Transcript IEEE Piscataway, NJ

Interoperability
for the NHIN
Thomas Jepsen, IEEE-USA MTPC
Version 1.3
Updated July 5, 2005
What is Interoperability?
“Ability of two or more systems or components to
exchange information and to use the information
that has been exchanged.”
Source: IEEE Standard Computer Dictionary:
A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990
“Functional” vs. “Semantic”
Interoperability
Functional Interoperability:
•Shared Architectures
•Shared Methods
•Shared Frameworks
Semantic Interoperability:
•Shared Datatypes
•Shared Terminologies
•Shared Codings
Source: IEEE 1073/ISO TC215 WG2.1/CEN TC251 WGIV
Point of Care Medical Device Communications
A Real World Model: The
Internet/World Wide Web
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Functional interoperability –
browsing/searching/online purchasing
work the same, regardless of what
browser I use or what operating system
my computer uses
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Semantic interoperability – the functional
interoperability of the Internet/WWW relies
on the semantic interoperability provided
by http, html, xml, etc…
What is NHIN?
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National Health Information Network
Not a “physical” network, but rather a
“conceptual” network
May include information that is not in electronic
online format – e.g. legacy paper records
May consist of multiple networks with linkages to
each other
To be built upon existing network technology
Part of the nation’s critical infrastructure
Who May Use NHIN?
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Healthcare professionals use it to diagnose and treat patients (e.g.
telemedicine, home healthcare)
Healthcare professionals use it to access/update/transfer electronic health
records (EHR) and other personal health information (PHI)
Patients use it to access/verify EHR information and other PHI
Public health officials use it to broadcast healthcare/epidemiological alerts
and healthcare-related information
Medical/emergency first responders use it to obtain PHI in emergency
situations
Healthcare providers and insurors use it to submit/process/pay insurance
claims
Public health agencies use it to obtain information on quality of healthcare
Pharmacists may use it to fill prescriptions electronically
Functions of the NHIN
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Fast, Ubiquitous Access to online Electronic
Health Records
Online Claims Processing
Transport of Medical Images
Emergency Medical Response
Coordination of Health Information Networks
Telehealth for rural/underserved areas
Longitudinal EHR
Home Healthcare
E-Prescription
Source: Position Statement: National Health Information Network, with
emphasis on Security and Privacy Issues, June 2005
Interoperability Considerations
NHIN Function
Interoperability Requirement
Responsibility/ Standards
Body
Medical Terminology
Common language for medical
procedures
Systematized Nomenclature for
Medicine (SNOMED), ICD9,
ICD10, LOINC, CPT
Ubiquitous Availability of EHR
Standards for format and
content of EHR
HL7 EHR Functional Model
Online Claims Processing –
Large Clinics
Standard Protocols and
Messages
HIPAA Transaction Sets, ANSI
X12N EDI
Online Claims Processing –
Small Clinics
Standard Protocols and
Messages, Discovery Process
W3C, OASIS, WS-I, ebXML
Medical Imaging
Definition of lossless image,
transport format, transport
protocol, image encryption
DICOM, MPEG, JPEG
Emergency Medical Response
Authorization to access
Personal Health Information
(PHI), reliability, security, privacy
HIPAA Privacy Rule, HIPAA
Security Rule, reliability?
Coordination of Health
Information Networks
Interoperability among public
health information systems
(NIH, CDC, FDA) and
healthcare facilities
Public Health Information
Network (PHIN) standards,
ebXML, HL7
Interoperability Considerations (cont)
NHIN Function
Interoperability Requirement
Responsibility/Standards
Body
Telehealth
Video standards, bandwidth,
QOS, reliability, security, privacy
HIPAA Security, HIPAA Privacy,
IEEE 802.1ah, reliability?
Medical Instrumentation
Message standards, transport
protocols
IEEE 1073
Longitudinal EHR
Compatible, persistent storage
formats
ISO/TR 21089 Trusted End to
End Information Flows, ASTM
E31 Continuity of Care Record
(CCR)
Home Healthcare
Device certification,
instrumentation standards,
reliability, security, privacy
FDA Center for Devices and
Radiological Health, IEEE 1073,
HIPAA Privacy, HIPAA Security,
reliability?
E-prescription
Drug codes, security, privacy,
reliability
NCPDP SCRIPT, HIPAA
Privacy, HIPAA Security,
reliability?
Known Gaps in the Interoperability
Picture
QOS/Bandwidth Requirements for video
transmission – IEEE 802.1ah is working
on QOS standards for streaming
multimedia over Ethernet
 Network Reliability – no known standards
 Need to identify NHIN as part of national
critical infrastructure
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Other Areas for Investigation
New Protocols?
 Standards for lossless imaging?
 Security Standards?
 Encryption?
 Standards for network compatibility?
 Compatible storage formats?
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Moving Forward…
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Recommendations for action:
paper on interoperability – complete by
Nov/Dec 2005
 White paper on interoperability for greater depth
 Recommendations/liaisons to standards bodies –
IEEE Reliability Society, Critical Infrastructure
Committee, 802.1ah
 Request input from NCHIT, HHS, CDC, FDA, etc. on
requirements
 Other?
 Position
Recommended Reading
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Semantics: Chen C., “Visualizing Semantic Spaces and Author Co-Citation Networks
in Digital Libraries,” http://www.pages.drexel.edu/~cc345/papers/ip_m/ip_m.pdf
IEEE 802.1ah: Cherry S., “Ethernet’s High-Wire Act,” IEEE Spectrum, April 2005, 635.
Critical Infrastructure:
 Miller et al, “Toward Interoperable First Response,” IEEE IT Professional,
Jan/Feb 2005, 13-20.
 Kun L. and Bray D., “Information Infrastructure Tools for Bioterrorism
Preparedness,” IEEE Engineering in Medicine and Biology, Sept/Oct 2002, 6985.
 Kun L., “Technology and Policy Review for Homeland Security,” IEEE
Engineering in Medicine and Biology, Jan/Feb 2004, 30-44.
PHIN: Snee N. and McCormick K., “The Case for Integrating Public Health
Networks,” IEEE Engineering in Medicine and Biology, Jan/Feb 2004, 81-88.
National Health Information Infrastructure: http://www.hsrnet.net/nhii
Related Pending Legislation
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[Enzi] Better Healthcare Through Information Technology Act
S.1262, Health Technology to Enhance Quality Act of 2005
S.1223, Information Technology for Health Care Quality Act
S.1227, Health Information Technology Act of 2005
HR2234, 21st Century Health Information Act of 2005
HR1251, Connecting the Operations of National Networks of
Emergency Communications Technologies for First Responders Act
of 2005
HR747, National Health Information Incentive Act of 2005
HR2807, Medicare Telehealth Enhancement Act of 2005
Contact Info
Thomas C. Jepsen,
IEEE-USA Medical Technology Policy
Committee
[email protected]
Phone: 919-933-0377