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Interoperability for the NHIN Thomas Jepsen, IEEE-USA MTPC Version 1.3 Updated July 5, 2005.

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Presentation on theme: "Interoperability for the NHIN Thomas Jepsen, IEEE-USA MTPC Version 1.3 Updated July 5, 2005."— Presentation transcript:

1 Interoperability for the NHIN Thomas Jepsen, IEEE-USA MTPC Version 1.3 Updated July 5, 2005

2 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

3 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

4 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…

5 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 nations critical infrastructure

6 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

7 Functions of the NHIN Fast, Ubiquitous Access to online Electronic Health Records Fast, Ubiquitous Access to online Electronic Health Records Online Claims Processing Online Claims Processing Transport of Medical Images Transport of Medical Images Emergency Medical Response Emergency Medical Response Coordination of Health Information Networks Coordination of Health Information Networks Telehealth for rural/underserved areas Telehealth for rural/underserved areas Longitudinal EHR Longitudinal EHR Home Healthcare Home Healthcare E-Prescription E-Prescription Source: Position Statement: National Health Information Network, with emphasis on Security and Privacy Issues, June 2005

8 Interoperability Considerations NHIN FunctionInteroperability RequirementResponsibility/ Standards Body Medical TerminologyCommon language for medical procedures Systematized Nomenclature for Medicine (SNOMED), ICD9, ICD10, LOINC, CPT Ubiquitous Availability of EHRStandards 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 ImagingDefinition of lossless image, transport format, transport protocol, image encryption DICOM, MPEG, JPEG Emergency Medical ResponseAuthorization 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

9 Interoperability Considerations (cont) NHIN FunctionInteroperability RequirementResponsibility/Standards Body TelehealthVideo standards, bandwidth, QOS, reliability, security, privacy HIPAA Security, HIPAA Privacy, IEEE 802.1ah, reliability? Medical InstrumentationMessage standards, transport protocols IEEE 1073 Longitudinal EHRCompatible, persistent storage formats ISO/TR 21089 Trusted End to End Information Flows, ASTM E31 Continuity of Care Record (CCR) Home HealthcareDevice certification, instrumentation standards, reliability, security, privacy FDA Center for Devices and Radiological Health, IEEE 1073, HIPAA Privacy, HIPAA Security, reliability? E-prescriptionDrug codes, security, privacy, reliability NCPDP SCRIPT, HIPAA Privacy, HIPAA Security, reliability?

10 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

11 New Protocols? Standards for lossless imaging? Security Standards? Encryption? Standards for network compatibility? Compatible storage formats? Other Areas for Investigation

12 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?

13 Recommended Reading Semantics: Chen C., Visualizing Semantic Spaces and Author Co-Citation Networks in Digital Libraries, IEEE 802.1ah: Cherry S., Ethernets High-Wire Act, IEEE Spectrum, April 2005, 63- 5. 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, 69- 85. 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:

14 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

15 Contact Info Thomas C. Jepsen, IEEE-USA Medical Technology Policy Committee Phone: 919-933-0377

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