University of Utah College of Nursing, Salt Lake City, Utah, USA.
Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA.
J Am Med Inform Assoc. 2020 Jul 1;27(7):1000-1006. doi: 10.1093/jamia/ocaa055.
The objective of this project was to enable poison control center (PCC) participation in standards-based health information exchange (HIE). Previously, PCC participation was not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow.
We adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. We used rapid prototyping to determine requirements for an HIE dashboard for use by PCCs and developed software called SNOWHITE that enables poison center HIE in tandem with a poisoning information system.
We successfully implemented the process and software at the PCC and began sending outbound C-CDAs from the Utah PCC on February 15, 2017; we began receiving inbound C-CDAs on October 30, 2018.
With the creation of SNOWHITE and initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah Poison Control Center, we accomplished the first participation of PCCs in standards-based HIE in the US. We faced several challenges that are also likely to be present at PCCs in other states, including the lack of a robust set of patient identifiers to support automated patient identity matching, challenges in emergency department computerized workflow integration, and the need to build HIE software for PCCs.
As a multi-disciplinary, multi-organizational team, we successfully developed both a process and the informatics tools necessary to enable PCC participation in standards-based HIE and implemented the process at the Utah PCC.
本项目旨在使中毒控制中心（PCC）能够参与基于标准的健康信息交换（HIE）。此前，由于软件不符合 HIE 标准、缺乏信息学基础设施以及需要将 HIE 流程集成到工作流程中，因此 PCC 无法参与。
我们改编了健康水平七统一临床文档架构（C-CDA）咨询记录，以适应 PCC 的用例。我们使用快速原型设计来确定用于 PCC 的 HIE 仪表板的要求，并开发了名为 SNOWHITE 的软件，该软件可与中毒信息系统一起实现中毒中心的 HIE。
我们在 PCC 成功实施了该流程和软件，并于 2017 年 2 月 15 日开始从犹他州 PCC 发送出站 C-CDA；我们于 2018 年 10 月 30 日开始接收入站 C-CDA。
通过创建 SNOWHITE 并启动从犹他州毒物控制中心发送出站 C-CDA 咨询记录的 HIE 流程，我们实现了美国 PCC 首次参与基于标准的 HIE。我们面临着一些挑战，这些挑战也可能存在于其他州的 PCC 中，包括缺乏一组强大的患者标识符来支持自动患者身份匹配、急诊部门计算机化工作流程集成方面的挑战，以及为 PCC 构建 HIE 软件的需求。
作为一个多学科、多组织的团队，我们成功地开发了使 PCC 能够参与基于标准的 HIE 的流程和信息学工具，并在犹他州 PCC 实施了该流程。
