美国卫生部关于国家医疗信息网NHIN的RFI

西风瘦马

(转自http://www.gold-sign.cn/news_detail.asp?id=186&pid=7)
HHS’ Request for Information (RFI) on National Health Information Network (NHIN)
美国卫生部关于《国家医疗信息网》(NHIN)的信息征询(RFI)
http://www.hhs.gov/healthit/rfi.html
茅海萼　赵蒙海　译

PLEASE NOTE: The Request for Information is being made available through the Internet solely as a means to facilitate the public's access to this document.  Though it is not intended or expected, should any discrepancy occur between this document and the document published in the Federal Register on November 15, 2004, the Federal Register publication controls.  
请注意：本次信息征询RFI以互联网为唯一手段来获得，以方便公众得到此文件。若此文件与2004年11月15日联邦注册出版的文件有任何差异，虽然不是有意或期望产生此种差异，但以联邦注册出版物为准。
Last revised: January 28, 2005

DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Coordinator for Health Information Technology
美国卫生与福利部
医疗信息技术全国协调员

Development and Adoption of a National Health Information Network
国家医疗信息网的开发和采用
AGENCY:  Department of Health and Human Services.
机构：卫生与福利部
ACTION:  Request for Information.
行动：信息征询

[ 本帖最后由 西风瘦马 于 2007-5-21 20:05 编辑 ]

西风瘦马

SUMMARY:  
概述：

Public comment is sought regarding considerations in implementing the President’s call for widespread adoption of interoperable electronic health records (EHRs) within 10 years.  On April 27, 2004, President Bush established the position of the National Health Information Technology Coordinator.  On May 6, 2004, Secretary Tommy G. Thompson appointed David J. Brailer, MD, PhD to serve as National Coordinator for Health Information Technology.  The Executive Order signed by the President required the National Coordinator to report within 90 days of operation on the development and implementation of a strategic plan.  This Framework for Strategic Action entitled:  “The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care” (the Framework), was presented at the Health Information Technology Secretarial Summit II on July 21, 2004.  The Framework is posted for reference at: [http://www.hhs.gov/onchit/framework/].  The Framework outlines an approach toward the nationwide implementation of interoperable health information technology in both the public and the private sectors.
总统号召在10年内广泛采用可互操作的(interoperable)电子病历(EHR)，为实施这项号召，在此向公众征询其有关思路的评述。2004年4月27日总统Bush设立了医疗信息技术(HIT, Health Information Technology)全国协调员职位，2004年5月6日卫生与福利部(HHS)部长Tommy G. Thompson任命David J. Brailer (MD, PhD)为HIT全国协调员。总统签发的行政令要求全国协调员于就职90天内，对战略规划的开发和实施提出报告。此战略行动框架报告的题目是：“HIT的下十年：提供以病人为中心的和信息丰足的医疗服务”(下称框架报告，Framework)，在2004年7月21日的HIT第二次部长峰会(Secretarial Summit II)上呈报。该框架报告贴在www.hhs.gov/onchit/framework供大家参考，它勾画了可互操作的HIT在公共和私人领域做全国性实施的方法。

In order to realize a new vision for health care through the use of information technology, the report called for a sustained set of strategic actions, embraced by the public and the private health sectors, which will be taken over many years.  The Framework outlined four major goals: inform clinical practice with use of EHRs, interconnect clinicians so that they can exchange health information using advanced and secure electronic communication, personalize care with consumer-based health records and better information for consumers, and improve public health through advanced biosurveillance methods and streamlined collection of data for quality measurement and research.  
为了实现医疗服务利用信息技术的新愿景，该框架报告倡议了一套持续的战略行动，包括公共和私人医疗服务领域，需要多年的实施。它勾画了四项主要目标：使用EHR来使临床实践信息化，使用先进安全的电子通讯来互联起医生使他们能交流医疗信息，使用基于病人的病历和适合病人的更好信息化来将医疗服务个性化，通过先进的生物监控方法和流畅精确的数据收集做高质量的测量和研究来改善公共健康。

This Request for Information (RFI) addresses the goal of interconnecting clinicians by seeking public comment and input regarding how widespread interoperability of health information technologies and health information exchange can be achieved.  This RFI is intended to inform policy discussions about possible methods by which widespread interoperability and health information exchange could be deployed and operated on a sustainable basis.  
本次信息征询RFI，是就有关如何达成医疗信息技术和医疗信息交换的广泛的互操作性(可互操作能力，interoperability)，来寻求公众评价和进议，强调的是将医生互联起来的目标，意图是，针对在可持续基础上实现和运作广泛互操作性和医疗信息交换的各种可能方法，广泛周知有关这些方法的政策讨论。

[ 本帖最后由 西风瘦马 于 2007-5-21 20:08 编辑 ]

西风瘦马

DATES:  Responses should be submitted to the Department of Health and Human Services (HHS), Office of the National Coordinator for Health Information Technology (ONCHIT), on or before 5:00 P.M. EST on January 18, 2005.
日期：任何响应，应在2005年1月18日东部时间下午5点之前，发送给卫生与福利部(HHS)的医疗信息技术全国协调员办公室(ONCHIT)。

ADDRESSES:  Electronic responses are preferred and should be addressed to: NHINRFI@hhs.gov in the Office of the National Coordinator for Health Information Technology, Department of Health and Human Services.  Include NHIN RFI Responses in the subject line.  Non-electronic responses will also be accepted.  Please send to:
地址：请尽量采用电子方式来响应，其发送地址为HHS-ONCHIT的NHINRFI@hhs.gov，并请在主题行内写入NHIN RFI Response(国家医疗信息网信息征询的响应)。非电子方式的响应也可接受，请寄送下述地址：
Office of the National Coordinator Health Information Technology
Department of Health and Human Services
Attention:  NHIN RFI Responses
Hubert H. Humphrey Building, Room 517D
200 Independence Avenue, S.W.
Washington, DC  20201

FOR FURTHER INFORMATION:  On December 6, 2004, there will be a technical assistance conference call to answer questions from potential responders.  More details will be provided on how to participate in this call on the ONCHIT website [http://www.hhs.gov/onchit/].  Additionally, a public, online Frequently Asked Question (FAQ) page will be provided to answer questions throughout the response period on ONCHIT’s website.
Please direct email inquiries and responses to NHINRFI@hhs.gov.  For additional information, contact Lee Jones or Lori Evans, in the Office of the National Coordinator for Health Information Technology at toll free 877-474-3918.
其它信息：2004年12月6日将有一次技术协助电话会议，来回答潜在征询响应者的问题，ONCHIT主页www.hhs.gov/onchit上将就如何参加此电话会议提供详细信息。此外，整个响应期间在该主页上将提供公开和在线的常见问题解答FAQ来回答问题。
任何询问和响应，请指送email到NHINRFI@hhs.gov。需要其它信息也可通过免费电话877-474-3918联系ONCHIT的Lee Jones或Lori Evans。

[ 本帖最后由 西风瘦马 于 2007-5-21 20:16 编辑 ]

西风瘦马

BACKGROUND:  
背景：

As the nation embarks on the widespread deployment of EHRs, a variety of concomitant challenges and barriers must be addressed.  One of these is interoperability, or the ability to exchange patient health information among disparate clinicians and other authorized entities in real time and under stringent security, privacy and other protections.  Interoperability is an essential factor in using health information technology to improve the quality and efficiency of care in the United States.  Interoperability is necessary for compiling the complete experience of a patient’s care, for maintaining a patient’s personal health records and for ensuring that complete health information is accessible to clinicians as the patient moves through various healthcare settings.  Interoperability is needed for clinicians to make fact-based decisions so medical errors and redundant tests can be reduced.  Interoperability is also critical to cost-effective and timely data collection for biosurveillance, quality measurement and clinical research.  In short, interoperability is essential for realizing the key goals that are desired from health information technology.  
当国家着手广泛实施EHR时，必须重视其相伴产生的各种挑战和阻碍。其中之一就是互操作性，即在严格的安全、隐私和其它保护条件下，在远隔着的医生和其它授权组织之间，实时地交换病人医疗信息的能力。这种互操作性，对于利用信息技术来改进全美国医疗服务的质量和效率，是一项基础因素。为了汇编病人的完整医护史、为了维护病人的个人健康纪录、以及为了在病人移动于不同医疗场所时确保其各有关医生能获得完整的医疗信息，互操作性都是必须的。医生需要互操作性来作出循证决策并降低医疗失误和重复检查，生物监控、质量衡测、和临床研究要求的低耗高效与及时的数据收集，互操作性也是关键性的。简而言之，对于实现医疗信息技术所期望的那些关键目标，互操作性是最基本的。

With the exception of a few isolated regional projects, the United States does not currently have meaningful health information interoperability capabilities.  Moreover, the broad set of actions and tasks that are needed to achieve interoperability are not well-defined.  It is known that interoperability requires a set of common standards that specify how information can be communicated and in what format.  On this, there has been considerable effort and progress achieved by private sector organizations such as Health Level 7 (HL7), and by the American National Standards Institute (ANSI), both of which are voluntary consensus standards setting organizations.  Also, HHS and other federal agencies have advanced the adoption of standards through the Consolidated Health Informatics (CHI) initiative, as well as the Public Health Information Network (PHIN) and National Electronic Disease Surveillance System (NEDSS) under the leadership of the Centers for Disease Control and Prevention (CDC).  With HHS participation, HL7 has also created a functional model and standards for electronic health records.  
除了少数隔绝着的地区性项目之外，全美国目前还没有有意义的医疗信息互操作能力，而且，达到互操作性所需要的广泛成套的行动和任务也没有很好地定义。大家都知道互操作性需要一套共同标准来确定信息以什么格式和如何能被通讯。对此，已经有私人组织如HL7、以及美国国家标准局ANSI进行并取得了相当大的努力和进步——这两者都是自发的多数同意式标准设定组织。同时，HHS和其它联邦机构也推进了对标准的采用，例如通过联合医疗信息学(CHI, Consolidated Health Informatics)倡议，以及疾病预防与控制中心CDC领导的公共卫生信息网PHIN和全国电子疾病监控系统NEDSS。随着HHS的加入，HL7也已经为电子病历创立了功能模型和标准。

However more remains to be done to achieve interoperability and to determine the process by which these tasks should be pursued in the public and private sectors.  Clearly needed are interconnection tools such as mobile authentication, identification management, common web services architecture and security technologies.  Also needed are precisely defined implementation regimens that are specified at the level of software code.  There is also a need for common networking and communication tools to unify access and security.  Aside from this, mechanisms for ensuring the sustainable operation of these components on a widespread and publicly available basis must be defined.  There are potentially other components that may not be known at this time.  The collective array of components that underlie nationwide interoperability is referred to as a National Health Information Network (NHIN) in the Framework.   
然而，要达到互操作性，要确定让公共和私人组织从事那些任务所需遵循的程序，还有更多的事情要做。明确需要的(组分)是互联工具，如移动认证、身份管理、通用WEB服务架构、以及安全技术；还有需要的是精确定义的在软件代码水平上指定的实施规则，以及为统一信息的获取和安全所要求的通用联网与通讯工具。此外，为确保这些组分在广泛和公众可得的基础上能可持续地运作，还需要定义保障机制。还有一些其它潜在的组分，目前还不知道。构成全国性互操作性基础的这些组分集合阵列，在框架报告中被称为全国医疗信息网NHIN。

[ 本帖最后由 西风瘦马 于 2007-5-21 20:17 编辑 ]

西风瘦马

The NHIN could be developed and operated in many ways.  It could include state-of-the-art web technologies or more traditional clearinghouse architectures.  It could be highly decentralized or somewhat centrally brokered.  It could be a nationwide service, a collection of regional services or a set of tools that share common components.  It could be overseen by public organizations, by private organizations, or by public-private consortia.  Regardless of how it is developed, overseen or operated, there is a compelling public interest for a NHIN to exist.  
NHIN可以以多种方式开发和运作。它可以用最新式的WEB技术、或比较传统的票据交换式架构；它可以是高度分散式的、或某种程度上集中代理式的；它可以是全国性的服务、或一些地区性服务的集合、或共享一些通用组分的一套工具；对它的监督可以是公共组织、或私人组织、或公共-私人联合体。不管它是如何开发、监督、或运作的，NHIN的存在是有着公众瞩目的公共利益的。

Therefore, the National Coordinator for Health Information Technology is seeking comments on and ideas for how a NHIN can be deployed for widespread use.  To begin this process, the National Coordinator is inviting responses about the questions in this RFI.  We intend to explore the role of the federal government in facilitating deployment of a NHIN, how it could be coordinated with the Federal Health Architecture (FHA), and how it could be supported and coordinated by Regional Health Information Organizations (RHIOs).  (For additional information on the FHA and the RHIOs, please refer to the report:  “The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care,” at: [http://www.hhs.gov/onchit/framework/]).
所以，就NHIN应如何开发以便广泛使用，医疗卫生技术全国协调员正在寻求评议和设想。为启动这个进程，协调员邀请对此信息征询RFI中所列问题的响应。在促进NHIN开发、它与联邦卫生架构(FHA, Federal Health Architecture)如何协调、以及地方医疗信息组织(RHIOs)能如何支持和协调它等方面，我们意图拓展联邦政府的作用。(有关FHA和RHIOs的其它信息，可参照www.hhs.gov/onchit/framework上的报告“HIT的下十年：提供以病人为中心的和信息丰足的医疗服务”。)

There are many perspectives that can be brought to bear on this important topic.  Health information technology organizations, healthcare providers, industry associations and other stakeholders all have important insights that will inform future deliberation.  In the interest of having the most compelling, complete and thorough responses possible, we encourage interested parties to collaborate and submit unified responses to this RFI wherever possible.  Comments from the public at large are also invited.
有很多观点/期望会带来施加向这个重要课题的压力。医疗信息技术组织、医疗服务供应者、行业组织及其它利益相关者，都会有将知会到未来商议中去的重要内在要求。为了获得尽可能有力、完整和全面的响应，我们鼓励有关利益方，在任何可能之处，合作起来并提出对此RFI的响应。同时欢迎来自普遍公众的评述。

[ 本帖最后由 西风瘦马 于 2007-5-21 20:17 编辑 ]

西风瘦马

REQUEST FOR INFORMATION:
信息征询

General
通则

1.The primary impetus for considering a NHIN is to achieve interoperability of health information technologies used in the mainstream delivery of health care in America. Please provide your working definition of a NHIN as completely as possible, particularly as it pertains to the information contained in or used by electronic health records. Please include key barriers to this interoperability that exist or are envisioned, and key enablers that exist or are envisioned. This description will allow reviewers of your submission to better interpret your responses to subsequent questions in this RFI regarding interoperability.
1、考虑NHIN的主要推动力是为了获得美国主流医疗服务中所用医疗信息技术的互操作性。请尽可能完整地提出你对NHIN的定义，特别是它的有关电子病历中包涵和使用的信息。请包括对此互操作性已经存在或预想到的关键阻碍因素和关键性促进因素。这种描述将使得您的进议的评阅者能更好地理解您对于本RFI有关互操作性的后续问题的响应。

2.What type of model could be needed to have a NHIN that: allows widely available access to information as it is produced and used across the health care continuum; enables interoperability and clinical health information exchange broadly across most/all HIT solutions; protects patients’ individually-identifiable health information; and allows vendors and other technology partners to be able to use the NHIN in the pursuit of their business objectives? Please include considerations such as roles of various private- and public- sector entities in your response.
2、需要什么样的模型，能让NHIN做到下述几点：当信息横跨医疗领域被产生和使用时，允许对该信息的广泛可得的存取；广泛横跨着多数/所有HIT产品方案，来实现互操作性和临床医疗信息交换；保护病人的个人可识别健康信息；并允许产品供应商和其它技术合作方为了他们的业务目标能利用NHIN。像不同的私人和公共组织的作用等思路，也请在您的响应中涵盖。

3.What aspects of a NHIN could be national in scope (i.e., centralized commonality or controlled at the national level), versus those that are local or regional in scope (i.e., decentralized commonality or controlled at the regional level)? Please describe the roles of entities at those levels. (Note: “national” and  “regional” are not meant to imply federal or local governments in this context.)
3、NHIN中，什么方面在范围上是全国性的(即集权化的公共性或在全国水平上进行控制的)，或地方性的或区域性的(即分权化的公共性或在地区水平上进行控制的)？请描述在那些不同水平上的各种组织的作用。(注意：本文中“全国性”和“地区性”并不意味着联邦政府或地方政府。)

[ 本帖最后由 西风瘦马 于 2007-5-21 20:02 编辑 ]

西风瘦马

Organizational and Business Framework   
组织与业务框架

4.What type of framework could be needed to develop, set policies and standards for, operate, and adopt a NHIN? Please describe the kinds of entities and stakeholders that could compose the framework and address the following components:  
a.How could a NHIN be developed? What could be key considerations in constructing a NHIN? What could be a feasible model for accomplishing its construction?
b.How could policies and standards be set for the development, use and operation of a NHIN?
c.How could the adoption and use of the NHIN be accelerated for the mainstream delivery of care?
d.How could the NHIN be operated? What are key considerations in operating a NHIN?
4、要对NHIH进行开发、设定政策与标准、运营、以及推广，需要什么类型的框架？对构成框架的组织和相关利益者，请描述其种类，并强调下述组分：
A、NHIN应如何开发？在构建NHIN中关键思路是什么？为完成此构建，可行的模型是什么？
B、为开发、使用和运作NHIN，政策和标准应如何设定？
C、如何能加速主流医疗服务对NHIN的采用？
D、NHIN可如何运作？运作NHIN中的关键思路是什么？

5.What kind of financial model could be required to build a NHIN?  Please describe potential sources of initial funding, relative levels of contribution among sources and the implications of various funding models.
5、建设NHIN需要什么类型的财务模型？请描述初始融资的潜在来源、这些来源的相对贡献水平、以及不同融资模型的意义。

6.What kind of financial model could be required to operate and sustain a functioning NHIN?  Please describe the implications of various financing models.  
6、需要什么样的财务模型来运作和维持NHIN的职能？请描述不同财务模型的含义。

7.What privacy and security considerations, including compliance with relevant rules of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), are implicated by the NHIN, and how could they be addressed?
7、隐私和安全考虑在NHIN中意味着什么样——包括对HIPAA(1996医疗保险随身性和可靠性法案)有关规则的遵循？它们应如何强调实施？

8.How could the framework for a NHIN address public policy objectives for broad participation, responsiveness, open and non-proprietary interoperable infrastructure?
8、为了有广泛的参与和回应、开放的和非专有的互操作基础设施，NHIN框架应如何表述其公共政策目标？

[ 本帖最后由 西风瘦马 于 2007-5-21 20:20 编辑 ]

西风瘦马

Management and Operational Considerations
管理和运作思路

9.How could private sector competition be appropriately addressed and/or encouraged in the construction and implementation of a NHIN?
9、在建设和实施NHIN中，私人领域的竞争应如何合适地强调和/或鼓励？

10.How could the NHIN be established to maintain a health information infrastructure that:
a.evolves appropriately from private investment;
b.is non-proprietary and available in the public domain;
c.achieves country-wide interoperability; and
d.fosters market innovation.
10、应如何建立NHIN以便维护医疗信息基础设施，使之能：
A、从私人投资中合适地演进出来；
B、属于非专有的和公共领域可得的；
C、能达成全国范围的互操作性；以及
D、抚育市场创新。

11.How could a NHIN be established so that it will be utilized in the delivery of care by healthcare providers, regardless of their size and location, and also achieve enough national coverage to ensure that lower income rural and urban areas could be sufficiently served?
11、NHIN应如何建立，以至于不论什么样大小和位置的医疗服务提供者在其服务中会使用它，同时又能取得足够的全国覆盖使得较低收入的农村和城市区域也能得到充分的服务？

12.How could community and regional health information exchange projects be affected by the development and implementation of a NHIN? What issues might arise and how could they be addressed?
12、开发和实施NHIN会如何影响那些社区和区域医疗信息交换项目？会产生什么问题，如何解决？

13.What effect could the implementation and broad adoption of a NHIN have on the health information technology market at large? Could the ensuing market opportunities be significant enough to merit the investment in a NHIN by the industry? To what entities could the benefits of these market opportunities accrue, and what implication (if any) does that have for the level of investment and/or role required from those beneficiaries in the establishment and perpetuation of a NHIN?
13、NHIN的实施和广泛采用，对于医疗信息技术市场会有什么影响？随之继起的市场机会，能足以奖酬行业对NHIN的投资吗？这些市场机会的好处能自然赋予什么样的机构，这对于在NHIN建立和维护中的受益方的投资水平和应有作用，又有什么含义(若有的话)？

[ 本帖最后由 西风瘦马 于 2007-5-21 20:21 编辑 ]

西风瘦马

Standards and Policies to Achieve Interoperability
达成互操作性的标准和政策
(Question 4b above asks how standards and policy setting for a NHIN could be considered and achieved.  The questions below focus more specifically on standards and policy requirements.)   
(上述问题4b询问的是NHIN的标准和政策设定应如何考虑和得到，下面的问题是更专门地关注于标准和政策本身的要求。)

14.What kinds of entity or entities could be needed to develop and diffuse interoperability standards and policies? What could be the characteristics of these entities?  Do they exist today?
14、开发和传播互操作性标准与政策，需要什么类型的机构？这些机构的特性是什么？它们现在存在吗？

15.How should the development and diffusion of technically sound, fully informed interoperability standards and policies be established and managed for a NHIN, initially and on an ongoing basis, that effectively address privacy and security issues and fully comply with HIPAA? How can these standards be protected from proprietary bias so that no vendors or organizations have undue influence or advantage? Examples of such standards and policies include: secure connectivity, mobile authentication, patient identification management and information exchange.
15、技术坚实、充分周知的互操作性标准与政策，为了NHIN应如何建立与管理其开发和传播，在起始和后续持续过程中，能有效地反映私密和安全问题并充分遵循HIPAA？

16.How could the efforts to develop and diffuse interoperability standards and policy relate to existing Standards Development Organizations (SDOs) to ensure maximum coordination and participation?  
16、开发和传播互操作性的标准与政策的努力，应如何与现有标准开发组织(SDO)关联起来，以便确保最大程度的协调和参与？

17.What type of management and business rules could be required to promote and produce widespread adoption of interoperability standards and the diffusion of such standards into practice?
17、为促进和产生对互操作性标准的广泛采用和这些标准向实践中的传播，需要什么类型的管理和业务规则？

18.What roles and relationships should the federal government take in relation to how interoperability standards and policies are developed, and what roles and relationships should it refrain from taking?
18、有关如何开发互操作性标准和政策方面，联邦政府应采取什么样的作用和关系，以及另有些什么作用和关系不应采取？

[ 本帖最后由 西风瘦马 于 2007-5-21 20:22 编辑 ]

西风瘦马

Financial and/or Regulatory Incentives and Legal Considerations
财务和/或法规激励与立法考虑

19.Are financial incentives required to drive the development of a marketplace for interoperable health information, so that relevant private industry companies will participate in the development of a broadly available, open and interoperable NHIN? If so, what types of incentives could gain the maximum benefit for the least investment?  What restrictions or limitation should these incentives carry to ensure that the public interest is advanced?  
19、为驱动互操作医疗信息市场的发展，以至于有关的私人行业公司会参与广泛可得的、开放的、和可互操作的NHIN，是否需要财务激励？若是，什么样的激励能从最小的投资中获得最大的收益？这些激励应同时含有什么样的禁止和限制来保障推进公共利益？

20.What kind of incentives should be available to regional stakeholders (e.g., health care providers, physicians, employers that purchase health insurance, payers) to use a health information exchange architecture based on a NHIN?
20、区域性的利益相关者(如医疗服务供应者、医生、购买医疗保险的雇主、付费人)能得到什么样的激励，才能去使用基于NHIN的医疗信息交换架构？

21.Are there statutory or regulatory requirements or prohibitions that might be perceived as barriers to the formation and operation of a NHIN, or to support it with critical functions?
21、是否存在有法令或法规的要求或禁制，对于NHIN的构建与运作，被认为是阻碍，或被认为在关键职能上是支持它的？

22.How could proposed organizational mechanisms or approaches address statutory and regulatory requirements (e.g., data privacy and security, antitrust constraints and tax issues)?
22、建议的组织机制或方法，能如何实现法令和法规的要求(如数据私密性、反托拉斯禁制、和税务问题)？

[ 本帖最后由 西风瘦马 于 2007-5-21 20:26 编辑 ]

西风瘦马

Other
其它

23.Describe the major design principles/elements of a potential technical architecture for a NHIN. This description should be suitable for public discussion.
23、对NHIN的可能技术架构，描述其主要涉及原理/构成。这种描述应适合于作公众讨论。

24.How could success be measured in achieving an interoperable health information infrastructure for the public sector, private sector and health care community or region?
24、在为公共领域、私人领域、和医疗社区或区域达成互操作的医疗信息基础建设中，其成功与否应如何测量？

签署：2004.11.9.
David J. Brailer, MD, PhD
National Coordinator Office of the National Coordinator for Health Information Technology

BILLING CODE:  4150-24

[ 本帖最后由 西风瘦马 于 2007-5-21 20:30 编辑 ]

西风瘦马

Office of the National Coordinator for Health Information Technology
医疗信息技术全国协调员办公室
Request for Information (RFI) on National Health Information Network (NHIN)
关于《国家医疗信息网》(NHIN)的信息征询(RFI)
http://www.hhs.gov/healthit/rfi.html
Last revised: January 28, 2005

On January 18, 2005, 5:00 PM EST, the public comment period for responding to the Request for Information (RFI) on National Health Information Network (NHIN) closed. The National Coordinator thanks everyone who submitted responses to the RFI. In the coming months, the Office of the National Coordinator for Health Information Technology (ONC) will work with federal colleagues to review the responses and develop a public summary report.
2005年1月18日东部时间下午5点，是响应《国家医疗信息网》(NHIN)信息征询(RFI)的公众评价期的截止时间。协调员感谢每一位向RFI发出响应的人。以后的几个月，医疗信息技术全国协调员办公室(ONC或ONCHIT)将会同联邦同事一道，评阅这些响应，并编制总结报告。

As the nation embarks on the widespread deployment of EHRs, a variety of concomitant challenges and barriers must be addressed. One of these is interoperability, or the ability to exchange patient health information among clinicians and other authorized entities in real time and under stringent security, privacy and other protections. There are many perspectives that can be brought to bear on this important topic. Health information technology organizations, healthcare providers, industry associations and other stakeholders all have important insights that will inform future deliberation.
当国家开始广泛开展电子健康纪录(EHR)时，各种伴随而来的挑战和阻碍必须被重视起来。其中之一是互操作性，即实时地、在严格安全与私密及其它保护措施下、在临床医生和其它授权机构之间交流病人健康信息的能力。有很多观点/期望会带来施加向这个重要课题的压力，医疗信息技术组织、医疗服务提供者、行业协会和其它利益相关者，都会有将知会到未来商议中去的重要内在要求。

On November 15, ONCHIT released the RFI to learn how widespread interoperability of health information technologies and health information exchange could be achieved through a NHIN. The RFI is available through ONCHIT's website. While we provide this document on our website, the document that is published in the Federal Register is the official government publication.
11月15日，ONCHIT发布了RFI，来学习医疗信息技术和医疗信息交换通过NHIN能达到如何广泛的互操作性。RFI可以通过ONCHIT网站获得，该文件在通过网站提供的同时，还在联邦登记作为正式政府出版物出版。

On December 6th, from 2:30-4:30 PM, EST, ONCHIT hosted a technical assistance conference call to answer questions regarding the RFI. Over 550 people participated in the call. An Adobe PDF version of the transcript of the call is available: Transcript of December 6th Technical Assistance Conference Call.
If you have questions regarding the NHIN, please direct them to our office via email to onchit.request@hhs.gov or via phone at 202-690-7151.
12月6日东部时间下午2:30~4:30，ONCHIT主持了一次技术协助电话会议，来回答有关RFI的问题，超过550人参加。PDF版的会议纪录可在网上获得。
若有任何与NHIN有关的问题，可以将问题通过email发到onchit.request@hhs.gov，或打电话202-690-7151。

[ 本帖最后由 西风瘦马 于 2007-5-21 20:34 编辑 ]

西风瘦马

我可以用州际高速公路系统来类比。艾森豪威尔直接看到了纳粹高速公路对于一个国家两线作战的巨大战略优点，所以作为总统，他把州际高速公路系统视作为一个国家安全项目，虽然其直接效益是展现为州际商务。他并没有等待各个州来逐个地把事情弄好，或要求隔绝分离着工作的志愿者来产生他要的架构。

   HIT标准，如果不是国家安全事务，那就什么也不是——这么说，不仅仅依据于生物恐怖袭击或传染病控制，还依据于国家竞争力。各个SDO正在以较低成本建立服务于更好医疗的智力基础，其成功与否，将决定国家将继续繁荣，还是将倒塌在旋风般上升的医疗费用之剑下。对SDO努力的资金支持，应该满钵满桶地来自于联邦政府，同时由私人组织足够自主地管理，以保证利益相关者的意见表述和标准采纳。ONCHIT1是一个正等待着某个桶来落进去的水滴。  

......呵呵，“以保证利益相关者的意见表述和标准采纳”......咱们如何保证啊？
......美国政府(HHS)在“有关国家安全的事务”HIT标准上，向全社会征集邀请(request)社会上各种利益相关方的需求(information)，咱们谁能来征求一番啊

[ 本帖最后由 西风瘦马 于 2007-6-1 14:22 编辑 ]

西风瘦马

在中国，医疗信息化的利益相关者都有谁呢？
医院的信息主管，无疑是最主要的——有医院信息学会吗？要的是不仅仅强调管理，还要强调诊疗信息！
医院的放射医生、检验医生、ICU/麻醉医生等，也是——这些人有各自的学会；
医院的院长们，无疑也是——有医院管理学会；
医院的设备科长们，也是——有医学工程学会；
医疗信息产品的提供者，包括HIS、PACS/RIS、LIS、CIS等，以及3D厂家，肯定是利益相关者——好像没有专门的学会；
医疗设备制造商——美国有NEMA，中国呢？
还有谁呢？IT厂家，医疗主管部门，CDC，医保部门，商业保险公司，等等，不少啊！
这些方方面面的利益相关者，其代表喉舌都有吗？是谁呢？
这些喉舌都说过些啥？

[ 本帖最后由 西风瘦马 于 2007-6-5 00:47 编辑 ]