IEEE Piscataway, NJ

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

 Functional interoperability – browsing/searching/online purchasing work the same, regardless of what browser I use or what operating system my computer uses  Semantic interoperability – the functional interoperability of the Internet/WWW relies on the semantic interoperability provided by http, html, xml, etc…

What is NHIN?

      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?

        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

        

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

Medical Terminology Ubiquitous Availability of EHR Online Claims Processing – Large Clinics Online Claims Processing – Small Clinics Medical Imaging Emergency Medical Response Coordination of Health Information Networks

Interoperability Requirement

Common language for medical procedures

Responsibility/ Standards Body

Systematized Nomenclature for Medicine (SNOMED), ICD9, ICD10, LOINC, CPT HL7 EHR Functional Model Standards for format and content of EHR Standard Protocols and Messages Standard Protocols and Messages, Discovery Process Definition of lossless image, transport format, transport protocol, image encryption Authorization to access Personal Health Information (PHI), reliability, security, privacy Interoperability among public health information systems (NIH, CDC, FDA) and healthcare facilities HIPAA Transaction Sets, ANSI X12N EDI W3C, OASIS, WS-I, ebXML DICOM, MPEG, JPEG HIPAA Privacy Rule, HIPAA Security Rule, reliability?

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 Longitudinal EHR Home Healthcare E-prescription Message standards, transport protocols IEEE 1073 Compatible, persistent storage formats Device certification, instrumentation standards, reliability, security, privacy Drug codes, security, privacy, reliability ISO/TR 21089 Trusted End to End Information Flows, ASTM E31 Continuity of Care Record (CCR) FDA Center for Devices and Radiological Health, IEEE 1073, HIPAA Privacy, HIPAA Security, 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

Other Areas for Investigation

 New Protocols?

 Standards for lossless imaging?

 Security Standards?

 Encryption?

 Standards for network compatibility?

 Compatible storage formats?

Moving Forward…

 Recommendations for action:  Position 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?

Related Pending Legislation

        [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, 21 st 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