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)

Permanent URL: https://etd.library.emory.edu/concern/etds/tq57nr03d?locale=en
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Abstract

Executive Summary

PROBLEM

            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.

 

BACKGROUND

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.

 

PURPOSE

 

            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.

Specific Aims

 

      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).          

 

APPROACH

 

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.

 

OHAA system

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

 

INTRODUCTION 4

BACKGROUND 4

BUSINESS NEED 8

PURPOSE 8

HYPOTHESIS 9

HIGH LEVEL REQUIREMENTS 10

MAJOR DELIVERABLES 11

ENTERPRISE ARCHITECTURE 11

SOLUTION 13

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

Datasources 22

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

 

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