NSG/542 Week 5: Interoperability, Standards and Privacy, sample paper

Sending the Referral Instead of Reading It Aloud: Interoperability, Data Standards and Privacy Rules for an Electronic Organ Donation Referral

[Student Name]

University of Phoenix

NSG/542: Information Workflow

Week 5 Assignment

[Instructor Name]

[Date]

The hospital, its systems and the partner organization are a composite written for a model paper.

The redesigned referral workflow proposed in Week 4 prefills a referral form with clinical data, but the nurse still reads that form aloud to the organ procurement organization's call center by phone. Reading structured data aloud to someone who types it into another system is a sign of poor interoperability. This paper examines whether and how the referral could be sent electronically.

What Interoperability Means Here

Interoperability is the ability of two systems to exchange data and use the data they receive. It has levels: the systems must be able to connect and transmit, the data must arrive in a structure both understand and the meaning of each element, such as a Glasgow Coma Scale score or a ventilator setting, must be the same in both. A referral sent electronically but interpreted differently at the other end would be faster and less safe than a phone call. Unertl et al. (2010) note that workflows depend on artifacts passing between actors; when an artifact crosses organizational boundaries, interoperability decides whether it arrives intact.

Three Options

Option 1: keep the phone referral, with the prefilled form on screen. This requires no technical work and keeps a human conversation, which coordinators value for asking follow-up questions. But it keeps the risk of misheard numbers and the delay of manual entry.

Option 2: a secure electronic referral message sent from the record to the organization's case management system when the nurse submits the form, followed by a short confirmation call. This removes manual reentry and gives both sides an identical record, while keeping a brief conversation.

Option 3: a continuous automated feed that sends data for every ventilated patient to the organization so it can identify potential donors itself. This could catch cases staff miss, but it would send far more data than needed about patients who never meet a trigger.

Recommendation

Option 2 fits best. It sends data only when a trigger is met and the nurse submits the referral, keeps a human conversation and ends manual reentry. Option 3 is set aside because it would disclose data about many patients who are not candidates, which conflicts with the minimum necessary principle discussed below.

Data Standards

For the message to be reliable, both systems must use shared standards. The message would use HL7 standards, either a version 2 message or a FHIR-based exchange, depending on what the organization's system supports, with patient demographics, the referral trigger, vital signs, ventilator settings and laboratory values carried in defined fields. Laboratory tests would be identified with LOINC codes, so that a potassium value is recognized as the same test in both systems, and diagnoses with ICD-10-CM codes. The Glasgow Coma Scale score would be sent as a coded observation rather than free text. Units of measure would be included with every value, since a missing unit is a common source of misinterpretation.

Privacy: Why the Disclosure Is Permitted

The HIPAA Privacy Rule generally requires patient authorization for disclosures of protected health information, but it lists uses and disclosures that are permitted without authorization. Among them, covered entities may disclose protected health information to organ procurement organizations and other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating donation and transplantation (Uses and Disclosures for Which an Authorization or Opportunity to Agree or Object Is Not Required, 2023). This provision sits alongside the federal requirement that hospitals notify their organization of imminent deaths and deaths (Condition of Participation: Organ, Tissue, and Eye Procurement, 2023).

Privacy: What Still Limits the Disclosure

Being permitted is not the same as being unlimited. The minimum necessary standard generally requires covered entities to share only as much protected information as the task at hand calls for. The referral message will therefore include only the data elements the organization needs to evaluate a potential donor, identified in Week 3, and not the full record. Family contact information will be included because the organization needs it to coordinate the approach, but social history unrelated to donation will not.

Security of Remote Access

Week 4 proposed that coordinators receive time-limited, read-only remote access to the record after a referral. Access will be granted automatically for 72 hours after a referral, limited to the referred patient, logged and reviewed monthly by the privacy office. Coordinators will use individual accounts with multifactor authentication. Access will end automatically, and any extension will require a request.

Implementation Considerations

The electronic referral requires work from both sides: an interface agreement, mapping of data elements, testing with synthetic patients and a fallback to phone referral if the interface fails. The confirmation call remains so that a message that fails to arrive is noticed within minutes. The hospital's information security team and the organization's technical staff will jointly test the interface, including failure scenarios.

Semantic Pitfalls

Some data elements are easy to send and easy to misread. A Glasgow Coma Scale score of 3 means something different in a sedated patient than in one who is not sedated, so the message will include current sedation infusions alongside the score. Time stamps must carry time zones, since the organization serves hospitals in two states. And the trigger type must be coded from a fixed list rather than written as text, so the organization's system can route cases automatically. Each of these was identified in a walkthrough with the organization's clinical staff, which is why testing includes clinicians and not only interface analysts.

Testing and Fallback

Testing will include synthetic patients for each trigger, a patient with missing laboratory values and a message sent while the interface is down. The fallback, a phone referral using the prefilled form, is part of the workflow from the start, so staff know what to do when the interface fails.

Governance

Because the exchange crosses organizations, a written agreement will define the data elements, the purpose, security requirements, breach notification and review. The agreement will be reviewed annually by the hospital's privacy officer, the organization's compliance officer and the informatics lead.

Why Not Wait for a Regional Exchange

Some regions route data through a health information exchange, and the organization serves hospitals connected to one. A direct interface was chosen because the regional exchange does not yet carry donation referrals and waiting would delay the benefit for an uncertain period; the design will be revisited if the exchange adds this service.

Conclusion

Sending referrals electronically, triggered only when a patient meets a referral trigger and followed by a brief confirmation call, would end manual reentry while keeping a human conversation. HL7 messaging with coded observations and laboratory codes makes the data reliable, the Privacy Rule permits the disclosure and the minimum necessary standard and security controls limit it. Week 6 will bring these decisions together in a data distribution plan.

References

Condition of Participation: Organ, Tissue, and Eye Procurement, 42 C.F.R. § 482.45 (2023).

Unertl, K. M., Novak, L. L., Johnson, K. B., & Lorenzi, N. M. (2010). Traversing the many paths of workflow research: Developing a conceptual framework of workflow terminology through a systematic literature review. Journal of the American Medical Informatics Association, 17(3), 265-273. https://doi.org/10.1136/jamia.2010.004333

Uses and Disclosures for Which an Authorization or Opportunity to Agree or Object Is Not Required, 45 C.F.R. § 164.512 (2023).