Architecting a cloud-based system for effective treatment planning in Emergency care among ESRD (Chronic Kidney Disease) patients Public

Abstract

Background: Various medications are cleared by kidneys; therefore, dialysis patients are at risk for adverse drug events. Patients with end-stage renal disease need frequent, ongoing dialysis care and many end up in Emergency care due to other medical conditions. ER providers and dialysis providers are challenged by incomplete or delayed transfer of pertinent clinical data from hospitalizations. A system-thinking approach is needed to overcome the information gap between outpatient dialysis providers and hospitals sharing clinical information through a health information exchange (HIE). Use of cloud based datahub, and emerging HL7 FHIR messaging systems to transfer data in this will support in the architecting of this solution.

Table of Contents

CHAPTER I: INTRODUCTION.. 1

Introduction and Rationale. 1

Review of the Literature. 2

End Stage Renal Disease and Chronic Kidney Disease. 2

Existing Emergency Department (ED) Processes. 3

Data Sharing. 4

Health Information Exchange. 5

Georgia Health Information Network (GaHIN). 6

Problem Statement. 7

Purpose. 8

Project Addressed. 10

Significance Statement. 11

Definition of Terms. 11

CHAPTER II: METHODOLOGY.. 13

Introduction. 13

Data Type and Description. 13

Project Design. 14

Procedures. 15

Instruments. 15

Data Analysis. 16

Key Findings from ED Interviews. 16

CHAPTER III: RESULTS. 19

Proposed Solution Design. 19

Cloud Computing. 19

Amazon Web Services (AWS). 20

Integration Tools. 22

API (Application Programming Interface). 23

Data flow diagram... 25

Hybrid Cloud. 26

Legacy Systems. 26

Cutting-Edge Systems. 27

Data Linkage. 28

Access Control policies. 29

Health Level 7 (HL7). 30

HL7 FHIR.. 31

FHIR Integration. 33

Summary. 34

CHAPTER IV: DISCUSSION.. 36

Introduction. 36

Summary of project. 36

Implications. 36

Limitations. 37

Challenges in Implementing the Proposed System... 38

Recommendations and next steps. 40

Cost. 41

Conclusion. 41

CHAPTER V: EXECUTIVE SUMMARY.. 42

References. 45

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Public Health Informatics
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Public Health Education Information Technology
Mot-clé	Public Health Informatics HL7 FHIR Amazon Web Services Cloud Computing Chronic Kidney Disease Interoperability
Committee Chair / Thesis Advisor	Kelley G. Chester, DrPH, MPH, Emory University
Committee Members	Mark Conde, Emory University

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