Abstract:
The present invention relates to systems and methods for constructing a regional medical data exchange infrastructure that can provide the aggregation and presentation of personal health data that previously exists in different health care organizations in a segmented fashion. More particularly, the present invention relates to systems and methods for establishing a regional medical data exchange infrastructure, identifying patients across multiple different organizations, creating patient medical data pointers and routing tables, and generating comprehensive medical data sets for an enrolled population. One feature of this present invention permits the regional medical data exchange infrastructure to be built without any protected health information (PHI) being stored in any centralized databases. Another feature of the present invention permits the continuous operation of the regional medical data exchange infrastructure even when the centralized facility experiences downtime. Exemplary embodiments of the present invention permit both local and global logging and tracking of data flows and user activities to satisfy HIPAA compliances. Alternative embodiments of the present invention permit the preservation of the data ownership for the participating organizations.

Description:
RELATED APPLICATION  
       [0001]     This patent application claims priority to U.S. Provisional Application Ser. No. 60/566,103 filed Apr. 29, 2004, which is incorporated herein by reference in its entirety. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The present invention relates to health information technology. Specifically, the present invention relates to a regional/national healthcare data sharing infrastructure.  
       BACKGROUND OF THE INVENTION  
       [0003]     Causes of poor quality healthcare can be linked to data, information, or knowledge that are inaccessible or of questionable value. Lost data, poor documentation, and lack of access all impede the delivery of high quality healthcare services. Medical decisions are often either delayed awaiting the receipt of data and/or based upon incomplete data. Such data can include for example, a patient&#39;s medical and/or familial history. Duplicative medical tests are often administered increasing healthcare costs. Public health agencies lack the ability to share critical information quickly and encounter difficulties when attempting to pool existing data for analysis. Existing decision support tools and technologies in the healthcare industry are generally confined within an individual organization&#39;s boundaries and/or limited to a subset of patient data. Advances in medical knowledge and treatment capabilities often take too many years to reach patients. In addition, many therapeutic interventions in use are not supported by evidence of effectiveness. Practice patterns differ across institutions and regions, resulting in varying health outcomes and costs of care. Patients and their healthcare providers trying to make informed health decisions often encounter conflicting information with varying degrees of quality. Further, care delivery is often extraordinarily wasteful of patients&#39; time. These and related factors result in a diminished standard of medical care, increased costs, regulatory compliance issues and consumer ill will.  
         [0004]     The healthcare industry is in need of adaptive and scalable new technologies to facilitate and automate information and knowledge transfer and thereby enhance the quality of medical care.  
       SUMMARY OF THE INVENTION  
       [0005]     It is an object of the invention to provide a data sharing infrastructure.  
         [0006]     It is a further object of the invention to enable regional and/or national health data sharing among healthcare organizations.  
         [0007]     It is an object of the invention to provide a mechanism to identify patients across multiple different organizations at a regional or national scale.  
         [0008]     It is an object of the invention to provide a method to link patient data from multiple different organizations to form a comprehensive presentation of the patient&#39;s electronic health record.  
         [0009]     It is an object of the invention to present the aggregated electronic health record in a form that is accessible to providers at points of care for the patients.  
         [0010]     It is an object of the invention to enable participating organizations in the data sharing infrastructure to prepare, normalize, and stage medical data for their patients to achieve efficient data sharing with other organizations in the infrastructure.  
         [0011]     It is an object of the invention to provide a set of clinical data transformation and integration services, an information interchange infrastructure, a modern electronic communication platform, a portal for electronic health records, and integrated decision support capabilities, all of which are extensible, scalable and can be integrated with other regional data sharing initiatives.  
         [0012]     It is an object of the present invention to improve patient safety, healthcare quality and efficiency.  
         [0013]     The present invention provides a method to link patient medical data from multiple different organizations. When a new patient enters into the system, a global identification number is generated and distributed into each local organization&#39;s master person indices. The same patient or person is cross-identified in different organizations using his/her demographic data. The demographic data is used to match the existing patient list within each organization. If a match is found within the organization&#39;s existing patient list, a linkage pointer is created and an inventory of existing medical data already stored in that organization is generated and stored in the local organization&#39;s data store.  
         [0014]     The present invention provides a method to normalize and stage medical data for individual organizations so that these data can be efficiently shared with other organizations in the same system. A standard schema for a clinical data repository (CDR) is created and distributed to each participating organization. The data from different backend systems of these organizations is converted into the CDR in standard format ready to be queried.  
         [0015]     The present invention provides an infrastructure to help organizations share data without a central clinical data repository. It provides an infrastructure to help organizations share data while no protected health information (PHI) leaves each organization without explicit authorization of the data supplier organization. In a preferred embodiment, a global counter is used to generate unique person identification numbers while the number(s) is stored in the local data store of each organization.  
         [0016]     The present invention provides an infrastructure to help organizations retain the ownership of their data and business transactions. The medical data always resides within the boundary of each organization and is not duplicated elsewhere unless data transfer authorization is made by the data supplier organization.  
         [0017]     The present invention provides a distributed transaction logging mechanism. Each organization is able to log the requests and responses en route in and out of the organization boundary and the logging is for the requests and responses related to their internal data only.  
         [0018]     Thus, the present invention relates to systems and methods for constructing a regional medical data exchange infrastructure that can provide the aggregation and presentation of personal health data that previously exists in different health care organizations in a segmented fashion. More particularly, the present invention relates to systems and methods for establishing a regional medical data exchange infrastructure, identifying patients across multiple different organizations, creating patient medical data pointers and routing tables, and generating comprehensive medical data sets for an enrolled population. One feature of this present invention permits the regional medical data exchange infrastructure to be built without any protected health information (PHI) being stored in any centralized databases. Another feature of the present invention permits the continuous operation of the regional medical data exchange infrastructure even when the centralized facility experiences downtime. Exemplary embodiments of the present invention permit both local and global logging and tracking of data flows and user activities to satisfy HIPAA compliances. Alternative embodiments of the present invention permit the preservation of the data ownership for the participating organizations.  
         [0019]     The above and other features and advantages are achieved through the use of a novel data sharing infrastructure and method as herein disclosed. There has thus been outlined, rather broadly, the more important features of the invention in order that the detailed description thereof that follows may be better understood, and in order that the present contribution to the art may be better appreciated. There are, of course, additional features of the invention that will be described further hereinafter.  
         [0020]     In this respect, before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangements of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments and of being practiced and carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein are for the purpose of description and should not be regarded as limiting.  
         [0021]     As such, those skilled in the art will appreciate that the conception upon which this disclosure is based may readily be utilized as a basis for the designing of other structures, methods and systems for carrying out the several purposes of the present invention. It is important, therefore, that equivalent constructions insofar as they do not depart from the spirit and scope of the present invention, are included in the present invention.  
         [0022]     For a better understanding of the invention, its operating advantages and the specific objects attained by its uses, reference should be had to the accompanying drawings and descriptive matter which illustrate preferred embodiments of the invention.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0023]      FIG. 1  illustrates the architecture of the present invention.  
         [0024]      FIG. 2  illustrates the master patient indices at both the local and global level.  
         [0025]      FIG. 3  illustrates the matching of local patient IDs and patient medical data at the global level, across organizational boundaries.  
         [0026]      FIG. 4  illustrates an embodiment of patient data aggregation.  
         [0027]      FIG. 5  illustrates an embodiment of an entity&#39;s integration into a regional data sharing system.  
         [0028]      FIG. 6  illustrates a sample implementation of the present invention having a minimal Public Health Information configuration. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0029]     The architecture of the present invention is preferably designed with considerations of security, privacy, performance, and industry open standards for interoperability, recognizing the successes and failures of current local healthcare information infrastructure initiatives. The architecture is further designed to be decentralized in nature while minimizing the transportation of patient-identifiable Protected Health Information (PHI) over the shared network.  
         [0030]     The infrastructure of the present invention deploys a service-oriented architecture to be adaptable for diverse organizations with heterogeneous infrastructures. In application, a participant organization&#39;s existing infrastructure and technology investments are leveraged to the maximum extent. The federated master person index (MPI) and framework for secure, high performance clinical data sharing is designed to support the vast number of healthcare organizations throughout the country. Finally, the data analysis and reporting tools in the infrastructure for participating organizations will enhance the quality of clinical data services to participants. Participating organizations and clinicians can access data and services through mechanisms that are conveniently integrated with most current and future workflows.  
         [0031]     For environments with only internet access, a core health data portal can be used for real time aggregation and consolidation of patient data and communication. Organizations with a practice management system can automatically trigger the query, aggregation, consolidation, and printed summary for scheduled patients or arrived/admitted patients.  
         [0032]     For practices and organizations with an Electronic Health Record (EHR) system, a comprehensive set of web services and data transformation/integration adaptors are made available to simplify importing and exporting the clinical data between their existing systems and the network, as well as performing transactions (e.g. eligibility verification, orders/results), thereby integrating seamlessly into their workflows to achieve higher efficiency and accuracy of care.  
         [0033]      FIG. 1  illustrates an example of the physical layout of the infrastructure architecture, serving several organizations. As illustrated herein, core  102  comprises portal server(s)  104 , integration server(s)  106 , and backend server(s)  108 . Examples of portal server(s)  104  include but are not limited to Microsoft SharePoint server, IBM Websphere Portal Server, Plumtree portal server, portal applications developed in house, and the like. Integration server(s)  106  can be based on typical products such as Microsoft BizTalk server, IBM Websphere Integration Server, custom developed middleware, and the like. Backend server(s)  108  include but are not limited to Oracle database, IBM DB2, Microsoft SQL Server, and the like. Portal server(s)  104  provide aggregated medical data to users in a visual presentation. Integration server(s)  106  route and dispatch information to and from each organization, and to and from backend server(s)  108 . Backend server(s)  108  contain databases for logging and tracking information, for data stores to support integration server(s)  106  and portal server(s)  104 . In one embodiment, core  102  resides at a user site. In an alternate embodiment a user site communicates with core  102 .  
         [0034]     In this illustrated embodiment, organization A  120 , organization B  118 , organization C  122  and core  102  are protected by firewall(s)  110 . Such firewalls are known by those of ordinary skill in the art and include for example software and hardware products from vendors such as CISCO and Checkpoint. Firewall(s)  110  impose restrictions on the information flow in and out of the organizations. Within each organization, there are back end IT system(s)  114 , enterprise integration engine(s)  116 , and a health data exchange environment including one or more satellite server(s)  112  and potentially one or more legacy server(s). Back end IT system(s) are known by those of ordinary skill in the art and include for example IDX, Meditech, IBM mainframe, and the like. Enterprise integration engine(s)  116  are also known by those of ordinary skill in the art and include for example Microsoft BizTalk, IBM Websphere Integration Server, Seebeyond eGate, Novell eXtend, and the like. Environments amenable to health data exchange including one or more satellite server(s)  112  include but are not limited to Microsoft IIS server, IBM Websphere application server, and the like. Satellite server(s)  112  can contain servers acting as a web portal for electronic health records, servers for databases and clinical data repository (CDR), and servers hosting software applications such as decision support and medical references.  
         [0035]     In a preferred embodiment, integration server(s)  106  communicates with one or many satellite server(s)  112 . Such integration server(s)  106  and satellite server(s)  112  also serve as health data routing servers to direct requests and responses to appropriate destination. For example, when core  102  receives a request from medical information for patient  124 , via portal servers  104 , integration server(s)  106  forward this requests to satellite server(s)  112  in each organization where the patient matching is initiated. Once the match is found and response with local medical data is sent back to satellite server(s)  112 , satellite server(s)  112  forward the data back to core  102 .  
         [0036]     Another example is where a user within individual organization A  120  requests to receive medical records for patient  124 . The request is sent to local satellite server(s)  112 . If patient  124  is previously registered and a global ID exists in local data pointer set  204 , the local satellite server(s)  112  can forward the request to local satellite server(s)  112  of other organizations, directly without going through core  102 . The existing global ID and local pointer set  204  within other organizations assists the system aggregate medical data and present back to the user in sample organization A  120 . This method provides resiliency to possible downtime of core  102 . In alternative embodiments, such communication between core  102  and satellite server(s)  112  can route via a virtual private network, a public network, a private network, or a secured link over a public network by way of a public key infrastructure.  
         [0037]     In one application service provider embodiment, satellite server(s)  112  is installed on the service provider premises. Satellite server(s)  112  can communicate with legacy server(s) including but not limited to Electronic Health Record (EHR), Hospital Information System (HIS), Practice Management System (PMS), or Claim Systems, by way of enterprise integration engine  116 . Legacy server(s) are known by those of ordinary skill in the art and can include products such as those available from EPIC, Cerner, or GE Healthcare providing electronic storage and presentation of patient medical information at the organization level. PMS systems are also known by those of ordinary skill in the art and can be obtained from IDX, McKesson, and Cerner providing data storage and application utilities to manage patient appointments, billing, claim processing, etc. Claim Systems for payer organizations are also generally available and include systems available from IDX, CSC, Cerner, etc to help insurance companies store, process, and administer medical claims. Thus, in a preferred embodiment, legacy server(s) can comprise legacy data related to a plurality of patients, such legacy data including patient demographic data or legacy demographic data.  
         [0038]     Enterprise integration engine  116  is an enterprise data messaging processing system. Enterprise integration engines are known by those of ordinary skill in the art and include IBM Websphere Integration Server, Microsoft BizTalk server, Seebeyond eGate, Novell extend, and the like. These systems can manage messaging flow and work flow amongst diverse application systems to provide coordination and integration of applications.  
         [0039]     In the embodiment illustrated in  FIG. 1 , core  102  communicates with satellite server(s)  112  at three differing service provider premises: sample organization B  118 , sample organization A  120 , and sample organization C  122 . Each sample organization also referred to herein as a source site. As illustrated, sample organization B  118  comprises back end IT system(s)  114 , wherein said back end system is an Electronic Health Record or a Hospital Information System. Communication between satellite server(s)  112 , Electronic Health Record or a Hospital Information System, and core  102  is enabled by EAI Engine  116 . Sample organization A  120  comprises back end IT system(s)  114 , wherein said data base is a claims system. Communication between satellite server(s)  112 , claims system, and core  102  is enabled by EAI Engine  116 . Sample organization C  122  comprises back end IT system(s)  114 , wherein said data base is an Electronic Health Record or a Hospital Information System. Communication between satellite server(s)  112 , Electronic Health Record or a Hospital Information System, and core  102  is enabled by EAI Engine  116   
         [0040]     In an alternative application service provider embodiment, satellite server(s)  112  is supplied by a vendor. Satellite server(s)  112  enables industry open standards for data transformation and transportation and serves as an intermediary layer for individual organizations to integrate with the health care data services.  
         [0041]     Smaller and medium sized provider organizations, may not have back end IT system(s)  114 , and/or enterprise integration engine(s)  116 . More often than not, these organizations do not have a sound infrastructure to support the local installation of satellite server(s)  112 . In this case, these organizations can take advantage of the health care data services from the data sharing system through individual physician subscriptions. These physicians will interact primarily with the EHR portal hosted by portal servers  104  in core  102 . They can send requests for medical information via the EHR portal and core  102  will use integration server(s)  106  to aggregate data from participating organization A  120 , organization B  118 , and organization C  122  and present these data back to the user via portal server  104 .  
         [0042]     Users in individual organizations can be authenticated by each organization&#39;s security infrastructure. They can also be authenticated by core  102 . In a preferred embodiment, HIPAA-compliant audit trails reside locally within each organization&#39;s boundary. For example, all transactions related to medical data stored in sample organization A  120  are logged in the local satellite servers  112  within organization A  120 . Information is not replicated in organization B  118  or organization C  122 . Also in a preferred embodiment, at the global level, the logging and audit trail for the data flow amongst all organizations can be stored in backend database servers  108  within core  102 , such logging information will not contain medical data or any protected health information from any of the individual organizations. The audit trails and transaction information logged in core  102  is different from that in satellite servers. Additionally the logging information in sample organizations A  120  is different from that in B  118  or C  122 . Thus, in a preferred embodiment, a local data flow audit trail is stored in each satellite server and a global audit trail is stored in backend server(s)  108 .  
         [0043]     The present invention further provides each participating service provider with a routing mechanism to identify other organizations that have preserved data related to a particular patient. As discussed above, in a preferred embodiment of the present invention, participating organizations or service providers connect to core  102  by way of a virtual private network to achieve maximum-security measures while avoiding the cost of establishing private networks. Each organization&#39;s satellite server(s) is able to communicate directly with other organizations for querying and passing private health information via the data routing servers.  
         [0044]     Each satellite server(s) has an organizational level master patient index for all of that organization&#39;s patients. As patients are registered in that organization, core  102  also assigns them a unique global identification code or global master patient index. A similar process allows interconnection with other local healthcare information infrastructures that have their own unique identifiers.  
         [0045]     Thus,  FIG. 1  includes organization A  120 , organization B  118 , organization C  122  and core  102 . These organizations are protected by firewalls  110 , examples of such firewalls including software and hardware products from vendors like CISCO and Checkpoint. These firewalls impose restrictions on the information flow in and out of the organizations. Within each organization, there are back end IT system(s)  114 , enterprise integration engine(s)  116 , and a health data exchange environment including one or more satellite server(s)  112 . Within core  102 , there are one or more servers hosting the portal of electronic health records or portal server(s)  104 . There are also one or more servers for enterprise application integration (EAI) engines and standard web services, e.g. integration server(s)  106 . Lastly, there are backend data stores or backend server(s)  108 . The arrows indicate connections and linkages amongst organizations and systems. These organizations can talk to core  102  as well as each other directly.  
         [0046]     Also depicted in  FIG. 1  is a typical patient  124  with organization level patient identification (ID) and medical data such as prescriptions (Rx) data, diagnosis (Dx) data, and radiology (RAD) data stored locally within each individual organization A  120 , organization B  118 , and organization C  122 , respectively.  
         [0047]     As illustrated in  FIG. 2 , core  102  stores data including but not limited to global master patient index, routing information, and the like. Preferably, core  102  does not store private health information. Distributed probabilistic matching with organization-level internal patient indices facilitates the resolution and assignment of global patient identification numbers. Thus, as depicted in  FIG. 2 , within each organization, a typical patient  124  has a specific type of medical data stored locally indexed by a local patient ID such as A 01 , B 22 , and C 433  for organization A  120 , organization B  118 , and organization C  122  respectively. A global patient ID is constructed as GID as illustrated in local data pointer set  204  and global data pointer set  202 . These data pointers provide information about the data locations and the information about local patient ID (PID) for typical patient  124 . Please note for illustration purpose,  FIG. 2  contains the scenario where patient  124  has data stored in all three sample organizations. In reality, patient  124  may have data stored in only one or two or more organizations or may not have data stored in any of them.  
         [0048]     In the embodiment where minimal protected health information (PHI) is stored in core  102 , the global patient ID and local patient ID mapping, the data location information, and other pertinent information are synchronized between core  102  and satellite site server(s)  112 .  
         [0049]     The health data publication and subscription capabilities of the present invention enable usage accounting and access control for health data sharing. In addition, by separating the registration from the data query process, all clinical data traveling across the secured networks between participants can thus be de-identified, linked solely by the global identification code. Furthermore, queries for data are directed using this unique identifier to only the organizations that have the data, thereby minimizing the traffic on the network and reducing latency.  
         [0050]     The present invention provides alternate means for reducing latency when clinicians need the data. For instance, patient data for an organization can be cached on sending and receiving organization&#39;s local satellite servers which also serves to minimize the impact on an organization&#39;s source systems and eliminates the need for a central private health information repository.  
         [0051]     The invention enables automated subscription, for example by Primary Care Physicians (PCP&#39;s), for data on their patients. The data are published as soon as they become available and can be incorporated directly into the PCP&#39;s electronic health record system for instant access during future visits.  
         [0052]     Similarly, test orders transacted through the network can also be resulted through the network. Latency can also be reduced for organizations such as emergency rooms where registering and admitting a patient can automatically trigger the query, aggregation, consolidation, and printing of a patient summary to be affixed to a paper chart.  
         [0053]     For clinicians and patients using web browsers to access the health data portal, the connections are made secure by using Secure Socket Layer (SSL) technologies to the portal. In an alternative embodiment, a virtual private network account can be established for each user. SSL technology incorporated into mainstream web browsers is available, for example, through Microsoft Internet Explorer. Security certificates can be purchased from Verisign and installed on the web portal server, the SSL can then be easily configured. VPN equipment and software can be purchased from CISCO and the configuration is known by those of ordinary skill in the art. Clinical data are aggregated transiently in the core. The core also has web services to perform user authentication, authorization and audit trails. Authorization is through established relationships, coverage relationships, patient consent, or emergency situations, modified by opt-out capabilities.  
         [0054]      FIG. 3  illustrates the matching of local patient IDs and patient medical data at the global level, and across organizational boundaries.  FIG. 3  also illustrates creation of data pointers to match local patient IDs as well as patient medical data together at the global level, across organizational boundaries. The sample scenario depicts how organization A  120  registers patient  124  into the global medical data sharing network. Step 1: organization A  120  sends demographic data and medical data pointers for patient  124  to satellite server(s)  112 . Step 2: local satellite server(s)  112  then forward the data to core  102  with proper data encryption and de-identification for security and privacy concerns. Step 3: core  102  then broadcasts the demographic data to organization B  118  and organization C  122 . Step 4: organization B  118  and organization C  122  use the demographic data received to seek a match in existing patient lists. If a match is found and patient  124  exists in the local system, the medical data pointers as well as local patient ID specific to organization B  118  and organization C  122  are forwarded back to core  102  in Step 5. Furthermore, if patient  124  is found in local data pointer set  204  or global data pointer set  202 , the existing global ID will be used to further cross map the patient and his/her data. If patient  124  can not be found in local data pointer set  204  or in global data pointer set  202 , a new global ID will be created in global data pointer set  202  and registered back into local data pointer sets  204 . Once global data pointer set  202  and local data pointer set  204  are constructed, patient  124  is ready to be identified across the organization boundaries and his/her medical data from different organizations is ready to be aggregated. Preferably, in core  102 , after a patient is registered, there is no storage of private health information.  
         [0055]      FIG. 4  illustrates an embodiment of patient data aggregation. Step 1: a request for medical information for a typical patient  124  is made through portal server(s)  104 . The demographic data is subsequently entered into integration server(s)  106 . Step 2: integration server(s)  106  forward the demographic information to organization A  120 , organization B  118 , and organization C  122 . Step 3: with each organization, the newly received demographic data is matched against the existing patient list. When a match is found, local data pointer set  204  is used to retrieve medical data stored in each organization. Step 4: each organization then forwards the encrypted and de-identified patient medical data back to core  102 , where the medical data is aggregated and presented through portal server(s)  104 . This embodiment depicts a typical situation where patient  124  has previously registered in the data sharing system. If at the time the request for medical record is entered patient  124  has not yet registered in the system, the process illustrated in  FIG. 3  is used to register this patient in the data sharing network first. The global data pointer set  202  can be stored in core  102  to back up the local data pointer set  204  and speed up data aggregation. The system will also function well without the global data pointer set  202  stored in core  102 , where core  102  will not have any protected health information (PHI) for the patient.  
         [0056]      FIG. 5  illustrates the inner working of individual organization&#39;s integration into the regional data sharing system. In the example depicted, the sample organization B  118  has back end IT system(s)  114 , as well first individual application/database system  508 , second individual application/database system  510 , third individual application/database system  512 , and fourth individual application/database system  514 . The back end system can contain multiple legacy systems such as first legacy system  502  and second legacy system  504 . Typical legacy systems are IBM Mainframe, IDX system, Meditech health information system (HIS). Typical individual application/database systems are radiology, cardiology, pharmacy, and practice management systems. The local enterprise integration engine(s)  116  acts as a bridge to translate between data sharing satellite servers  112  and first legacy system  502 , second legacy system  504 , first individual application/database system  508 , second individual application/database system  510 , third individual application/database system  512 , and fourth individual application/database system  514 . Additional software components filter data and messages such as integration adapter  506 . Integration adapter  506  can be different from organization to organization as the backend systems may be different.  
         [0057]     The present invention can be implemented in a variety of different fashions. It can be configured (a) to contain protected health information (PHI) in the core  102 ; or (b) to contain only metadata pointers such as global data pointer set  202  in the core  102 ; or (c) to contain no metadata pointers or PHI in the core  102 .  FIG. 6  illustrates the implementation scenario (c) where there are no PHI or metadata pointers in the middle of the infrastructure.  
         [0058]     The present invention can be configured for the core  102  to only contain a global patient ID counter  602 . Augmented local data pointer set  604  can be an expanded version of above defined local data pointer set  204 . Augmented local data pointer set  604  contains the information contained in above defined global data pointer set  202  so that the operation of the entire system can be continued even when core  102  is offline. When implementing the present invention, users can choose to embed the entire information contained in the aforementioned global data pointer set  202  in augmented local data pointer set  604 , or they can choose to embed only partial information contained in global data pointer set  202  in augmented local data pointer set  604 .  FIG. 6  gives an example where an additional pointer set can be included for performance purposes or can be excluded from the local data pointer set for complete segregation of organizational specific PHI.  
         [0059]     Clinical data are exchanged between multiple independent healthcare organizations, or sites, an example of which is outlined in Table 1, below:  
                                                                                                                               Healthcare Information Exchange (HIE) Example Data Types                   Examples of Shared Data Types            Organization   Payer   Clinic 1   Hospital   Clinic 2               Lab       LOINC. Lab results   LOINC. Lab results from   LOINC. Lab results               from EHR   LIS   from LIS       Radiology       HL7 CDA Release 2.0   HL7 CDA Release 2.0 for   HL7 CDA Release               for textual reports   textual reports from RIS   2.0 for textual               from RIS       reports from RIS       Pharmacy/   NCPDP-SCRIPT   RxNorm for Drug   RxNorm for Drug   RxNorm for Drug       Allergies   (RxNorm) From data   Allergies and   Allergies and SNOMED-   Allergies and           warehouse daily from   SNOMED-CT for   CT for Allergic Reaction   SNOMED-CT for           PBM   Allergic Reaction   from HIS   Allergic Reaction               from EHR       from EHR       In-Patient           HL7 V3 Draft for                   Admissions, Discharges,                   and Transfers, as well as                   ER visits from IDX PMS       Out-Patient               HL7 V3 Draft for                       Arrivals from IDX                       Encounter Manager       Dictation/       HL7 CDA Release 2.0   HL7 CDA Release 2.0 for   HL7 CDA Release       Transcription       for progress notes and   admitting history &amp;   2.0 for progress               consults from Softmed   physicals, operative notes,   notes and consults               Transcription   consults and discharge   from Softmed                   summaries from Softmed   Transcription                   Transcription       Claims   X12-837 (CPT-4.           ICD-9 translated into           SNOMED-CT) from           IDX       Enrollment/   X12-834 &amp; 270/271       Eligibility   from IDX Enrollment           System. Includes           PCP and           demographics       Pt Reported       Other   Referrals: X12-278   HL7 CDA Release 2.0   HL7 CDA Release 2.0 for           from IDX MCA   for colonoscopy and   GI and Cardiology               non-invasive   procedure reports from               cardiology procedure   HIS               reports from EHR.                    Further Examples of Shared Data Types            Organization   Payer   Clinic 1   Hospital   Clinic 2               Lab       LOINC. Lab results from   LOINC. Lab results   LOINC. Lab results               EHR   from LIS   from LIS       Radiology       HL7 CDA Release 2.0   HL7 CDA Release 2.0   HL7 CDA Release 2.0               for textual reports from   for textual reports from   for textual reports               RIS and DICOM for   RIS and DICOM for   from RIS and DICOM               images from PACs   images from PACs   for images from       Pharmacy/   NCPDP-SCRIPT   RxNorm for Drug   RxNorm for Drug   RxNorm for Drug       Allergies   (RxNorm) From   Allergies and SNOMED-   Allergies and   Allergies and           data warehouse   CT for Allergic Reaction   SNOMED-CT for   SNOMED-CT for           daily from PBM   from EHR   Allergic Reaction from   Allergic Reaction from                   HIS   EHR       In-Patient           HL7 V3 Draft for                   Admissions,                   Discharges, and                   Transfers, as well as ER                   visits from IDX PMS                   (See also Claims)       Out-Patient       HL7 V3 Draft for       HL7 V3 Draft for               Scheduled Appointments       Arrivals from IDX               and Procedures from       Encounter Manager               IDXTend Scheduling       AND hl7 v3 Draft for               (See also Claims)       Scheduled                       Appointments from                       IDXTend Scheduling                       (See also Claims)       Dictation/       HL7 CDA Release 2.0   HL7 CDA Release 2.0   HL7 CDA Rewlease       Transcription       for progress notes and   for admitting history &amp;   2.0 for progress notes               consults from Softmed   physicals, operative   and consults from               Transcription   notes, consults and   Softmed Transcription                   discharge summaries                   from Softmed                   Transcription       Claims   X12-837 (CPT-4.   X12-837 (CPT-4. ICD-9   X12-837 (CPT-4. ICD-   X12-837 (CPT-4.           ICD-9 translated   translated into   9 translated into   ICD-9 translated into           into SNOMED-   SNOMED-CT) from   SNOMED-CT) from   SNOMED-CT) from           CT) from IDX   IDX BAR   IDX BAR   IDX BAR       Enrollment/   X12-834 &amp;       Eligibility   270/271 from IDX           Enrollment           System. Includes           PCP and           demographics.       Pt Reported       HL7 CDA Release 2.0               for telephone messages               from EHR       Other   Referrals: X12-278   HL7 CDA Release 2.0   HL7 CDA Release 2.0   ASTM CCR if           from IDX MCA   for colonoscopy and   for GI and Cardiology   required to convey           ASTM CCR If   non-invasive cardiology   procedure reports from   Advance Directives           required to convey   procedure reports from   HIS. ASTM CCR if           Advance Directives   EHR. EKG&#39;s from   required to convey               MUSE system. ASTM   Advance Directives and               CCR if required to   follow-up instructions               convey Advance   following discharge.               Directives                    Further Examples of Shared Data Types                    Other Out Patient       Treatment       Organization   Other Payers   Providers   Other Hospital Providers   Integrators               Lab       LOINC. Lab results   LOINC. Lab results from LIS               from EHR.       Radiology       HL7 CDA Release 20   HL7 CDA Release 20 for               for textual reports from   textual reports from EHR and               EHR and DICOM for   DICOM for images from               images from PACs   PACs       Pharmacy/   NCPDP-SCRIPT   RxNorm for Drug   RxNorm for Drug Allergies   NCPDP-       Allergies   (RxNorm   Allergies and   and SNOMED-CT for   SCRIPT               SNOMED-CT for   Allergic Reaction from HIS   (RxNorm               Allergic Reaction from               EHR       In-Patient           HL7 V3 Draft for Admissions,                   Discharges, and Transfers, as                   well as ER visits from PMS                   (See also Claims)       Out-Patient       HL7 V3 Draft for               Arrivals and Scheduled               Appointments from               PMS (See also Claims)       Dictation/       HL7 CDA Release 2.0   HL7 CDA Release 2.0 for       Transcription       for progress notes and   admitting history &amp; physicals,               consults from EHR   operative notes, consults and                   discharge summaries from                   HIS       Claims   X12-837 (CPT-4. ICD-   X12-837 (CPT-4. ICD-   X12-837 (CPT-4. ICD-9           9 translated into   9 translated into   SNOMED-CT) from PMS           SNOMED-CT)from   SNOMED-CD) from           Claims system   PMS       Enrollment/   X12-834 &amp; 270/271       Eligibility   from Enrollment           System. Includes PCP           and demographics.       Pt Reported       Other   ASTM CCR if   ASTM CCR if required   HL7 CDA Release 2.0 for GI,           required to convey   to convey Advance   Pulmonary, Cardiology           Advance Directives   Directives   procedure reports and ASTM                   CCR if required to convey                   Advance Directives and                   follow-up                        Reference               Organization   Laboratories   Imaging Centers   Patients               Lab   LOINC. Lab results           from LIS. HL7 V3           Draft for Lab orders       Radiology       HL7 CDA Release 2.0 for               textual reports from EHR               and DICOM for images               from PACs       Pharmacy/       Allergies       In-Patient       Out-Patient       Dictation/       Transcription       Claims       Enrollment/       Eligibility       Pt Reported           HL7 CDA Release 2.0 for “emails” via                   patient portal, as well as patient annotations                   to their SAFT Health record. ASTM CCR if                   required to convey Advance Directives       Other                  
 
         [0060]     The infrastructure is extensible and adaptable for future participating organizations, a set of industry open standards including but not limited to HL7, DICOM, NCPDP-SCRIPT, CDA, X12, RxNorm, SNOMED, LOINC, CCOW, and the like are adopted where applicable.  
         [0061]     To enable the incorporation of clinical data into existing EHR systems by participating service providers or other organizations, the infrastructure is constructed to allow bidirectional data transformation between participants&#39; existing formats and the industry-standard formats used in specific embodiments of core  102 . The implementation of this invention can support different EAI engines from different vendors such as Microsoft BizTalk, IBM Websphere Integration Server, Seebeyond eGate, etc. To enhance the security, performance, and standardization, the data from backend systems are funneled into the satellite servers  112  and stored there as a staging environment for further participation of data sharing.  
         [0062]     The architecture and operation models of the present invention are aimed to be replicable for larger healthcare communities. The emphasis on service-oriented architecture makes this approach adaptive to the diverse infrastructures that are present among different organizations. The emphasis on leveraging existing infrastructure and technology investment lowers the entry barriers for new participants. The industry open standards will sustain future evolution of technologies, promote interoperability and make the solutions vendor independent.  
         [0063]     The infrastructure is designed to decouple the network from the idiosyncrasies of individual infrastructures in order to minimize latency and impact on an organization&#39;s production systems.  
         [0064]     The unique master person index approach and data routing mechanism minimize network traffic, maximize performance, ensure PHI data security, and enable a high degree of scalability, including integration with other local healthcare information infrastructures.  
         [0065]     Having now described a few embodiments of the invention, it should be apparent to those skilled in the art that the foregoing is merely illustrative and not limiting, having been presented by way of example only. Numerous modifications and other embodiments are within the scope of one of ordinary skill in the art and are contemplated as falling within the scope of the invention and any equivalent thereto. It can be appreciated that variations to the present invention would be readily apparent to those skilled in the art, and the present invention is intended to include those alternatives. Further, since numerous modifications will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation illustrated and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the invention.