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class="c25"><p class="c6"><span class="c0">Patient-Centered EHR Features and Demo</span></p><p class="c6"><span class="c1">Michael Chen, MD and Adrian Gropper, MD</span></p><p class="c6"><span class="c1">October 15, 2016</span></p><p class="c2"><span class="c1"></span></p><p class="c23"><span class="c12 c7">March 29, 2017</span><span class="c1 c12"> - NOSH 2.0 and an updated blockchain-enabled version of HIE of One is in the works. As of today, the online demo is no longer available while we upgrade and debug a better mobile EHR experience and the very-soon-to-be-public blockchain sign-on technology from our Ethereum partners. This may take a couple of weeks. Thank you for your patience.</span></p><p class="c23 c30"><span class="c1 c12"></span></p><p class="c23"><span class="c12">In the meantime, check out the 6 short videos of the </span><span class="c12 c7">old demo</span><span class="c12"> on </span><span class="c11 c12"><a class="c4" href="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DP6FaUAcq6FI%26list%3DPLn9P7BiqUmmjk09q4I57cvPwysvsScm1p&sa=D&ust=1490824463817000&usg=AFQjCNFCmiC4K7WPhgCaUq12M_mezE5CrQ">this playlist, 22 min. total</a></span><span class="c1 c12">.</span></p><p class="c2"><span class="c0"></span></p><p class="c6"><span>This website demonstrates a patient-centered health record based on the FHIR and HEART interoperability standards. </span><span class="c11"><a class="c4" href="#id.1pimf1ifq9ye">Skip to </a></span><span class="c28"><a class="c4" href="#id.1pimf1ifq9ye">the old demo</a></span><span class="c1">.</span></p><p class="c16"><span>The 6 short videos in </span><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://www.youtube.com/watch?v%3DP6FaUAcq6FI%26list%3DPLn9P7BiqUmmjk09q4I57cvPwysvsScm1p&sa=D&ust=1490824463819000&usg=AFQjCNH8Eh_deIQzaGtlxKw6GfFJ2UfHSQ">this playlist</a></span><span class="c1"> cover the demo essentials, but please, do try them yourself.</span></p><p class="c2"><span class="c1"></span></p><p class="c6"><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 624.00px; height: 234.67px;"><img alt="" src="images/image10.png" style="width: 624.00px; height: 234.67px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c2"><span class="c1"></span></p><p class="c6"><span class="c7">CAUTION: The open source code associated with this demo is intended to inform standards and regulations and is NOT SECURE and NOT TESTED FOR CLINICAL USE. We hope you will join our GitHub communities and contribute.</span></p><p class="c2"><span class="c0"></span></p><p class="c2"><span class="c0"></span></p><p class="c29"><span class="c11"><a class="c4" href="#h.85chilkisntr">Introduction</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.a539k931nk1f">Demo Use Cases</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.99faa1cva9xz">User Credentials and this Demo</a></span></p><p class="c9"><span class="c11"><a class="c4" href="#h.5sbr8k8jifp">Demos</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.q67l9alj807a">Demo 1 - Alice uses a patient portal to consent to health information exchange.</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.lw6wuawf96ne">Demo 2 - Dr. Smart can preview and work directly in Alice’s patient-centered health record.</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.x9726qiamufz">Demo 3 - Alice wants a second opinion from Dr. Second in a new practice.</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.tc0em8yicy95">Demo 4 - Dr. Second is a curbside consult and wants to work directly in Alice’s patient-centered record.</a></span></p><p class="c9"><span class="c11"><a class="c4" href="#h.j0i25o48e83z">Summary and Next Steps</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.khak7c4iaorz">Next Steps</a></span></p><p class="c9"><span class="c11"><a class="c4" href="#h.699g5755uivz">Figures and Sequence Diagrams</a></span></p><p class="c9"><span class="c11"><a class="c4" href="#h.bahpfwgdfoky">References</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.kidgl7plondp">Source Code</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.rjhktfrh1ijr">HIE of One</a></span></p><p class="c18"><span class="c11"><a class="c4" href="#h.pax3diqmsuhm">Standards</a></span></p><p class="c21"><span class="c11"><a class="c4" href="#h.rxhoph3xak19">Related Projects</a></span></p><p class="c2"><span class="c0"></span></p><p class="c2"><span class="c0"></span></p><p class="c2"><span class="c1"></span></p><p class="c2"><span class="c1"></span></p><p class="c6"><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 624.00px; height: 398.35px;"><img alt="" src="images/image04.png" style="width: 624.00px; height: 398.35px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c24"><span class="c1">Figure 1 - Three Actors and their Agent Technology</span></p><p class="c2"><span class="c1"></span></p><p class="c2"><span class="c1"></span></p><h3 class="c8" id="h.85chilkisntr"><span class="c17 c7">Introduction</span></h3><p class="c2"><span class="c1"></span></p><p class="c6"><span class="c1">The user experience for both clinicians and patients is designed to match the typical health information exchange (HIE) “opt-in” pattern where patients are given a simple form for consent to HIE participation and everything else follows without further action by the patient. The typical HIE experience is also maintained from the clinician perspective. As with most HIEs, a clinician using a FHIR and HEART-aware EHR can access the patient-centered record even before that patient has knowingly authorized such access.</span></p><p class="c2"><span class="c1"></span></p><p class="c6"><span class="c1">Beyond the typical HIE experience, our patient-centered EHR can be accessed by clinicians directly without an EHR by simply using a standard or mobile Web browser. This is convenient for second opinions, telemedicine, and privacy-sensitive encounters where the physician-patient team decides they would rather avoid exposure to a large institutional EHR. Other benefits include a solution to the multiple portals problem as HIE of One provides a single point of contact across all of the hospitals, practices, health plans, and other service providers with a standard FHIR and HEART interface. Unlike typical HIEs, the HEART-enabled HIE of One allows the patient fine-grained control over sharing parts of their health record and even specific users within an institution.</span></p><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.a539k931nk1f"><span class="c19 c7">Demo Use Cases</span></h4><p class="c2"><span class="c1"></span></p><p class="c6"><span>The demo shows two FHIR + HEART EHRs. The first EHR, used by Dr. Smart, has our patient, Alice, already registered and able to access the EHR patient portal. She simply enters her “medical email address” (a regular email address optimized for medical interoperability) and consents to a linkage between the EHR and her patient-centered health record. The second EHR, used by </span><span>Dr. Second</span><span class="c1">, represents a new provider and doesn’t yet have Alice registered. That user has received a link to Alice’s patient-centered health record and must supply his credentials to be allowed access. This second EHR also demonstrates the “clipboard” use-case because, once the credentials are accepted, patient registration, demographics, insurance, and key medical history can be automatically transferred from Alice’s patient-centered health record to the new provider’s EHR.</span></p><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.99faa1cva9xz"><span class="c19 c7">User Credentials and this Demo</span></h4><p class="c2"><span class="c1"></span></p><p class="c6"><span class="c1">Typical EHRs maintain HIPAA compliance through a complex credentialing process for all users. This credentialing is either delegated to a participating (federated) hospital or it is done directly by a licensed physician. The patient-centered approach to health records interoperability can also use federated hospital credentials but it can also accept direct access by individual physicians listed in a trusted directory (e.g: a medical society directory). Unlike typical HIEs, HIE of One is not limited to interoperability within a specific state. In this demo, standards-based identity federation is represented by OpenID Connect compliant Google ID and the physician directory is represented by the national NPI database. A future update will add self-sovereign ID based on blockchain technology.</span></p><p class="c2"><span class="c1"></span></p><h3 class="c8" id="h.5sbr8k8jifp"><a id="id.1pimf1ifq9ye"></a><span class="c17 c7">Demos </span></h3><p class="c6"><span class="c1">(NOTE: Click the Demo 1, 2, 3, or 4 link for the corresponding sequence diagram.)</span></p><p class="c6"><span class="c7">(</span><span>NOTE:</span><span class="c7"> </span><span>In this demo, </span><span>https://shihjay.xyz</span><span class="c1"> is Alice’s personal domain hosting her personal tech.)</span></p><h4 class="c10" id="h.q67l9alj807a"><span class="c11"><a class="c4" href="#id.r7wmmvdxu6tq">Demo 1</a></span><span class="c19 c7"> - Alice uses a patient portal to consent to health information exchange.</span></h4><p class="c2"><span class="c1"></span></p><p class="c6"><span class="c1">DEMO HINT: In Step 1, 8, etc… Open the link in a New Tab to keep these instructions open.</span></p><p class="c2"><span class="c1"></span></p><ol class="c14 lst-kix_tmdgsxcaehic-0 start" start="1"><li class="c5"><span class="c11 c7"><a class="c4" href="https://www.google.com/url?q=https://shihjay.xyz/reset_demo&sa=D&ust=1490824463841000&usg=AFQjCNHpEC0zl6K9D6PKR4CdbrgFsi5VZQ">Reset Demo</a></span><span> - Please enter your email address for updates - we won’t share it with anyone. </span><span>A </span><span>10-minute timer</span><span> reduces demo collisions.</span><span class="c1"> Reset Demo hides the one-time initialization that gave Alice a blank patient-centered health record account.</span></li><li class="c5"><span class="c7">Patient Portal</span><span class="c1"> - You are Alice, a patient of Dr. Smart. Sign In. If challenged, you will find demo ID / password as you mouse-over a field.</span></li><li class="c5"><span class="c7">Introduce Your Patient-Centered Record</span><span> - Alice enters an email address linked to her patient-centered record, the only thing for her to remember. Accept the</span><span> demo hint</span><span class="c1">. </span></li><li class="c5"><span class="c7">Opt-In</span><span class="c1"> - Alice also signs-in to her HIE of One authorization server and allows Dr. Smart’s practice to use her patient-centered record. Alice’s default policies are shown and can be changed. Notice how patient-centered design eliminates patient ID matching problems.</span></li><li class="c5"><span class="c7">Confirmation</span><span> - Dr. Smart’s EHR confirms the FHIR / HEART linkage. Alice is done. A convenience link to her HIE of One combined list of connected practices. </span><span>patient-centered health record</span><span class="c1">.</span></li><li class="c5"><span class="c7">Browse - </span><span>The HIE of One Authorization Server lists the NOSH patient centered record and the recently added mdNOSH practice of Dr. Smart. The </span><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 48.00px; height: 20.00px;"><img alt="" src="images/image09.png" style="width: 48.00px; height: 20.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span><span class="c1">button lets Alice browse her very sparse record.</span></li><li class="c5"><span class="c7">Logout</span><span> - Logout in the upper right menu (AS) or Lock (health record) </span><span>to prepare for the next demo</span><span class="c1">. You can then close these tabs. </span></li></ol><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.lw6wuawf96ne"><span class="c11"><a class="c4" href="#id.e9vl0m2ehgxb">Demo 2 </a></span><span class="c19 c7">- Dr. Smart can preview and work directly in Alice’s patient-centered health record.</span></h4><p class="c2"><span class="c1"></span></p><ol class="c14 lst-kix_tmdgsxcaehic-0" start="8"><li class="c5"><span class="c11 c7"><a class="c4" href="https://www.google.com/url?q=http://noshchartingsystem.com/oidc/login&sa=D&ust=1490824463848000&usg=AFQjCNE1nkQXQrRwBWO717PgU_Z9J0HbSQ">Sign-In as Dr. Smart</a></span><span> into your practice. You will see Alice on your </span><span>patient list</span><span class="c1">. Alice’s name clicks to a preview. The green button takes you to her patient-centered record.</span></li><li class="c5"><span class="c7">Preview</span><span class="c1"> - Click Alice’s Name to get a SMART-app-inspired quick look at her patient-centered record. Click Medication List.</span></li><li class="c5"><span class="c7">Authenticate</span><span> to Alice’s authorization server. Click </span><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 146.00px; height: 20.00px;"><img alt="" src="images/image07.png" style="width: 146.00px; height: 20.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span><span>. (Recall </span><span class="c11"><a class="c4" href="#id.flv33lkw4lce">Step 4</a></span><span class="c1"> where Alice’s policies allowed your practice as a trusted identity provider.)</span></li><li class="c5"><span class="c7">Identify</span><span> - Alice’s </span><span>authorization server</span><span> is politely asking you to identify yourself. In this case, your identity is an email address but it could be anything. Click Allow.</span></li><li class="c5"><span class="c7">Preview</span><span class="c1"> - Your mdNOSH practice management system is like a SMART app into Alice’s patient-centered record. Click Medications. Click back to Patient Summary.</span></li><li class="c5"><span class="c7">Click</span><span> </span><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 155.00px; height: 20.00px;"><img alt="" src="images/image06.png" style="width: 155.00px; height: 20.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span><span> - Single sign-on takes you her </span><span>patient-centered record</span><span>.</span><span> </span><span> (You may need to click Login with mdNOSH again)</span><span class="c1">. </span></li><li class="c5"><span class="c7">Write a prescription</span><span class="c1"> - Click Edit Medications on the left pane. Click + Add and fill in the name, dose, quantity, frequency, and reason. Click Save.</span></li><li class="c5"><span class="c7">Logout</span><span class="c1"> of Alice’s patient-centered health record by clicking the tiny lock icon in the upper right corner.</span></li><li class="c5"><span class="c7">Back to Patient List</span><span class="c1"> and Patient Summary > Medication List. Note how FHIR has updated the quick look at Alice’s medications to include the one you just prescribed.</span></li><li class="c5"><span class="c7">Logout</span><span class="c1"> from mdNOSH. You’re logged out of mdNOSH practice management system and Alice’s patient-centered health record. Close the mdNosh and patient-record tabs.</span></li></ol><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.x9726qiamufz"><span class="c11 c7"><a class="c4" href="#id.e9vl0m2ehgxb">Demo 3</a></span><span class="c7"> - Alice wants a second opinion from Dr. Second in a new practice.</span><span class="c19 c7"> </span></h4><p class="c6"><span class="c1">His practice’s FHIR EHR does not have Alice as a patient yet and needs her “clipboard” information.</span></p><p class="c2"><span class="c1"></span></p><ol class="c14 lst-kix_tmdgsxcaehic-0" start="18"><li class="c5"><span class="c11 c7"><a class="c4" href="https://www.google.com/url?q=https://shihjay.xyz/nosh/uma_auth&sa=D&ust=1490824463857000&usg=AFQjCNEHt1N4F4TxNyxFg56XV75iCgaSWQ">Sign-In as Alice</a></span><span> - Alice, or anyone with access to her patient-centered record can launch an invitation. Click to the Share page using the green arrow</span><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 26.09px; height: 20.00px;"><img alt="" src="images/image02.png" style="width: 26.09px; height: 20.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span><span class="c1">.</span></li><li class="c5"><span class="c7">Invite</span><span> - Use your Gmail address in the middle block for an invitation. Click Submit. (Recall </span><span class="c11"><a class="c4" href="#id.flv33lkw4lce">Step 4</a></span><span class="c1"> where Alice’s policies allowed Google as a trusted identity provider.)</span></li><li class="c5"><span class="c7">Scope of Access</span><span class="c1"> - Alice can accept the defaults or limit the scope of FHIR resources that Dr. Second and his practice can access. Click Send Invitation.</span></li><li class="c5"><span class="c7">Logout</span><span> of Alice’s patient-centered health record by clicking the tiny lock icon in the upper left corner. Check Gmail for a link to </span><span>Alice’s </span><span>patient-centered record. </span><span class="c7 c22">Don’t click it!</span></li><li class="c5"><span class="c11 c7"><a class="c4" href="https://www.google.com/url?q=http://noshchartingsystem.com/oidc/doctor_login&sa=D&ust=1490824463860000&usg=AFQjCNHaWQ1Rs7RPxPKshGgtbNgQbeqPFQ">Sign-in as Dr. Second</a></span><span class="c1"> - Unlike Dr. Smart, you are using a plain FHIR / HEART EHR that is not configured to single sign-on to Alice’s patient-centered record. </span></li><li class="c5"><span class="c7">Enter the Link</span><span> - On your patient list page, </span><span>copy/paste the link you received</span><span class="c1"> into the patient search box. (We pre-filled it to saved you the fuss) (NOTE: the patient link could have come from an HIE relationship locator service or a Direct message into the EHR.)</span></li><li class="c5"><span class="c7">Authenticate</span><span> - The requesting party, Dr. Second has no prior relationship with Alice but Alice’s policies trust Google as an identity provider. </span><span>Login with Google</span><span class="c1">.</span></li><li class="c5"><span class="c7">Clipboard Preview</span><span> - FHIR / HEART enable transfer of Alice’s info from her patient centered record to the Clipboard holding area of Dr. Second’s EHR.</span><span> </span><span>Note her meds.</span></li><li class="c5"><span class="c7">Register Alice </span><span>- Dr. Second clicks Add Patient to convert the clipboard info into a new patient registration and </span><span>add Alice</span><span> to his </span><span>patient list</span><span class="c1">.</span></li><li class="c5"><span class="c7">Logout</span><span class="c1"> Dr. Second. He is now logged out of his practice management system. This is needed for Demo 4.</span></li></ol><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.tc0em8yicy95"><span class="c11"><a class="c4" href="#id.r7wmmvdxu6tq">Demo 4</a></span><span class="c19 c7"> - Dr. Second is a curbside consult and wants to work directly in Alice’s patient-centered record.</span></h4><p class="c2"><span class="c1"></span></p><ol class="c14 lst-kix_tmdgsxcaehic-0" start="28"><li class="c5"><span class="c11 c7"><a class="c4" href="https://www.google.com/url?q=https://shihjay.xyz/nosh/uma_auth&sa=D&ust=1490824463867000&usg=AFQjCNF2enAJ2PbNt3YcsL8JNo5kzkXM-w">Sign-In as Alice</a></span><span> - Alice, or anyone with access to her patient-centered record, clicks to the Share page - the green arrow</span><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 26.09px; height: 20.00px;"><img alt="" src="images/image02.png" style="width: 26.09px; height: 20.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span><span class="c1">.</span></li><li class="c5"><span class="c7">Invite</span><span class="c1"> - Use your Gmail address in the middle block for an invitation. Click Submit. (Recall Step 4 where Alice’s policies allowed Google as a trusted identity provider.)</span></li><li class="c5"><span class="c7">Scope of Access</span><span class="c1"> - Alice can accept the defaults or limit the scope of FHIR resources that Dr. Second and his practice can access. Click Send Invitation.</span></li><li class="c5"><span class="c7">Logout</span><span> of Alice’s patient-centered health record by </span><span>clicking the lock icon</span><span> in the upper right corner. Check Gmail for a link to Alice’s patient-centered record. (HINT: If you don’t actually want to check your Gmail, the link is: https://shihjay.xyz/nosh/login/provider ) </span><span class="c7 c26">Don’t click it!</span></li><li class="c5"><span class="c7">DEMO NOTE:</span><span> To see standards-based OpenID Connect sign-on, copy and paste the link into another browser where you’re not signed-in to Gmail. </span><span>Login using Google</span><span class="c1">.</span></li><li class="c5"><span class="c7">NPI Check</span><span> - Alice’s policies may want to check Dr. Second’s credentials beyond what Google ID required. For now, </span><span>we’re using the NPI Registry</span><span class="c1">, which is not secure.</span></li><li class="c5"><span class="c7">Browser Access</span><span> - What if Dr. Second doesn’t have an EHR? C</span><span>lick the link to launch a Web browser and access Alice’s EHR directly.</span><span class="c1"> You can write a prescription here too.</span></li></ol><p class="c2"><span class="c1"></span></p><p class="c6"><span class="c1">You’re almost done...</span></p><p class="c2"><span class="c1"></span></p><ol class="c14 lst-kix_tmdgsxcaehic-0" start="35"><li class="c6 c13"><span class="c11 c7"><a class="c4" href="https://www.google.com/url?q=https://docs.google.com/forms/d/e/1FAIpQLSeuI-LhyYOeViA29cMfwapPoGxTjoDy82-CDgdilkEz_X8WJg/viewform&sa=D&ust=1490824463873000&usg=AFQjCNFgpLQDGHhZHmEqsPzohFYxDa4p6w">Please Leave a Comment</a></span><span> or question. Consider joining the </span><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://openid.net/wg/heart/&sa=D&ust=1490824463874000&usg=AFQjCNF4EPBd2bMq-kHAbNsDdx6MRIdyZA">HEART Workgroup</a></span><span class="c1"> to address your interoperability concerns.</span></li></ol><p class="c2"><span class="c1"></span></p><h3 class="c8" id="h.j0i25o48e83z"><span class="c17 c7">Summary and Next Steps</span></h3><p class="c2"><span class="c1"></span></p><p class="c31"><span class="c1">You have demonstrated a number of benefits for both physicians and patients enabled by the combined FHIR and HEART standards:</span></p><ul class="c14 lst-kix_osceut19cz29-0 start"><li class="c5"><span class="c1">A patient-centered health record that’s controlled by Alice and her physicians instead of any particular institution.</span></li><li class="c5"><span class="c1">A simple user experience for the patient and the physicians, modeled on Opt-In consent behavior typical of today’s health information exchanges. </span></li><li class="c5"><span class="c1">Using FHIR / HEART to automate the patient registration clipboard experience.</span></li><li class="c5"><span class="c1">Single sign-on based on identity federation standards.</span></li><li class="c5"><span class="c1">A cure for the multiple portals problem as multiple provider relationships are listed on a single patient-chosen management page.</span></li><li class="c5"><span class="c1">A solution to the patient ID matching problem based on standards and a patient-centered health record linked to an email address.</span></li></ul><p class="c2"><span class="c1"></span></p><h4 class="c3" id="h.khak7c4iaorz"><span class="c19 c7">Next Steps</span></h4><ul class="c14 lst-kix_xzlw0boqwuvt-0 start"><li class="c5"><span class="c1">Integrate blockchain-based self-sovereign ID as an alternative to federated single sign-on.</span></li><li class="c5"><span class="c1">Demo independent decision support at the point of care for physicians and patients.</span></li><li class="c5"><span class="c1">Improved user experience through access to a physician directory within the EHR.</span></li><li class="c5"><span class="c1">Demonstrate the provisioning of a new patient-centered health record.</span></li><li class="c5"><span class="c1">Integrate a blockchain-based time stamping service for audits of patient-centered health record activity.</span></li></ul><p class="c2"><span class="c0"></span></p><h3 class="c8" id="h.699g5755uivz"><span class="c17 c7">Figures and Sequence Diagrams</span></h3><p class="c2"><span class="c1"></span></p><p class="c6"><a id="id.flv33lkw4lce"></a><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 624.00px; height: 373.33px;"><img alt="" src="images/image08.png" style="width: 624.00px; height: 373.33px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><span class="c1">Figure 2 - Resource Registration Consent</span></p><p class="c15"><span class="c1"></span></p><p class="c24"><a id="id.r7wmmvdxu6tq"></a><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 624.00px; height: 458.67px;"><img alt="" src="images/image03.png" style="width: 624.00px; height: 458.67px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><span class="c1">Figure 3 - Sequence Diagram for Resource Registration Demo</span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><a id="id.e9vl0m2ehgxb"></a><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 624.00px; height: 1420.00px;"><img alt="" src="images/image01.png" style="width: 624.00px; height: 1420.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><span class="c1">Figure 4 - Sequence Diagram for User of EHR with Already-Registered Patient</span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><a id="id.gick86zh0bto"></a><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 624.00px; height: 888.00px;"><img alt="" src="images/image00.png" style="width: 624.00px; height: 888.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><span class="c1">Figure 5 - Sequence Diagram for EHR and New Patient Registration</span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><a id="id.1zzgva54vnzd"></a><span style="overflow: hidden; display: inline-block; margin: 0.00px 0.00px; border: 0.00px solid #000000; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px); width: 624.00px; height: 836.00px;"><img alt="" src="images/image05.png" style="width: 624.00px; height: 836.00px; margin-left: 0.00px; margin-top: 0.00px; transform: rotate(0.00rad) translateZ(0px); -webkit-transform: rotate(0.00rad) translateZ(0px);" title=""></span></p><p class="c15"><span class="c1"></span></p><p class="c24"><span class="c1">Figure 6 - Sequence Diagram for Clinician Signing-In to Patient-Centered EHR Directly</span></p><p class="c15"><span class="c1"></span></p><p class="c15"><span class="c1"></span></p><p class="c2"><span class="c0"></span></p><h3 class="c8" id="h.bahpfwgdfoky"><span class="c7 c17">References</span></h3><p class="c2"><span class="c0"></span></p><h4 class="c10" id="h.kidgl7plondp"><span class="c19 c7">Source Code</span></h4><ul class="c14 lst-kix_kpbfwdtrxt48-0 start"><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://github.com/shihjay2/hieofone-as&sa=D&ust=1490824463892000&usg=AFQjCNHGCQVs__tImiH1P4zJEPywVTUE8Q">https://github.com/shihjay2/hieofone-as</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://github.com/shihjay2/nosh-core&sa=D&ust=1490824463892000&usg=AFQjCNEkJjjO37mOow8xNH9a3LU_tzWaEA">https://github.com/shihjay2/nosh-core</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://github.com/HIEofOne/PublicWebsite&sa=D&ust=1490824463893000&usg=AFQjCNHNVN0LmleDEZGVRtJUmjewNkaMyA">https://github.com/HIEofOne/PublicWebsite</a></span><span> (this page at </span><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://hieofone.org&sa=D&ust=1490824463894000&usg=AFQjCNG8QYSVHODpaefa60eV5QI-0836kA">https://hieofone.org</a></span><span>)</span></li></ul><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.rjhktfrh1ijr"><span class="c7 c19">HIE of One</span></h4><ul class="c14 lst-kix_cmp1cn1lfyuf-0 start"><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://www.challenge.gov/wp-content/uploads/2016/09/HIEofOne-BusinessCase.pdf&sa=D&ust=1490824463895000&usg=AFQjCNFqsyjYRP0h4PWrxNCJ2ns20wiePg">Independent Decision Support at the Point of Care with HIE of One</a></span><span>;</span><span><a class="c4" href="https://www.google.com/url?q=https://www.challenge.gov/wp-content/uploads/2016/09/HIEofOne-BusinessCase.pdf&sa=D&ust=1490824463896000&usg=AFQjCNGXvnQE5kU_hyx1RGAzLwkyR03CpQ"> </a></span><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://www.challenge.gov/wp-content/uploads/2016/09/HIEofOne-BusinessCase.pdf&sa=D&ust=1490824463896000&usg=AFQjCNGXvnQE5kU_hyx1RGAzLwkyR03CpQ">Business Case</a></span><span>;</span><span><a class="c4" href="https://www.google.com/url?q=https://www.challenge.gov/wp-content/uploads/2016/09/HIEofOne-slides.pdf&sa=D&ust=1490824463897000&usg=AFQjCNE6eKwTQkScMvzOizPf1OWtBJtDVg"> </a></span><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://www.challenge.gov/wp-content/uploads/2016/09/HIEofOne-slides.pdf&sa=D&ust=1490824463897000&usg=AFQjCNE6eKwTQkScMvzOizPf1OWtBJtDVg">Slides</a></span><span>;</span><span><a class="c4" href="https://www.google.com/url?q=http://www.challenge.gov/challenge/move-health-data-forward-challenge/&sa=D&ust=1490824463897000&usg=AFQjCNHOP3B8dt4BS-hc8THzbo1oem8jxQ"> </a></span><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://www.challenge.gov/challenge/move-health-data-forward-challenge/&sa=D&ust=1490824463898000&usg=AFQjCNFMTLA-6Hk2TenVM8PCbbRAVjqhOQ">Move Health Data Forward Challenge</a></span><span class="c1">, September 8, 2016</span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://www.healthit.gov/sites/default/files/7-29-poweringthephysician-patientrelationshipwithblockchainhealthit.pdf&sa=D&ust=1490824463899000&usg=AFQjCNEYqNj72Q2K4ZKDRWpvacPTwYcEaA">Powering the Physician Patient Relationship with ‘HIE of One’ Blockchain Health IT;</a></span><span class="c11"> </span><span>ONC</span><span><a class="c4" href="https://www.google.com/url?q=http://www.hhs.gov/about/news/2016/08/29/onc-announces-blockchain-challenge-winners.html&sa=D&ust=1490824463899000&usg=AFQjCNEjWg4oMS3JgQhvb3lpWOvKsx7BGQ"> </a></span><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://www.hhs.gov/about/news/2016/08/29/onc-announces-blockchain-challenge-winners.html&sa=D&ust=1490824463900000&usg=AFQjCNGTBkUeXNCZTR2OjcsEvMqgV84w2Q">announces</a></span><span class="c1"> Blockchain challenge winners, August 29, 2016</span></li></ul><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.pax3diqmsuhm"><span class="c19 c7">Standards</span></h4><ul class="c14 lst-kix_lvtu9tomlaen-0 start"><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://openid.net/wg/heart/&sa=D&ust=1490824463901000&usg=AFQjCNEd74fwubQCe6mfPwGk8f_e5547jQ">http://openid.net/wg/heart/</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://kantarainitiative.org/confluence/display/uma/Home&sa=D&ust=1490824463902000&usg=AFQjCNFdFTBWk4G08HjV4Pz05Y9i53Qwpg">https://kantarainitiative.org/confluence/display/uma/Home</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://hl7.org/fhir/&sa=D&ust=1490824463902000&usg=AFQjCNGA_dMwPNSmvs-K2-RiFUdONQC9Vw">http://hl7.org/fhir/</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://openid.net/&sa=D&ust=1490824463903000&usg=AFQjCNEjJeFT3toXlMyFD0qMlfNGX78RDw">http://openid.net/</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://tools.ietf.org/html/rfc7033&sa=D&ust=1490824463904000&usg=AFQjCNGLfyrV6kltPbAS5B8FJNf2WfJw8A">https://tools.ietf.org/html/rfc7033</a></span></li></ul><p class="c2"><span class="c1"></span></p><h4 class="c10" id="h.rxhoph3xak19"><span class="c19 c7">Related Projects</span></h4><ul class="c14 lst-kix_dxesd2meue8r-0 start"><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://uport.me/%23home&sa=D&ust=1490824463905000&usg=AFQjCNGjyVSr1e9X030ncJDlgBKbYxeNzw">https://uport.me/#home</a></span><span class="c1"> </span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://patientprivacyrights.org/&sa=D&ust=1490824463906000&usg=AFQjCNGTA2iSNsZ5-r4Db3HpIokT4v6cCQ">https://patientprivacyrights.org/</a></span><span class="c1"> </span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=https://github.com/WebOfTrustInfo/rebooting-the-web-of-trust-fall2016&sa=D&ust=1490824463906000&usg=AFQjCNEkY6UhhGqDEuaYOEXZy3qQJHF7gw">https://github.com/WebOfTrustInfo/rebooting-the-web-of-trust-fall2016</a></span><span class="c1"> </span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://smarthealthit.org/&sa=D&ust=1490824463907000&usg=AFQjCNFPP2V5RoHbZtRMMzTfDyCCBAE0OA">http://smarthealthit.org/</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://hi-project.org/&sa=D&ust=1490824463908000&usg=AFQjCNE8jBno5vfETrLsAQ-4o22bTVOOCQ">http://hi-project.org/</a></span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://freedomboxfoundation.org/&sa=D&ust=1490824463908000&usg=AFQjCNHXDbhFm0Hn04jk8Os2xUShMIwMNg">http://freedomboxfoundation.org/</a></span><span class="c1"> </span></li><li class="c6 c13"><span class="c11"><a class="c4" href="https://www.google.com/url?q=http://www.goodrx.com/developer&sa=D&ust=1490824463909000&usg=AFQjCNGF42n-Oxj9TNRg5ftf7xFMbcSk7A">http://www.goodrx.com/developer</a></span><span> </span></li></ul><p class="c2"><span class="c1"></span></p><p class="c2"><span class="c27"></span></p></body></html>