Design and architect an Informatics solution to improve health outcomes for elderly patients suffering from loneliness-induced health issues. Open Access
Vijayan, Deepthi (Spring 2018)
Studies have shown that in the United States, roughly 33% of people older than 65 live alone, and that percentage increases to 50% among those older than 85. The effect of loneliness on the elderly population is becoming a public health crisis. Studies with controlled confounding factors such as demographics and objective isolation have shown that loneliness increases the odds of an early death by 26% as well as increases the early onset of cardiovascular diseases, cancer, accidents, suicide and diabetes among the elderly population.
Loneliness can be defined as a subjective negative feeling associated with a perceived lack of a wider social network (social loneliness) or the absence of a specific desired companion (emotional loneliness). This population is faced with numerous physical, psychological and social role changes that challenge their sense of self and capacity to live happily. Many people experience loneliness and depression in old age, either as a result of living alone or due to lack of close family ties and reduced connections with their culture of origin (1). By integrating clinical data as well as device tracking data among the elderly, the OHAA system would provide primary care physicians with a comprehensive understanding of patient health, enabling them to mitigate the onset of loneliness and improve health outcomes.
This thesis aims to design and architect an Informatics solution titled Online Healthy Aging Assistance (OHAA) tracking system, a cloud-based solution that will integrate with Electronic Health Records (EHR) systems and activity tracking apps (like the FitBit or iOS Health app) to improve health outcomes for elderly patients who are predisposed to loneliness-induced health issues. I am hypothesizing that using a web-based tracking system will assist health professionals to proactively track social isolation and minimize efforts when trying to extract relevant data about the patient’s current mental state, which can then drive reporting, analysis and decision support to address adverse health outcomes among seniors.
● Aim 1: Identify and describe the need for an informatics solution to improve person-centric health outcomes for patients over 65 who are predisposed to loneliness-induced health issues.
● Aim 2: Describe the impact and benefits of an informatics solution for primary care providers to improve health outcomes for patients over 65 through early intervention and detection.
● Aim 3: Develop a process flow to demonstrate the workflow and data exchange between the OHAA system, EHR system and activity tracking apps.
● Aim 4: Based on the requirements gathered from the stakeholders, design a blueprint of the informatics solution with artifacts like the Business Architecture, Information Architecture and the Technical architecture to demonstrate the interoperability between the OHAA system, the EHR system and activity tracking apps (like FitBit or the iOS Health app).
An initial literature review to understand the importance of the current effects of loneliness among the elderly population will be essential to this thesis. The literature review will help understand past studies on loneliness in the world of informatics. The next step would be to conduct interviews with potential stakeholders such as primary care providers, Gerontology health professionals, social workers at Wesley Woods and other mental health providers.
The following will be assessed in the interviews:
● The idea of an OHAA system that is integrated with a provider’s EHR and activity tracking apps.
● Indicators used to identify loneliness.
Additionally, interviews will be conducted with a solutions architect to understand the architectural building blocks of an interoperable informatics system.
Qualitative analysis and EHR
Patient health information like medications, treatment plans, and laboratory tests are typically captured in an EHR system. Additionally, during a health visit, each patient will be administered a short questionnaire by their primary care provider to determine their current mental state.
This questionnaire will comprise of 3-5 qualitative questions to assist the physician with gathering details on the living situation, patient mental health (alertness) as well as the number, type, and duration of social interactions.
Based on responses, the physician can determine if the patient is experiencing loneliness. This determination will be stored in the patient's medical records and synced with the OHAA system using standard data exchange platform like web services.
OHAA system and activity tracking
Based on the determination/degree of loneliness identified by the primary care provider, patients would also be supplied with and encouraged to use activity trackers (like a Fitbit or the iOS Health app). The data points from the activity tracker, namely heart rate, distance traveled, stress levels, breathing rate, and sleep patterns will also be integrated with the OHAA using standard data exchange APIs like the Rest API.
The OHAA system will present a comprehensive view of an individual’s social isolation, its effect on personal well-being, and help physicians make informed treatment decisions on the effects of loneliness to chronic illnesses like heart disease, hypertension, cancer, mental status and diabetes.
Based on the requirements gathered from the stakeholder engagements, the Business Architecture, Technical Architecture and Information Architecture would define the OHAA system. This solution would provide reporting tools necessary for physicians to make better decisions about a patient’s care through the use of predictive analysis. The novel idea for physicians to be able to detect and track the effects of social isolation among patients, determined by their medical records as well as their lifestyle activities, can potentially improve the health outcomes among the aging population.
Table of Contents
TABLE OF CONTENTS
BUSINESS NEED 8
HIGH LEVEL REQUIREMENTS 10
MAJOR DELIVERABLES 11
ENTERPRISE ARCHITECTURE 11
Physician’s EHR system 14
OHAA system and activity trackers 14
OHAA system 15
THE OPEN GROUP ARCHITECTURE FRAMEWORK (TOGAF) 15
BUSINESS ARCHITECTURE 16
Business Process Model 16
Business Process Template 17
DATA ARCHITECTURE 21
Data Management 21
Data Quality 23
Data Migration 24
Data Governance 25
TECHNOLOGY ARCHITECTURE 26
IT Infrastructure 27
APPLICATION ARCHITECTURE 33
OHAA and Activity tracker(FitBit) 34
OHAA Web Interface 36
EXECUTIVE SUMMARY 43
About this Master's Thesis
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