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1. Abstract

This Davies Report concerns the organization, Cleveland Clinic, who implemented the Hypertension
Improvement System. This organization functions in the "world" of enterprise healthcare which focus on
chronic disease management, along with the urgent need to improving hypertension control among
patients, and goal of maximizing blood pressure control to reduce cardiovascular events. This report
focuses on the role of Primary Care Provider, whose primary goals are to minimize uncontrolled
hypertension in their patient population. I focus on the primary functions of blood pressure
management and patient education and describe its success. I describe its Workflow, and provide an
example of the user's interaction with the system, including the cognitive processes involved (“using the
for technology patient care”). I describe the information system put into place, and how it works to
support that Workflow and the Functions. I also describe the modules comprising the system (Optum
One Analytics Platform, EPIC EMR, EMMI, Televox, MyChart), and how they, themselves, are "systems" in
their own right. I describe the data, information, knowledge employed by the modules and the system to
support those functions. Finally, I describe the technology underlying the information system.

I consider the standards in the system from each level of the Stack, in the context of interoperability. I
also describe the privacy, confidentiality, and security concerns addressed and any ethical issues either
explicit or implicit in their report.

I close with an assessment of the completeness of this report itself, an assessment of the Stack for
describing the project, and with my thoughts on what I gained from the exercise.

2. World

Within which “world” does this project “live”?

The project lives within the world of of many healthcare systems (in this case enterprise healthcare)
focusing on chronic disease management. In this case, hypertension contorl.

What imperative(s) from that world drove the organization to execute this project?

High prevalence of hypertension affecting 70 million Americans.

$46 billion in excess healthcare costs due to hypertension.

What National Academy of Medicine Initiative Goals played a role, if any?

Ensuring that population health is stable and does not cause a burden on the healthcare system

Enhancing the patient experience of care.

Reducing cost of healthcare. (per cap)

[Advanced: How did the “world” affect the requirements/specifications/design of the information system
solution?]

Enterprise healthcare system required this to manage a large population with large data (specifically
those with hypertension) and handle this large amount of data anyalytics, perhaps some patient
egagement and ensuring that the system is universally understood and therefore able to be understood
by health providers worldwide One of the factors that determine viability in information technology is
value, so the emphasing value would show good improvements in outcome.

3. Organization

Name of organization

Cleveland Clinic

Type of organization

A large, academic medical center and healthcare system.

Mission statement of organization:

"To provide better care of the sick, investigation into their problems, and further education of those who
serve."

What was the organization-level goal for this problem?

Maximizing blood pressure control among adult patients with hypertension.

Were any “New” Policies or Models involved?

• Enhanced workflows for accurate blood pressure measurement.

• Tools (especially those with visual recognition) within the EMR.

• Patient self-care

• Care gap identification

What evidence do they provide to demonstrate that the solution addressed their organization-level
goal?

10,500 additional patients achieved blood pressure control (based on available data from the it system)

Estimations: 131 fewer strokes, 100 fewer heart attacks, 75 fewer early deaths.

Financial impact: Extra ~$3 million distribution due to quality improvements.

[Advanced: How did the nature of the organization affect requirements/specifications/design of the
information system solution?

The large amount of data requires a solution that can manage and analyze this data. The system needs to
be centered around needs, be user-friendly for healthcare providers and handle large volumes of patient
data

4. Role

Primary Care Provider

[Advanced: Is this Role a primary (mission-critical) role for this project?]

Yes, the Primary Care Provider is mission-critical

manage patient hypertension, using the system

This is important to ensure that patient outcomes are beneficial

5. Functions

Name the primary Function this solution is supporting?

monitoring, intervention, and patient education and managing hypertension therefore

Maximizing the number of patients with controlled blood pressure levels.

What evidence is provided to demonstrate that they achieved this goal?

• Improved patient blood pressure control rates.

• Significant reductions in heath implications

• Positive patient feedback becaues of daily intervention

• Financial gains

[Advanced: Imagine that the system does not accomplish its goal. What evaluation framework might you
use, and why?]

The re-aim framework

Used to identify what needs to be reviewed again

6. Workflow

How does the report describe the workflow of the Role?

Office Visit Workflow:

High blood pressure detection

Intervention during office visit (could be education, or follow up)

Rechecking BP and EMR entry

Finding what patients have a high blood pressure

Outreach through messaging (effective in bulk)

Remote BP monitoring and virtual visits.

[Advanced: What is missing from this description?]

Communication between teem members,

specific protocols

Paste in a screen shot of a user interface relevant to the Role.

What theory of information behavior best applies to user’s interaction with this screen? Why do you say
so?

The Minimalist Theory

Eficient information displaying and not overcrowding to overcomplicate anything 7.

Information System

What is the name of the system?

Hypertension Improvement System, EPIC EMR, EMMI, Televox

What needs does the report list?

• Accurate blood pressure measure

• Are patients being managed?

• Minimalist visuals

• Finding patients that have history of high blood pressure

• Monitor of blood pressure throughout limits

What requirements?

• integration and easy access

• Tools to make patient experience simple and easy

• Support for team-based care.

What specifications?

• Development of care gap registry.

• Visual management tools in EMR.

• Bulk modal messaging (less burden on healthcare provider)

• Integration of home BP readings into EMR. (Crucial for communication)

What processes of software development did they use?

Likely an iterative process, refining the system based on user data and possibly feedback

Of the architectures presented in Module 3, which comes closest to that in the report?

SOA

service oriented architecture

Yes, it depended on existing systems that are are already proven to work like EPIC EMR, prior and
established ruling on previous data management that.

8. Module

What modules are included in this information system that are most relevant to the Function?

• EPIC EMR

• EMMI and Televox

• Care Gap Registry

[Advanced: Choose one module. How could it be considered an “information system” on its own?]

EPIC EMR is a very good system that follows SOA framework. It can be considered an information system
on its own, manages records, clinics workflow

9. DIKW

What are the primary data and their data types?

• Blood pressure readings (numerical data).

• Patient demographics (categorical data).

• Medication lists (text data).

• Appointment dates (date/time data).

• Care gap indicators (categorical data)

Trends in BP readings over time, as they provide cruciical inforamtion and indicate control levels.

What explicit knowledge does the system use to support the user?

• Hypertension management.

• Best practices for BP measurement.

• Patient self-management.

10. Technology

What technologies support this project?

EPIC EMR

EMMI and Televox

MyChart

Where on the Hype Cycle is the most important technology?

Remote patient monitoring devices are in the Slope of Enlightenment

11. Policies

Organizational agreements

Data-sharing agreements for coordinated care.

Workflows for hypertension management.

Functional standards

evidence-based clinical guideline

Identifiers/privacy

Use of unique patient identifiers (ensure follows HIPAA)

Information exchange

HL7 standards for data exchange between systems.

Data content

LOINC codes for lab tests

CT for clinical terminology

Transport

Secure web services and APIs

12. Privacy, Confidentiality, Security

How are privacy concerns addressed?

HIPAA regulations compliance

Access limited to right personel

How are confidentiality concerns addressed?

policty training

How are security concerns addressed?

Data encryption

Regular security audits and updates.

Intrusion detection, cyber secuirty software

13. Ethical concerns

What ethical concerns do the report authors raise?

Report did not tell what ethical concerns there were but implies the importance of patient consent

[No right or wrong answer: What ethical concerns do you see?]

• Remote monitoring

• Data security risks potentially compromising patient information

14. Reflection

The report was detailed in the in objectives, strategies, technologies, workflows, explicit ethical
considerations, and general standards such as health policy

What aspects of the report did the Stack analysis miss?

Human factors, such as socioeconomic factors, cultural factors, qualitative factors that are not analyzed
by the system

What did you learn from this assignment?

I learned about the complexities of implementing a large-scale health information system in a major
healthcare organization. The importance of technology with clinical workflows, data analytics in
population health, and addressing operability, privacy, and ethical considerations are very important