The US Health Information Exchange Initiatives. We Need to Leverage Them!

The following appeared a few days ago and I think is worth passing on.

CONNECT & NHIN Direct: What Are They?

HDM Breaking News, May 20, 2010

There has been a lot of talk in recent months of two federal initiatives to ease connectivity in the health care industry-CONNECT and NHIN Direct. One of them is real software and the other is an emerging recipe for connectivity. Here's a primer.

CONNECT is real, downloadable software with three components:

* Gateway, which implements nationwide health information network specifications for secure data exchange over the Internet;

* Enterprise Service Platform, which enables an organization to plug practice management and electronic health records systems into a framework to communicate with the Gateway; and

* Universal Client Framework, a platform to develop end-user applications that support meaningful use if a physician doesn't have an EHR.

CONNECT includes one or more open source applications for each of the components, plus some private vendor tools such as IBM/Initiate Systems' master patient index software.

The Department of Health and Human Services in March 2008 awarded a contract to Melbourne, Fla.-based Harris Corp. as the prime contractor to develop CONNECT, with Chantilly, Va.-based Agilex Technologies and Richardson, Texas-based Scenpro Inc. as subcontractors.

The Federal Health Architecture initiative, a collaboration of multiple federal departments and agencies, in April 2009 released CONNECT's source code as open source and began developing the open source community. Releases are announced on a quarterly basis, says David Riley, CONNECT initiative lead contractor and owner of Enaptics Consulting LLC, Marshall, Mo.

Organizations using CONNECT, some in full production and others in testing stages, include HealthBridge in Cincinnati, Thayer County Health Services in Nebraska, Indianapolis-based Regenstrief Institute, Departments of Defense and Veterans Affairs, Kaiser Permanente, and Orange County and Redwood MedNet in California.

NHIN Direct isn't developing connectivity software, but the tools to guide development. These include descriptions of standards, services and policies to enable secure health data transmission over the Internet.

Lots more detail is here:

http://www.healthdatamanagement.com/news/interoperability-connect-nhin-direct-hie-40313-1.html

The article provides 2 links:

The first is to http://nhindirect.org

Here is the intro to the front page:

The NHIN Direct Project

NHIN Direct is a project to expand the standards and service definitions that, with a policy framework, constitute the NHIN. Those standards and services will allow organizations to deliver simple, direct, secure and scalable transport of health information over the Internet between known participants in support of Stage 1 meaningful use.

The key deliverables of the project will be standards and service definitions, implementation guides, reference implementations, and associated testing frameworks. The project will not run health information exchange services.

The Nationwide Health Information Network is a set of standards, services and policies that enable secure health information exchange over the Internet. Several Federal agencies and healthcare organizations are already using NHIN technology to exchange information amongst themselves and their partners. This project will expand the standards and service descriptions available to the NHIN to address the key Stage 1 requirements for meaningful use, and provide an easy "on-ramp" for a wide set of providers and organizations looking to adopt. At the conclusion of this project, there will be one nationwide exchange, consisting of the organizations that have come together in a common policy framework to implement the standards and services.

The second provides this link to connectopensource.org which supports the community that is developing the key enabling software.

This is discussed here:

http://www.connectopensource.org/about/what-is-CONNECT

What is CONNECT?

CONNECT is an open source software solution that supports health information exchange – both locally and at the national level. CONNECT uses Nationwide Health Information Network (NHIN) standards and governance to make sure that health information exchanges are compatible with other exchanges being set up throughout the country.

This software solution was initially developed by federal agencies to support their health-related missions, but it is now available to all organizations and can be used to help set up health information exchanges and share data using nationally-recognized interoperability standards.

CONNECT can be used to:

• Set up a health information exchange within an organization
• Tie a health information exchange into a regional network of health information exchanges
• Tie a health information exchange into the NHIN

By advancing the adoption of interoperable health IT systems and health information exchanges, the country will better be able to achieve the goal of making sure all citizens have electronic health records by 2014. Health data will be able to follow a patient across the street or across the country.

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The Solution

Three primary elements make up the CONNECT solution:

• The Core Services Gateway provides the ability to locate patients at other organizations, request and receive documents associated with the patient, and record these transactions for subsequent auditing by patients and others. Other features include mechanisms for authenticating network participants, formulating and evaluating authorizations for the release of medical information, and honoring consumer preferences for sharing their information. The NHIN Interface specifications are implemented within this component.
• The Enterprise Service Components provide default implementations of many critical enterprise components required to support electronic health information exchange, including a Master Patient Index (MPI), XDS.b Document Registry and Repository, Authorization Policy Engine, Consumer Preferences Manager, HIPAA-compliant Audit Log and others. Implementers of CONNECT are free to adopt the components or use their own existing software for these purposes.
• The Universal Client Framework contains a set of applications that can be adapted to quickly create an edge system, and be used as a reference system, and/or can be used as a test and demonstration system for the gateway solution. This makes it possible to innovate on top of the existing CONNECT platform.

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It is my view that the drive being provided by the ‘meaningful use’ criteria for re-imbursement in the US will have the effect of seeing the rapid evolution of solutions (both commercial and open source) to meet those criteria and result in a very advanced National Health Information Network emerging over the next few years in the US.

The implementations that are presently appearing are deploying a variety of Standard Architecture bases – see here:

http://nhindirect.org/Specifications+and+Service+Descriptions

And as experience develops it seems likely a firm base of clarity on which approaches are best will emerge.

It seems to me there is a lot here that could support the proposed Local Health Networks and facilitate considerable progress pretty quickly.

I would love the NEHTA System Architects to tell me just what is wrong with this approach – but I am sure they don’t read here!

David.