The Most Important Report So Far this Year!

Almost as a sleeper, out of the blue, a press release appeared in my inbox from the Office of the National Health IT Co-ordinator (ONCHIT) of the US Department of Health and Human Services. On the basis it is a press release I assume the US would not mind me passing it on to readers of this blog.

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Prototype Architectures Summary Report Now Available

The Office of the National Coordinator for Health Information Technology (ONC) has released the Summary Report of the NHIN (Nationwide Health Information Network) Prototype Architectures. Key services and technical needs for the development of the NHIN are identified and detailed.

During the past year, four prototype architectures were developed, tested and successfully demonstrated. This collaborative work was completed by consortia led by Accenture, Computer Sciences Corporation, IBM and Northrop Grumman. This work addressed numerous critical issues for the “network of networks” that will be the NHIN. The prototype architectures describe methods to ensure privacy and security, consumer management of personal health records and information support for clinicians while are making clinical decisions.

The Summary Report catalogs the first year’s work and details common elements that will be used in the next step in the NHIN – “NHIN Trial Implementations.” The trial implementations will target state and regional health information exchanges (HIEs) in order to reflect the critical role of data exchange at the state level. The Request for Proposals (RFP) for the NHIN Trial Implementations is available at www.fedbizopps.gov . This phase of the NHIN development effort is expected to be conducted over twelve months (with two option years). The NHIN development process was structured to take the best elements of these prototype architectures and incorporate them into the NHIN Trial Implementations.

The Summary Report is a valuable working document designed to directly engage the state and regional HIEs that will be the “networks” that help make up the “network of networks” for the NHIN. The report was compiled by Gartner, Inc.

The report can be found on the HHS Health Information Technology website www.hhs.gov/healthit

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The report can be found at the following URL:

http://www.hhs.gov/healthit/healthnetwork/resources/

It is described as follows:

Summary Report on the Prototype Architectures (PDF - 1.73MB) and is downloadable by clicking on the hyperlink.

What is contained in the reports is a summary of an assessment by the Gartner Group four prototypes described above and analysis of how the US can now proceed to develop a National Health Information Network (NHIN) – based on appropriate standards and the already developed national Internet infrastructure.

Among the paragraphs from the Executive Summary that really caught my eye are the following:

“A cornerstone in the plan for interoperable health information technology is the progress that has been made toward enabling the creation of a Nationwide Health Information Network (NHIN), a “network of networks” that will securely connect consumers, providers and others who have, or use, health-related data and services, while protecting the confidentiality of health information. The NHIN will not include a national data store or centralized systems at the national level. Instead, the NHIN will use shared architecture (services, standards and requirements), processes and procedures to interconnect health information exchanges and the users they support.”

And that thus are we can report:

“Initial Successes

These contracts each validated important basic principles that underlie the current approach to the NHIN. These principles include:

· The possibility of operating the NHIN as a network of networks without a central database or services

· The criticality of common standards for developing the NHIN, particularly in the way that component exchanges interact with each other

· Synergies and important capabilities can be achieved by supporting consumers and healthcare providers on the same infrastructure

· Consumer controls can be implemented to manage how a consumer’s information is shared on the network

· There can be benefits from an evolutionary approach that does not dictate wholesale replacement or modification of existing healthcare information systems”

And lastly that:

The Synthesized Approach

The general approach of the contractors had much in common. Specifics varied to the degree that was expected from four independent efforts. Each contractor considered the NHIN as a set of distributed HIEs that work together to become the NHIN. They each identified specific functions that must be provided by the HIEs, including:

• Supporting secure operation in all activities related to the NHIN
• Protecting the confidentiality of personally identifiable health information as it is used by those who participate in the NHIN
• Reconciling patient and provider identities without creating national indices of patients
• Providing a local registry which may be used, when authorizations permit, to find health information about patients
• Supporting the transfer of information from one provider or care delivery organization to another in support of collaborative care
• Supporting secondary uses of data while protecting the identity of patients to the degree required by law and public policy

What this report makes clear is that, with attention to planning and detail, there is a clear viable incremental pathway towards the Health Information Network Australian also needs and that the technology to achieve what is needed is well within our grasp. The approaches adopted by all the participants were also very much Standards based.

It should also be noted the proposed approach also avoids the need for the NEHTA identity initiatives. I hope the architects of NEHTA’s non-plan carefully review what I think is an absolutely invaluable contribution to the development of National Health IT initiatives virtually anywhere. I look forward, with barely constrained excitement, to the outcomes of the work to be undertaken over the next year or so.

David.