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Concept & Facilities Achitecture Operations Applications Benefits

     
 

Platform Concepts and Facilities

MedCommons, Inc., markets and licenses separate MedCommons installations each of which is built upon the MedCommons Platform. The platform supports the long term storage of ‘Patient Medical Records and Related Documents’ in a controlled, secured, scalable, audit-able and reliable long term repository. The platform includes basic applications for Healthcare Document management and display, and for connection to Imaging Equipment and other special devices within the Healthcare Infrastructure. Some Platform customers and partners add additional document support and applications to handle those documents. The MedCommons Platform is HIPAA compliant and FDA-approved.

Archival Healthcare Document Repository

MedCommons, at the most basic level, keeps document archives in perpetuity and provides healthcare domain-specific applications for access to these documents. A Personal Health Record (PHR) is a particular collection of standards-based personal documents and is a prime component of a MedCommons Account.
A MedCommons Account can hold arbitrary documents in perpetuity. The builtin document types for Healthcare that are imported / exported by a MedCommons Account are:
  • CCR - the ASTM-standard structuring framework for the MedCommons PHR
  • DICOM - cardiology and radiology imaging
  • PDF - including signed documents
  • JPEG - still images, including those from digital cameras and cellphones
  • PNG - images from iPhones
MedCommons includes applications that allow for the generation, editing, transfer, and viewing of these builtin document types on a variety of form factor devices. Third party applications can be integrated to handle other document types
Importantly, MedCommons maintains private files for each account including:
  • Audit Log A detailed human-readable audit log proves traces of all individual updates to the PHR.
  • Individual Documents are fully accessed controlled by the MedCommons Consents System
MedCommons is both standards compliant and future-proof: As a lifetime personal archive, every new CCR document that is added to the account is 'merged' into the current personal health record. The specification of these merge rules is scripted and customizable. MedCommons applies the document type specific customer rules in order to adjust the current personal health record. Over time, new document types will be added as healthcare information standards evolve.

Health URLs

The MedCommons Health URL is the web address of a MedCommons account. Any user of the Health URL with Read authorization can see the actual Account ID. A Health URL can be further qualified with a Tracking Number or Document GUID to select a particular CCR. Entering the Health URL into a browser box displays the Current CCR or challenges the user to authenticate himself if necessary. A user with Write authorization may update a CCR using a POST request to the Health URL.
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Federation

MedCommons, Inc., markets and licenses separate MedCommons installations. Each installation, known as a MedCommons Instance interoperates with every other Instance unless the licensee deliberately opts-out. Each Instance contains a built-in system for creating and managing user accounts and identities, but consistent with current best practices in Identity Management, each Instance can also act as a Liberty Alliance Service Provider, or as on OpenID Client, and will run as a service provider (SP) with other federation schemes in the future. When using Liberty or OpenID, the MedCommons SP supports multiple Identity Providers concurrently, allows the licensee to offer Single Sign On using his existing system of IDs, and to support completely pseudonymous accounts.
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Global Services

In order to allow separate instances to interoperate, a redirection service is provided that allows a licensee to find a MedCommons document on any other MedCommons system via a unique ID known as a Tracking Number. Like the Credit Card networks, all MedCommons Account IDs are unique regardless of the actual MedCommons licensee or sponsor and any account and any separate instance can be accessed if the requisite consents are in place.
A redundant central coordination facility for both Tracking Numbers and Account Identitifers is maintained by MedCommons, Inc at www.medcommons.net. These tokens are handed out in large batches (by the thousands) to allow licensees to create their own accounts and documents without constant communications with MedCommons.

Accounts

Any action involving private information in MedCommons requires an Account. Accounts can be created via an API or via a self-service web page. There are three distinguishing properties of each MedCommons accounts:
  • an account can have a sponsor, in which case the sponsor pays the bill; otherwise the bill is paid by the account creator
  • verified patient - some administrator has checked the 'patient verified' box, presumably after vetting the patient's identity
  • archival vs temporary - an archival account has extra data safeguards and backup options whereas a temporary account is short-lived.
Anyone with Write privilege can control who can see this information and such access may be revoked by the verified patient at any time. Access authorization privilege including inviting other users and groups to have access is not separated from any other account modification privilege at this time.
A verified patient can control what information is in their medical records. The verified patient can change their mind at any point. They may change access to a medical record; they may delete something that they decide to delete.
A patient can see the same thing as the doctor or other viewer with Read access will see. This is the Current CCR (both views) and other tabs. Anyone can see who the list of people and groups who will see their record and who has ever seen their medical records.
Anyone may delegate certain actions to another user such as a family member who may be able to edit/delete a patient's medical record or a clinical practitioner of some sort may be given control. The verified surrogate can to override the others.

Consents

A consent (a.k.a. authorization) is an optionally signed document associated with an Account. Typically, but not necessarily, a Consent grants some entity (Doctor, Hospital, Computer System) access to a portion of the Account. MedCommons stores the Consent Documents currently associated with an Account. MedCommons also supports multiple forms of consents that can be modified by Licensees. There are three kinds of consents implemented in MedCommons:
  • plain paper like consents, which are printed with a barcode for possible faxback to MedCommons. These are then faxed back to the account and stored as titled PDFs.
  • interactive consents, where the user 'signs' a document on the screen, optionally with an additional 2 factor check like a custom sms delivered PIN
  • digitally signed XML consents, where some other authority is identifying the user and providing non-repudiation of the users signature (not yet implemented)

Groups

Health Records are routinely shared between patients, family members, doctors, and 3rd parties. Access to Health Records and other associated documents in MedCommons is provided by three mechanisms:
  • A tracking number/pin which permits anonymous access
  • A consent provides a means of providing permission to share documents
  • Direct login to the account
In MedCommons 1.0, the only documents subject to sharing are CCR but other documents types can be referenced as attachments and managed implicitly by access to the CCR.
MedCommons provides for optional patient control of all document sharing. Patient control requires verified patient status. New Accounts created in the context of a Group automatically grant sharing consent to that Group. Beyond the original creator group, other users and groups can be invited to access the Account.

Import/Export

These are the various means of importing documents and other info into a MedCommons Account with Account ID nnnnnnnnnnn:
  • send a barcoded fax to a toll free number, with the nnnnnnnnnn encoded in the barcode
  • upload a CCR using the MedCommons UI
  • send DICOM from OSIRIX or DICOM DDL
  • send CXP from just about anywhere, including google gadgets, blood pressure meters and glucometers
  • restore an account save-set made with the Export Backup Screen
These are the various means of exporting documents and other info from a MedCommons Account with Account ID nnnnnnnnnnn:
  • Export by Save CCR to file
  • Export by Save As a PDF in Acrobat or Preview
  • Export by download CCR, PDF, DICOM and all other attachments.
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Internal Storage Format

The MedCommons ISF is a a flexible, neutral internal storage format for PHRs designed with the following overall goals:
  • to make individual elements in the PHR accessible and updateable with very low overhead
  • to provide a neutral format that can reliably store any schema that MedCommons may wish to support. This includes both XML and non-XML based schemas
  • to support a detailed forensic log of all adjustments to the PHR
  • to allow different views, filters, or projections of this format into the "Current CCR', the 'Emergency CCR', and other forms
  • to support a means of maintaining and merging into the "Current CCR"
  • allow storage of meta data on elements that will assist with merging, tracking, auditing and mapping
  • to better facilitate future efforts to map between formats
  • to enable faster search within an account

Builtin Applications

Several applications and components are supplied with the MedCommons Instance and supported by MedCommons, Inc.

Unified Viewer

The brandable medcommons viewer supports multiple base document types. The minimum supported resolution is 1024*768 . A base document such as CCR can have many attachments, all of which are displayed equitably thru type specific viewers. The alternate view of the CCR, as a long white form, is standard across all MedCommons systems

Dashboard/Worklist

Every Worklist has a worklistURL that can be pasted into blogs, wikis, etc. There are some simple, easy to understand status fields that form the essence of the query, along with MedCommons Account Ids, group ids, and other data.

Printing

Utilizes the native host o/s printing facilities available to the user without requiring the installation, even via download, of extra components. A preview facility is always available. The printed document is not stored by MedCommons. If a user wants to store a printed document then the 'Save to File or PDF' options of the host operating systems printer dialogue can be utilized The layout and fonts on any printed page are insensitive to current screen display preferences and yield the same printed format regardless of user settings. The printed formats accommodate both US (letter, legal, etc) and World (A3,A4, etc) standard sizes without error. All printed pages are branded by MedCommons, the Customer (partner/affiliate/rhio/etc), or both.

DDL Gateway

The MedCommons application that permits the integration of DICOM from Hospital and Imaging Centers into MedCommons Accounts, and the delivery to radiologists and other professionals running DICOM workstations and displays. This applicaiton is provided in a form that can integrated into an online web portal or service.

MedShooter iPhone Application

A brandable iPhone app for shooting patient photos and videos, for use by sports trainers, dermatologists, and even patients who want to add imaging into their health records.

Facebook Family CareTeam

A brandable iPhone app for CareGiver and family members to support health needs of both the Elderly and the young.

Notifications

MedCommons Notifications are one-way messages delivered to users via Email, IM, RSS, SMS, Fax and Audio. The current implementation supports only Email. Notifications are delivered on a best-efforts basis and may be insecure from a HIPAA PHI perspective. The MedCommons applications do not depend on the delivery of notifications.
Any registered user can use the web interface to view past notifications related to any account under his administrative control. 		 

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© MedCommons Inc. 2009