Person health action icon  1696  ( FIG. 16A ) from the action icon section  1610  of main grid  1600  on search result page  1400  ( FIG. 16 ) or selecting a Individual Immunization tab  2720  when provided in the tab navigation bar  1015 . An alert section  2720  is provided on the page  2700  to bring to the user&#39;s attention any special alerts  2722 , allergies  2724 , and medications  2726  of the individual, each with a date and description. Clicking on any of the listed description in the alert section  2720  with bring up the details of the alert, allergies, or medication on an alert page (not shown), which is also accessible view a Alerts tab  2730  when provided in the navigation tab bar  1015 . 
         [0057]    An Individual Immunization summary section  2740  lists the immunizations of the individual and provides tabulated information such as for example, vaccine group, status, status data, expire on date, last dose date, next dose date, administer by, update date and updated by information. As with the other pages of the private web site  1010 , clicking on cell in the summary section  2740  will populate the fields provided in an Immunization Detail section  2750 . As the fields shown in the Immunization Detail section  2750  are either self explanatory or function in the same manner as other similar fields in other Details sections of the private web site  1010 , for brevity, no further details regarding are provided. 
         [0058]    Referring to  FIG. 28 , an Individual Problems page  2800  is shown which, as with the Individual Immunization page  2700 , shows the alert section  2720 . The Individual Problems page  2800  is accessible by the user from an Problems tab  2810  when provided in the navigation tab bar  1015  and also lists in a Individual Problems summary section  2820  the problems of the individual. Problem details are viewable by selecting on any of the listed problems in the Individual Problems summary section  2820  which populates the fields provided in a Problem Details section  2830 . As the fields shown in the Problem Details section  2830  are either self explanatory or function in the same manner as other similar fields in other Details sections of the private web site  1010 , for brevity, no further details regarding are provided. 
         [0059]    Referring to  FIG. 29 , an Individual Medication page  2900  is shown which, as with the Individual Immunization page  2700 , shows the alert section  2720 . The Individual Medications page  2900  is accessible by the user from an Individual Medication tab  2910  when provided in the navigation tab bar  1015  and also lists in an Individual Medications summary section  2920  the medications of the individual. Query box  2930  and query result section  2940  are provided which provides the user a RX dictionary and an auto insert function  2950  which populates a medication description, medical direction, and compliance information in a detail section for adding a new medication. It is to be appreciated that the RX dictionary is supported by the Unified Medical Language System from the National Library of Medicine and is based on the standards described in the Continuity of care Record from ASTM. Specifically, in one embodiment, drugs are keyed to RXNORM, and problems and procedures are keyed to SNOMED CT. For example, if a user types in “zym” a list like ZYMAR, ZYMINE, ZYMINE-HC, ZYMINE-D, with a list of generic names associated is provided. Dosage data is captured, as well as who filled the prescription, who administered the medication, and a patient report to track actual usage. As shown by  FIG. 30 , medication details are viewable by selecting on any of the listed medications in the Individual Medications summary section  2920  which populates the fields provided in a Medication Details section  2960 . As the fields shown in the Medication Details section  2960  are either self explanatory or function in the same manner as other similar fields in other Details sections of the private web site  1010 , for brevity, no further details regarding are provided. 
         [0060]    Referring to  FIG. 31 , an Individual Procedures page  3100  is shown which, as with the Individual Immunization page  2700 , shows the alert section  2720 . The Individual Procedures page  3100  is accessible by the user from a Procedures tab  3110  when provided in the navigation tab bar  1015  and also lists in a Individual Procedures summary section  3120  the procedures for the individual. Procedure details are viewable by selecting on any of the listed procedures in the Individual Procedures summary section  3120  which populates the fields provided in a Procedure Details section  3130 . As the fields shown in the Procedure Details section  3130  are either self explanatory or function in the same manner as other similar fields in other Details sections of the private web site  1010 , for brevity, no further details regarding are provided. 
         [0061]    Referring to  FIG. 32 , an Individual Notes page  3200  is shown which is accessible by the user from a Notes tab  3210  when provided in the navigation tab bar  1015  and also lists in a Individual Notes summary section  3220  notes on the individual. Note details are viewable by selecting on any of the listed notes in the Individual Notes summary section  3220  which populates the fields provided in a Note Details section  3230 . As the fields shown in the Note Details section  3230  are either self explanatory or function in the same manner as other similar fields in other Details sections of the private web site  1010 , for brevity, no further details regarding are provided. 
         [0062]    Referring now generally to the implementation of the above-described embodiments, many alternative approaches can be employed to achieve these embodiments. For example, selection devices for manipulating the cursor and other screen images or HTML objects can include a mouse, trackball, touch screen, light pointer, or optical or ultrasonic three-dimensional pointing system. Further types of input devices might include voice recognition, which includes voice dictation software. It is further to be appreciated that other pages, such as the alert page, vitals page, HIPPA page, admin page, medical equipment page, dental page, appointments page, results page, are not described herein but also form part of the invention, and as some aspects may be conventional are not described for brevity of the description. 
         [0063]    In one embodiment, the system architecture is based on the Microsoft Systems Architecture. The application also uses the ASP.NET Portal Application software. An embodiment of the present invention may be written using JAVA, C, and the C++ language and utilize object oriented programming methodology (OOP), such as encapsulation, inheritance, polymorphism, composition-relationship, and application frameworks. The benefits of OOP can be summarized, as follows. Objects and their corresponding classes break down complex programming problems into many smaller, simpler problems. Encapsulation enforces data abstraction through the organization of data into small, independent objects that can communicate with each other. Encapsulation protects the data in an object from accidental damage, but allows other objects to interact with that data by calling the object&#39;s member functions and structures. 
         [0064]    Subclassing and inheritance make it possible to extend and modify objects through deriving new kinds of objects from the standard classes available in the system. Thus, new capabilities are created without having to start from scratch. Polymorphism and multiple inheritances make it possible for different programmers to mix and match characteristics of many different classes and create specialized objects that can still work with related objects in predictable ways. Class hierarchies and containment hierarchies provide a flexible mechanism for modeling real-world objects and the relationships among them. 
         [0065]    Application frameworks free application programmers from the chores involved in displaying menus, windows, dialog boxes, and other standard user interface elements for personal computers. An event loop monitors the mouse, keyboard, and other sources of external events and calls the appropriate parts of the programmer&#39;s code according to actions that the user performs. The programmer no longer determines the order in which events occur. Instead, a program is divided into separate pieces that are called at unpredictable times and in an unpredictable order. By relinquishing control in this way to users, the developer creates a program that is much easier to use. 
         [0066]    Application frameworks reduce the total amount of code that a programmer has to write from scratch. However, because the framework is really a generic application that displays windows, supports copy and paste, and so on, the programmer can also relinquish control to a greater degree than event loop programs permit. The framework code takes care of almost all event handling and flow of control, and the programmer&#39;s code is called only when the framework needs it (e.g., to create or manipulate a proprietary data structure). 
         [0067]    A programmer writing a framework program not only relinquishes control to the user (as is also true for event loop programs), but also relinquishes the detailed flow of control within the program to the framework. This approach allows the creation of more complex systems that work together in interesting ways, as opposed to isolated programs, having custom code, being created repeatedly for similar problems. 
         [0068]    Thus, as is explained above, a framework basically is a collection of cooperating classes that make up a reusable design solution for a given problem domain. It typically includes objects that provide default behavior (e.g., for menus and windows), and programmers use it by inheriting some of that default behavior and overriding other behavior so that the framework calls application code at the appropriate times. 
         [0069]    There are three main differences between frameworks and class libraries. Class libraries are essentially collections of behaviors that the user can call when the user want those individual behaviors in the user program. A framework, on the other hand, provides not only behavior but also the protocol or set of rules that govern the ways in which behaviors can be combined, including rules for what a programmer is supposed to provide versus what the framework provides. With a class library, the code the programmer instantiates objects and calls their member functions. It&#39;s possible to instantiate and call objects in the same way with a framework (i.e., to treat the framework as a class library), but to take full advantage of a framework&#39;s reusable design, a programmer typically writes code that overrides and is called by the framework. The framework manages the flow of control among its objects. Writing a program involves dividing responsibilities among the various pieces of software that are called by the framework rather than specifying how the different pieces should work together. With class libraries, programmers reuse only implementations, whereas with frameworks, they reuse design. A framework embodies the way a family of related programs or pieces of software work. It represents a generic design solution that can be adapted to a variety of specific problems in a given domain. For example, a single framework can embody the way a user interface works, even though two different user interfaces created with the same framework might solve quite different interface problems. Thus, through the development of frameworks for solutions to various problems and programming tasks, significant reductions in the design and development effort for software can be achieved. 
         [0070]    A virtual private network (VPN) is a private data network that makes use of the public telecommunication infrastructure, maintaining privacy using a tunneling protocol and security procedures. A virtual private network can be contrasted with a system of owned or leased lines that can only be used by one company. The idea of the VPN is to give the company the same capabilities at much lower cost by using the shared public infrastructure rather than a private one. Phone companies have provided secure shared resources for voice messages. A virtual private network makes it possible to have the same secure sharing of public resources for data. Companies today are looking at using a private virtual network for both extranet and wide-area intranet. 
         [0071]    Using a virtual private network involves encrypting data before sending it through the public network and decrypting it at the receiving end. An additional level of security involves encrypting not only the data but also the originating and receiving network addresses. Microsoft, 3Com, and several other companies have developed the Point-to-Point Tunneling Protocol (PPTP) and Microsoft has extended Windows NT to support it. VPN software is typically installed as part of a company&#39;s firewall server. 
         [0072]    Transmission Control Protocol/Internet Protocol (TCP/IP) is the basic communication language or protocol of the Internet. It can also be used as a communications protocol in a private network (either an intranet or an extranet). When the user is set up with direct access to the Internet, the user computer is provided with a copy of the TCP/IP program just as every other computer that the user may send messages to or get information from also has a copy of TCP/IP. 
         [0073]    TCP/IP is a two-layer program. The higher layer, Transmission Control Protocol, manages the assembling of a message or file into smaller packets that are transmitted over the Internet and received by a TCP layer that reassembles the packets into the original message. The lower layer, Internet Protocol, handles the address part of each packet so that it gets to the right destination. Each gateway computer on the network checks this address to see where to forward the message. Even though some packets from the same message are routed differently than others, they will be reassembled at the destination. 
         [0074]    TCP/IP uses the client server model of communication in which a computer user (a client) requests and is provided a service (such as sending a Web page) by another computer (a server) in the network. TCP/IP communication is primarily point-to-point, meaning each communication is from one point (or host computer) in the network to another point or host computer. TCP/IP and the higher-level applications that use it are collectively said to be “stateless” because each client request is considered a new request unrelated to any previous one (unlike ordinary phone conversations that require a dedicated connection for the call duration). Being stateless frees network paths so that everyone can use them continuously. Note that the TCP layer itself is not stateless as far as any one message is concerned. Its connection remains in place until all packets in a message have been received. 
         [0075]    Many Internet users are familiar with the even higher layer application protocols that use TCP/IP to get to the Internet. These include the World Wide Web&#39;s Hypertext Transfer Protocol (HTTP), the File Transfer Protocol (FTP), Telnet (Telnet) which lets the user logon to remote computers, and the Simple Mail Transfer Protocol (SMTP). These and other protocols are often packaged together with TCP/IP as a “suite.” 
         [0076]    Personal computer users usually get to the Internet through the Serial Line Internet Protocol (SLIP) or the Point-to-Point Protocol (PPP). These protocols encapsulate the IP packets so that they can be sent over a dial-up phone connection to an access provider&#39;s modem. 
         [0077]    Protocols related to TCP/IP include the User Datagram Protocol (UDP), which is used instead of TCP for special purposes. Other protocols are used by network host computers for exchanging router information. These include the Internet Control Message Protocol (ICMP), the Interior Gateway Protocol (IGP), the Exterior Gateway Protocol (EGP), and the Border Gateway Protocol (BGP). 
         [0078]    Internetwork Packet Exchange (IPX) is a networking protocol from Novell that interconnects networks that use Novell&#39;s NetWare clients and servers. IPX is a datagram or packet protocol. IPX works at the network layer of communication protocols and is connectionless (that is, it doesn&#39;t require that a connection be maintained during an exchange of packets as, for example, a regular voice phone call does). Packet acknowledgment is managed by another Novell protocol, the Sequenced Packet Exchange. Other related Novell NetWare protocols are: the Routing Information Protocol (RIP), the Service Advertising Protocol (SAP), and the NetWare Link Services Protocol (NLSP). 
         [0079]    Hypertext Markup Language (HTML) is the set of markup symbols or codes inserted in a file intended for display on a World Wide Web browser page. The markup tells the Web browser how to display a Web page&#39;s words and images for the user. Each individual markup code is referred to as an element (but many people also refer to it as a tag). Some elements come in pairs that indicate when some display effect is to begin and when it is to end. 
         [0080]    HTML is a formal Recommendation by the World Wide Web Consortium (W3C) and is generally adhered to by the major browsers, Microsoft&#39;s Internet Explorer and Netscape&#39;s Navigator, which also provide some additional non-standard codes. The current version of HTML is HTML 4.0. However, both Internet Explorer and Netscape implement some features differently and provide non-standard extensions. Web developers using the more advanced features of HTML 4 may have to design pages for both browsers and send out the appropriate version to a user. Significant features in HTML 4 are sometimes described in general as dynamic HTML. HTML 5 is an extensible form of HTML called Extensible Hypertext Markup Language (XHTML). 
         [0081]    Extensible Markup Language (XML) is a flexible way to create common information formats and share both the format and the data on the World Wide Web, intranets, and elsewhere. For example, computer makers might agree on a standard or common way to describe the information about a computer product (processor speed, memory size, and so forth) and then describe the product information format with XML. Such a standard way of describing data would enable a user to send an intelligent agent (a program) to each computer maker&#39;s Web site, gather data, and then make a valid comparison. XML can be used by any individual or group of individuals or companies that wants to share information in a consistent way. 
         [0082]    XML, a formal recommendation from the World Wide Web Consortium (W3C), is similar to the language of today&#39;s Web pages, the Hypertext Markup Language (HTML). Both XML and HTML contain markup symbols to describe the contents of a page or file. HTML, however, describes the content of a Web page (mainly text and graphic images) in terms of how it is to be displayed and interacted by a user. For example, a &lt;P&gt; starts a new paragraph. XML describes the content in terms of what data is being described. For example, a &lt;PHONENUM&gt; could indicate that the data that followed it was a phone number. This means that an XML file can be processed purely as data by a program or it can be stored with similar data on another computer or, like an HTML file, that it can be displayed. For example, depending on how the application in the receiving computer wanted to handle the phone number, it could be stored, displayed, or dialed. 
         [0083]    XML is “extensible” because, unlike HTML, the markup symbols are unlimited and self-defining. XML is actually a simpler and easier-to-use subset of the Standard Generalized Markup Language (SGML), the standard for how to create a document structure. XML markup, for example, may appear within an HTML page. Early applications of XML include Microsoft&#39;s Channel Definition Format (CDF), which describes a channel, a portion of a Web site that has been downloaded to the user hard disk and is then is updated periodically as information changes. A specific CDF file contains data that specifies an initial Web page and how frequently it is updated. Applications related to banking, e-commerce ordering, personal preference profiles, purchase orders, litigation documents, part lists, and many others are anticipated. 
         [0084]    Although not limited to, the following are some noted advantages of the present invention. The system  100  provides the technical capability that enables health and human service providers to share protected health information of their clients/patients—through an electronic central data repository. The system  100  is designed to be the public sector outpatient component of a comprehensive regional electronic health information infrastructure that facilitates standards-based electronic communication and real-time sharing of electronic health information records-across multiple providers. Access to a complete set of client/patient information at point of care has been demonstrated to reduce medical errors, and improve both cost and treatment effectiveness. The system  100  has been intentionally developed using originally authored and public domain open-source computer code, and current commercially available software technologies. Business rules demonstrating a commitment to non-proprietary and non-vended products facilitate greater opportunity for interoperability with multiple systems, and greater accessibility to public health and human service safety net providers. 
         [0085]    Some other noted, and not to be limited by, characteristics are: mobile device support for WAP/WML and Pocket Browser devices, clean code/html content separation using server controls, pages that are constructed from dynamically-loaded user controls, configurable output caching of portal page regions, and multi-tier application architecture. The system  100  also provides ADO.NET data access using SQL stored procedures, data content tracking and logging, XML serialization and schema support, SOAP support, SMTP and POP3 email support, Microsoft&#39;s Windows authentication—username/password in Active DS or NT SAM, and forms authentication using a database for usernames/passwords. Also provided is role-based security to control user access to portal content, user-based security to control user access to application objects, Web Services for interoperability support, Web Services for better usability, SQL Server Reporting Services, and IIS 5.0 and SQL compatibility. The system  100  also uses Microsoft&#39;s Server 2000 Applications, Microsoft&#39;s Windows 2000 Advanced Server Operating System, system tape backup with remote storage of tapes, Cisco Systems&#39; VPN encryption for secure connections, HIPAA Privacy and Security rule compliance, SNOMED CT integration, and HL7 version 3 standards compliance. 
         [0086]    Although not limited to, it is further noted that there are also specific unique components of the system  100  that provide significant advantages over comparable current state of the art products. First, the system  100  is developed for use in an outpatient setting, which is where over 80% of health care services are provided. Second, the system  100  maintains health information records both individually and as a part of a household unit. This is particularly useful for clients/patients whose eligibility for service is tied to household factors such as income, and clinically useful for providers who are working with multiple members of one family. Third, the system  100  has a system of role-based access, which readily facilitates multiple user access to a health information record while protecting access to certain kinds of information as required by federal and state law such as HIPAA. Fourth, each bit of data resident in the system  100  is time, date, and user stamped to insure security and facilitate accountability among multiple users of a central record, while insuring that the records can be readily and routinely updated. All data changes are logged and stored in tables on the server. This further facilitates restoration of data precluding the need to refer to tape back ups and it provides the ability to report log changes. 
         [0087]    While various embodiments have been described above, it should be understood that they have been presented by way of example only, and not limitation. Thus, the breadth and scope of a preferred embodiment should not be limited by any of the above-described exemplary embodiments, but should be defined only in accordance with the following claims and their equivalents.