Halamka: How to build a long distance service for healthcare

张琨

Halamka: How to build a long distance service for healthcareBy Mary Mosquera
Tuesday, September 29, 2009

To Dr. John Halamka, co-chairman of the Health IT Standards Committee, the nationwide health information network (NHIN) is a kind of long distance carrier, with health information exchanges in the role of connecting people via local phone exchanges.
“Generally healthcare information exchange is local,” he wrote recently in his blog, “Life as a Healthcare CIO.”
“Hospitals, labs, pharmacies, clinician offices, and public health in a region exchange data for a specific purpose. Privacy and data use concerns are resolved locally.”
“I do not believe that an architecture that requires a monolithic central database in the basement of the Whitehouse is going to be acceptable to stakeholders.”
Halamka listed several success factors for the NHIN, including governance via a NHIN framework for policy and technology, mostly likely orchestrated by the HIT Standards Committee could serve this purpose.
NHIN development would also require education and promotion. The Office of the National Coordinator for Health IT could do this or partner with health IT organizations, such as the National eHealth Collaborative or the e-Health Initiative, he said.
Incentives related to meaningful use would encourage health information exchange, as well as a desire to access federal stakeholders, including, CDC, SSA, and FDA, and CMS via electronic health record systems.
Ideally, EHRs, HIEs, and the NHIN should use the same standards for data transport, content and vocabularies to assure that they can easily integrate regional and national information efforts, he wrote.
And, to gain the trust of consumers,  healthcare organizations should agree upon “a set of security and privacy rules, including data use and reciprocal support agreements to which everyone who links to the NHIN must conform,” Halamka said.
His blog is at http://geekdoctor.blogspot.com/.

张琨

他的blog地址我刚也打不开，是不是被和谐了？

我是全球范围内诸位大牛集体的粉丝，简称环球牛粉

张琨

刚刚翻墙去了国外，把原文和comments摘录这里

Building the Nationwide Healthcare Information Network
I describe interoperability as a set of business partners with aligned incentives who exchange data to enhance efficiency, reduce costs, and improve coordination of care. Generally healthcare information exchange is local - hospitals, labs, pharmacies, clinician offices, and public health in a region exchange data for a specific purpose. Privacy and data use concerns are resolved locally. I do not believe that an architecture that requires a monolithic central database in the basement of the Whitehouse is going to be acceptable to stakeholders.

So what is the Nationwide Healthcare Information Network (NHIN) likely to be?

It will be a federated network of networks based on a common set of policies and data standards, enabling local, regional and domain specific (VA, DOD, Children's Hospitals) networks to connect with each other. Think of HIE's as similar to local phone exchanges and the NHIN as long distance service. What is required for a successful implementation of a "long distance carrier" for healthcare data?

1. Governance - A national framework for setting policy and technology for the NHIN. The HIT Policy and HIT Standards Committee could serve this purpose.

2. Education/Promotion - We need to ensure all state HIEs think of the NHIN as a connector between regional activities and understand how to use it. ONC could do this or partner with an organization such as the National eHealth Collaborative (NaeHC) or the e-Health Initiative (eHI).

3. Incentives - Meaningful use provides a powerful set of incentives to foster healthcare information exchange. Ideally, communications with Federal stakeholders such as CDC, SSA, FDA, and CMS would be done via the NHIN. This will incentivize all stakeholders to purchase EHRs and build HIEs which are compliant with NHIN policies and data standards.

4. Common transport, content and vocabulary standards - When EHR and HIE data exchanges are built, implementers have a choice of architectures and standards to implement. The work of HITSP and the HIT Standards Committee is architecture neutral, but provides enough constraints in the standards to reduce the number of choices, enhancing interoperability. Ideally, EHRs, HIEs, and the NHIN should should the same data transport (SOAP or REST over TLS), the same content (HL7 2.51, CCD, NCPDP Script 10.x, X12 4010 or 5010), and the same vocabularies (LOINC, SNOMED-CT, RxNorm, UNII) ensuring easy integration of regional and national efforts.

5. An agreed-upon set of security and privacy rules, including data use and reciprocal support agreements to which everyone who links to the NHIN must conform. Entities that link into the NHIN, and consumers who allow their information to be sent over the network, should be able to safely assume that some well defined, basic protection rules are enforced throughout, and that some well defined rules for representing, exchanging, and enforcing authorizations and consents are in place throughout the network.

Over the next year, the HIT Policy and Standards Committees are likely to work on NHIN related issues. I look forward to a secure nationwide network of networks with common policies and data standards that supports healthcare reform, public health, and the needs of patients, providers and payers. This is something we will create - we do not need to wait for our children to build it!
Posted by John Halamka at 3:00 AM
3 comments:

GreenLeaves said...

    The following article has some good points and a link to a paper looking at EHR in different nations. http://ehr.healthcareitnews.com/blog/cautious-look-around-world

    As John succinctly points out, it is about governance, standards and incentives. I think many of these countries are ahead because they are smaller, have government involved in healthcare and standards.
    September 28, 2009 3:30 PM
DBBaker said...

    Excellent description of the NHIN vision and potential! The only thing I would add to your characterization is that the NHIN should be viewed as an essential, trusted enabler for high quality, well coordinated health care for individuals, as well as for protecting communities at the local, state, and national levels. Ultimately, “incentives” for use should be inherent – to carry your telephone exchange analogy a step further, we certainly don’t need to “incentivize” people to use their cell phones! We use the phone service because it provides value (inherent incentive) to individuals and organizations, and a defined level of privacy protection. That should be the goal of the NHIN as well – not to dictate how enterprises, states, or regional exchanges do their jobs, but to provide a common framework for enabling basic connectivity and base-level protection.
    September 28, 2009 9:20 PM
gershater said...

    Woohoo! A blog post I have been looking for that describes the requirements of trust and agreed technologies to support NHIN and HIEs.
    I have past experience with Identity and Trust (SAML and similar technologies.
    I plan to investigate how these Identity technologies relate to HealthIT
    September 29, 2009 4:09 PM

也摘录一段他的演讲，是他对RFID在医院里的应用的见解。这位仁兄兴趣广泛，而且对新技术研究深入，观点有insight。
http://video.soso.com/search/res ... &pg=1&ch=v.res.play

wholx

可以用google reader看他的博客，试试看