### $0.035 0.00% ## Persistent Information Exchange (PIE) Rank 434 Market Cap$15.11 M
Volume 24H 0 PIE
Open 24H $0.035 Low/High$0.035 - $0.035 Compare to Persistent Information Exchange is a Proof of Stake cryptocurrency created to make blockchain technology easy to use. This includes features like social send, where users can send coins through social media platforms like Facebook or Twitter. The name PIE is based on the premise that the blockchain is an immutable record of trading values: An exchange of information that is persistent.  Mkt.Cap$ 15.11 M Volume 24H 0.00000000 PIE Market share 0% Total Supply 43 M PIE Proof type PoS Open $0.03 Low$ 0.03 High \$ 0.03
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# Persistent Information Exchange

The qualitative findings of this study can expand our understanding of the value propositions, challenges, and strategic solutions regarding the connection of states through ISE. Additionally, we discuss our findings as they relate to the efforts of national HIE. The complexities of the US health care system and nuances of state law make this a particularly interesting context of study. Lastly, long-term financial uncertainties pose enough risk to upend even the most technologically advanced effort. Complicating the ROI problem is the growing recognition that RHIOs face a long time horizon before what may be termed functionality, profitability, or sustainability are achieved.

### External links

ISE offered providers the opportunity to refer their patients to a more comprehensive list of connected ISE health care professionals. New technologies are quickly overcoming ‘technological barriers' and ‘technology based objections' to data sharing. In fact, healthcare is well behind the curve on information sharing in comparison to many other industries. If we believe broadly accessible information is a path to significant improvements in quality, failure to act in a concerted fashion is likely to have a deleterious impact on health and healthcare nationally as cost constraints and provider shortages mount. Fourth, with federal government cooperation and support, encourage states to be the fundamental geographical unit for HIE activities.

## Metadata standard

In order to understand barriers and facilitators in the U.S. of HIE adoption, we reviewed the published research literature between 2010 and 2015. Our search yielded 664 articles from Medline, PsychInfo, Global health, InSpec, Scopus and Business Source Complete databases. This article presents the compiled organizational and end user barriers and facilitators along with suggested methods to achieve continuity of care through HIE. Accurate and up-to-date patient data are crucial to the health of patients and the sustainability of the health care-delivery system.1 A single, robust longitudinal record of patients’ health care encounters, testing, and medication (regardless of patient location) is important to providing comprehensive care. Our results indicate that expansion of the ISE of patient health data is necessary to support this goal, because health systems are increasingly crossing state lines, providers are serving patients in different states, and patients are traveling long distances for specialized medical care.

Hubs are (existing) services that collect and aggregate information about links from their respective communities. Example hubs for the communities of data centers, repositories, and journals include DataCite, OpenAIRE [1, 2], and Crossref, respectively. Figure 2 provides a schematic overview of the proposed multi-hub infrastructure.

Interview discussion indicated that the implementation of HIE and ISE may cause substantial culture shock for some health care providers. First, latent competitive issues mean providers are wary of sharing information, fearing the loss of patient volume and decreased revenue, as indicated by an interviewee. Second, buy-in is difficult when providers are unable to retrieve information quickly. One interviewee revealed, “[…] like any other business, you have to have good technology with the process and procedure put in place […]”.

As we can see, natural hubs such as Crossref, DataCite, and OpenAIRE each aggregate information about links from a community. For instance, DataCite is an existing infrastructure that aggregates information from the community of data centers. With the increasing role of data in the research enterprise, there is increasing interest in getting and exposing the links between publications and the underlying data [3, 4, 5]. Interviewees discussed national HIE efforts with some degree of uncertainty regarding sustainability, structure, and services.

Sharing of these medical information happens through fax or emails or by the patients themselves. Health information exchange can't substitute the patient-provider communication, but it can surely increase the completeness of the patient’s records which will have the patient's history, present medications, and other health-related information. Timely sharing of important patient information can help in decision making in critical times.

The Link Information Package defined above provides the high level elements which would be serialised into a structure, schema or ontology of some kind. However, interoperability is not complete without application of encoding and semantic standards to the values that can be entered into those elements. At this point in the development of Scholix there is a commitment to apply standards, but firm decisions have not yet been taken.

### Personal health records

Amir Aryani is working in the capacity of a project manager for Australian National Data Service (ANDS), and he is the co-chair of the Data Description Registry Interoperability WG in Research Data Alliance. His research is focused on the interoperability between research information systems, and he is leading the Research Graph project to build a large-scale distributed graph that enables connecting heterogeneous data infrastructures. It is expected that all Scholix hubs will at least support a JSON/RESTful combination. The successor working group has committed to providing guidelines for serialising the information model via an XML and JSON schema and to documenting any corresponding exchange protocols.

First, most publishers, data centers, repositories, and infrastructure providers remain disconnected. Second, the inherent heterogeneity resulting from the considerably different individual agreements and practices hinders global interoperability.

## Regional health information organizations

• Adrian is active in building national policy frameworks to unlock the value in the research data outputs of publicly funded research.
• For example, ISEs can learn from the early efforts of the Office of the National Coordinator and more recent efforts of the Sequoia Project with the development of a common state-level (as opposed to national-level) data-use reciprocal sharing agreement.
• The Scholix framework targets the latter by establishing an agreed interoperability framework and thus creating a pull factor to incentivise the former.

The literature supplemented the interviews by providing further description, particularly providing an indication of the potential challenges ISE could face as connectivity crosses state lines among many different providers and provider organizations. We also looked for supporting evidence related to strategies proposed by interviewees. It is of note that this analysis produced a sparse listing of peer-reviewed literature principally focused on ISE (using search terms including ISE, cross-state exchange, and other synonyms with HIE-related terms), reinforcing the need for further ISE research in this area. For example, an urgent care center that is connected to an RHIO or other HIE facilitator could have access to all the information on patients in the area and therefore might not need to repeat a test or x-ray, or pursue certain aspects of medical history irrelevant to the final diagnosis.

It also acknowledges that the envisioned future with robust, production-strength workflows for the aggregation of links by the various hubs from their constituencies will not materialize overnight. We argue that the proposed framework allows for the transition from the current state to the envisioned future state. A key element for managing this transition is the inclusion of the existing DLI Service as one of the proposed hubs to allow for organizations to contribute links in a flexible way while automated, standardized workflows are being implemented. Scholix is a proposed conceptual framework to drive interoperability between providers of links between research data and the literature.

It is of note that when interviewees were asked if there was anyone in other states who could serve as a key informant for the process, references were made to one or more members of our interview panel. Persistent connections added for HTTP 1.0 used an extra header to request the client keep the connection alive; HTTP 1.1 assumes all connections to be persistent unless otherwise specified. HTTP 2.0 expands the persistent connection to enable numerous requests and returns of data to be exchanged simultaneously over a single connection. The past 20 years have witnessed fits and starts in addressing the nation's need for HIE. We are in the very early days of the widespread adoption of the technologies necessary to adopt effective HIE.

Rather, the framework respects existing local community standards and supports the submission of such information to hubs using standards. It is expected that hubs translate from existing local community standards using the conceptual and information models, and expose the information to other hubs using standard Scholix approaches. The Scholix model would lend itself to semantic web approaches and the initiative is open to working with potential new hubs that would support and document the Scholix framework using e.g., the Web Ontology Language (OWL). The PROV model may also have application to inform the provenance information of the link [17]. The Scholix interoperability framework does not mandate how to format and exchange a Link Information Package.

The main capability of RD-Switchboard is connecting datasets to grants, publications and researchers across multiple registries, and the outcome of the process is captured as a database using the Research Graph schema. The integration of Scholix framework into this system enables RD-Switchboard to ingest trusted information about the relations between datasets and publications, and enrich these relations using complementary information captured in the Research Graph database. The outcome can lead to a new discovery of links between datasets, publications and other scholarly works. New approaches to managing chronic illness and associated changes in roles and responsibilities for non-physician healthcare professionals is another instance that might support HIE development.

Hylke Koers is Director of Research Communities at Elsevier, based in Amsterdam. A physicist by training, Dr. Koers is passionate about improving the way researchers communicate and he enjoys the challenges of connecting innovative web technology with the social dynamics of scholarly publication. Before joining Elsevier, Hylke was Business Development Manager for MathJax, an open-source engine for rendering mathematics on the web. At Elsevier he was responsible for the Content Innovation program, which advances the format of the scholarly article through interactive data viewers and bi-directional linking with primary data at external data repositories. Together with Adrian Burton, Hylke co-chaired the ICSU-WDS / RDA Working Group on “Publishing Data Services” which delivered the Scholix framework.

### Persistent Information Exchange (PIE) market events

This builds on the previous administration's call for interoperable health information technology and its creation of the Office of the National Coordinator for Health Information Technology (ONC). For nearly two decades organizations and collaboratives have tried to facilitate HIE; unfortunately, the failures far outnumber the successes. The history, problems, and subsequent lessons of HIE efforts offer insights and options for increasing the probability of successful, meaningful HIE, today.

The Scholix framework requires further extension, documentation, standardisation, serialisation schema and investigation of new applications and approaches. Help expand and refine the Scholix guidelines and suggest new ways of application. In the first instance the framework has focused on the information flows needed to create a critical mass of data-literature link information.

It seems nearly impossible to garner support for any effort at assessment without clearly explicated measures, foci, methods of reporting, and included entities. Likewise, organizational change supporting HIE requires sufficient political support, not simply weak legislation or overtures.21 HITECH provides strong incentives for the adoption of HIE supporting technology. Crossref and DataCite are collaboratively working on providing literature-data links via the Event Data service. Event Data is partly shared infrastructure between the two organizations, and partly independent services by Crossref and DataCite, as Event Data is a generic service for links between DOIs and other resources, some of which fall outside the scope of Scholix. The Event Data service follows the Scholix specification for describing links, and makes the links available to other Scholix Hub partners.

Adrian Burton is the Director of Services at the Australian National Data Service (ANDS). Adrian has provided strategic input into several national infrastructure initiatives, including Towards an Australian Research Data Commons, The National eResearch Architecture Taskforce, and the Australian Research Data Infrastructure Committee. Adrian is active in building national policy frameworks to unlock the value in the research data outputs of publicly funded research. Before being involved in research infrastructure, Dr Burton taught South Asian Linguistics and conducted research at the Australian National University and was responsible for liaison between academic staff and central information and technology services. The overall goal of achieving better linking between data and literature must be complemented with advances in policy, community awareness, practice and capacity and capability which are being championed by a number of other initiatives.

However, RHIOs enter into a landscape that is much more diverse, with more than one effort that has managed to survive to maturity making this long timeframe more evident. While grant funding and HITECH incentives may help meet start-up costs, neither may ever produce a convincing value proposition for those likely to lose from more efficient and informed healthcare. The reality of the situation is that efficient, effective healthcare primarily benefits the patient, their community, but not necessarily providers. Short of additional clear incentives or regulation, ROI for providers is long to develop and difficult to identify.