Applications

Telemedicine

A telemedicine consultation anywhere in the world, can be arranged in seconds over MedCommons. A HealthURL account is created for the patient and shared by the practitioners. The account can be temporary or can persist for follow-up.

The use of a Health URL for telemedicine offers significant benefits over typical point-to-point connections. Secure, Web browser access is easier than VPN connections and accessible behind firewalls and even over low-grade connections in the developing world. The Health URL approach enables a practically unlimited number of participants for team consultation and medical education. Participants can be pre-registered or invited ad-hoc using a PIN. Pre-registered participants can be notified of telemedicine activity through a group worklist or the corresponding RSS feed.

Health URL accounts allow the import of a JPEG images from a digital camera, scanned documents or DICOM images. Users who need to store images and documents locally because of low speed or intermittent Internet connections can do so. The sophisticated open source OsiriX workstation is freely available and integrated with the Health URL for use with locally cached images and by radiologists, cardiologists and surgeons who need sophisticated measurement, 3D and image fusion tools.

Telemedicine consultations are typically covered under HIPAA treatment consent and thus do not require separate authorization by the patient. Temporary HealthURL accounts can be deleted, converted to archival HealthURL accounts or allowed to expire. Regardless, Health URL accounts include the HIPAA-mandated Activity Log.

HIPAA Records Requests

All practices are required to process medical records requests from patients and authorized caregivers. By using a HealthURL instead of paper, the Health Information Management (HIM) department of a hospital or any practice can formalize and document their records release process while reducing labor and paper-handling costs.

The MedCommons Health URL Appliance enables users to customize the records request form templates as needed. The resulting form can be printed and filled out on a clipboard in the traditional way or it can be filled out on-line with any Web browser. Caregivers can print the request form associated with a Health URL on-demand. Remote authorization options are available when requesting practices have acceptable MedCommons credentials, a satisfactory Fax connection or can respond to a PIN challenge that has been authorized by the patient.

Instead of printing paper, records can be printed directly to PDF and attached to the patient's Health URL. Paper records can be scanned directly into the Health URL using a bar-coded fax cover sheet specific to the Health URL account. Instead of burning CDs, the radiology film library can send DICOM directly to the Health URL using free MedCommons DDL utility.

Some hospitals can save labor and materials costs while improving customer service by merging film library and HIM operations around a Health URL appliance.

Film libraries and most HIM departments charge for processing records requests. The MedCommons Health URL appliance allows the practice to charge the requester's credit card.

Most important, patient care, patients and referring clinicians will be better served by faster processing and integration of imaging, reports, authorizations into a standard format suitable for Web access, download or automated processing by standards-based EHRs.

Outcomes Registry

National and international public health, biosurveillance, post-market drug and device follow-up and pay-for-performance programs require updating of 'outcomes registries' after clinical encounters. A MedCommons Health URL supports both the privacy and information aggregation needs of outcomes registries using non-proprietary, open standards throughout.

SAML 2.0 certificates and federated identity options combine with the Health URL's access authorization and Account Activity Log mechanisms to support any combination of registries including legally mandated, IRB-approved and patient authorized systems.

The CCR-native information model of MedCommons Health URLs benefits integration and operation of outcomes registries. As clinical encounters generate CCR documents and export them to the patient's Health URL, configurable routines merge the CCR objects into a separate SQL database that corresponds to each patient's information model. The MedCommons Current CCR is a live document derived from the account database on-demand anytime the Health URL is accessed.

Registries can subscribe to RSS feeds or accept email-notifications of Health URL merge activity. If authorized, the registry can access some or all of the Current CCR or the entire account.

The ASTM-CCR is designed to make anonymization relatively easy. Although not included in the initial release of the MedCommons Health URL appliance, anonymization features can be supported as custom integration project with interested licensees.

Retail Clinics

Retail clinics in stores, pharmacies and workplaces depend on good communications with physicians to offer continuity of care. Adding Health URL support to their information system allows the clinic to reduce costs, improve client loyalty and become better integrated with local primary care and hospital practices.

The Health URL is superior to a paper printout because it will not be lost, can be updated as laboratory results come in and can trigger emails to the patient as well as the patient's designated caregivers.

The Health URL can be provided by either the retail clinic or the patient's designated practice provides a good way to communicate results while keeping the patient "in the loop". By analogy with phone number portability or ATM networks, MedCommons will route Health URL transactions to the MedCommons licensee hosting that particular account. Licensees can brand, control policy and customize the functionality exposed by their Health URL appliance to differentiate their services.

MedCommons, in the role of routing service, does not need to access private health information and does not add HIPAA risk and cost to either the retail clinic or physician's practice.

In cases where health care organizations and primary care practices choose to operate or supervise retail and employer-based clinics, installation of a MedCommons Health URL appliance can provide a simple and cost-effective means to extend their clinical network throughout a region. MedCommons credit card processing can be optionally integrated into the account forms.

On the other end of the spectrum, national-scale retail services can benefit from MedCommons support for scalable, standards-based federated identity management and single sign-on mechanisms that cross state jurisdictions and reach beyond health care to government, insurance, telecommunications and banking services.

Radiology Services

Imaging centers, after hours coverage, 3D processing labs, sports medicine and sub-specialty interpretation practices depend on broad reach and service excellence to drive referrals. MedCommons Health URLs provide Web browser convenience, DICOM and PACS integration and integrated on-line order capture without proprietary hardware or costly virtual private networks (VPN).

As a foundation for your radiology services network, MedCommons Health URLs are standards-based for better integration and lower costs than proprietary network solutions.

Continuity of Care Record (CCR) integration provides clinical context to both orders and reports. Diverse notification options including email, cell phones, and shared on-line access help are a key service to your referring physicians.

Although many will opt for the speed and convenience of on-demand Web browser access, surgeons and other image-dependent specialists benefit from integration of the Health URL their existing DICOM workstation or the freely available with the sophisticated open source OsiriX workstations.

OsiriX is a full-featured diagnostic workstation available as free software for the Macintosh. Although OsiriX can use the MedCommons DDL utility via DICOM, MedCommons provides a higher level of integration with a plug-in optimized for OsiriX. The plugin automatically launches OsiriX to view DICOM references in a MedCommons CCR and it automatically opens a new Report CCR with DICOM references already attached.

The MedComons Health URL appliance makes it easy and safe to bring DICOM CDs into small practices and large hospitals alike. Free downloadable utilities process the CD and send the DICOM to the appliance in one step. An inexpensive, dedicated PC can be used to avoid the risk of infection by unknown software. Users throughout your organization can then view the DICOM without in their Web browser and using a consistent and familiar user interface regardless of the source vendor. If desired, users with PACS or diagnostic workstations can import the DICOM via the Health URL without any risk of infection from foreign media.

Home Care

New devices, professional services and family supports can collaborate to provide safe and effective care in the home. A patient's Health URL provides a single point of contact for the collaborators. Standards-based devices with Internet access will connect directly and securely into the Health URL using standard protocols.

Please contact MedCommons for a demonstration of secure Health URL access from cell phones.

Direct input by patients and unaffiliated providers is not practical in today's EHR systems for both workflow and security reasons. For now, the the EHR user's Web browser can access the patient's Health URL directly.

Disease Management

Disease management protocols are driven from an up-to-date view of the patient's record. The patient's Health URL aggregates information from primary care, specialists, consultants, retail clinics and family supports and organizes it into a standard XML document accessible as the Current CCR with separate attribution for each data source. Authorized disease management services can access either the Current CCR or search through all of the documents in the Health URL account. Protocol output in CCR format can update the patient's Current CCR directly or as a PDF document.

Sports Medicine

Sports injuries often happen on the road. A Health URL for team members can help to speed diagnosis and support decisions by bringing together resources familiar with the patient, resources available on site and specialist consultants wherever they might be. MedCommons Health URLs provide the ability to capture and communicate diagnostic imaging within minutes directly from CT or MR scanners and digital X-ray equipment. The MedCommons administrator's console manages email, cell phone, fax, group and PIN assignments to enable ad-hoc collaboration without delay.

Tertiary Care Referrals

Transplants, cancer therapy and major surgery can be delayed while necessary images, documents, reports and laboratory results are gathered from primary care, local hospitals and imaging facilities. A Health URL is accessible directly by all information sources. Patient authorization forms can be managed as documents in the Health URL directly or via fax.

Social Networks

Chronically ill patients, medical residents and lifelong students increasingly come together in Internet forums. Example cases and anonymized health records are a valuable addition to these forums.