NHIN project shows promise for nationwide rollout
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The goal of the project was to demonstrate the secure exchange of clinical data among health information exchanges in the U.S. This was successfully realized in a testing event in August 2008, and public demonstration events in September and December 2008 when electronic patient data were exchanged among cooperative members using NHIN-conformant specifications. (The September event demonstrated the retrieval and display of data from other cooperative members in the context of a fictional patient who had suffered a heart attack while visiting Indianapolis, while the December event demonstrated the ability to obtain records electronically to assess disability eligibility.)
“As we kick the tires on the structures and representations, we found they would work fairly well,” said Kuperman, who is from the department of inoperability informatics at New York-Presbyterian Hospital in New York City.
However, Kuperman adds that there is more work to be done to provide data for specified terminologies. Specifically, he says that most provider organizations are not well positioned to be more compliant with the proposed terminologies.
If NHIN was to move closer to widespread implementation, the privacy challenges also would be “quite complex,” Kuperman said. Privacy and security challenges did not get tackled as part of this particular project. In fact, the project was undertaken with test data because the required data use agreement to ensure patient privacy couldn’t be figured out in the project time period, partly due to the complexity of state privacy laws.
“Some of the interstate privacy concerns are still quite complex and need to be addressed,” Kuperman said. As a result, the Office of the National Coordinator for Health IT (ONC) has focused on this explicit goal, in order to tackle some of the privacy issues with interstate data exchange, including patient consent models.
“There’s still a lot more work to be done on the privacy side,” he says. “Likewise, on the security side, there is still more work to do be done to assess the technical safeguards, in terms of encryption, as well as policies about authorizations, authentication and auditing mechanisms to support security for the final creation of a NHIN.”
Based on the implementation projects, some of the specifications were “not sufficiently mature” for their designed purposes, said Kuperman. He identified quality reporting as one of the most outstanding examples, as the specifications for quality were at a “very rudimentary stage, and require further development.” Other specifications that require more attention include biosurveillance, consumer-based applications, such as EHRs, as well as messaging and referrals.
“The project covered a few common scenarios. There are more specialized healthcare scenarios that would require additional specifications built out, such as surgical scenarios, transfers of care, etc.,” Kuperman said.
However, the current NHIN specifications appear to be a suitable technical foundation for vendors to build commercial HIE network solutions, wrote the authors, noting that the technology partners of the members of the NHIN Trial Implementations Cooperative were beginning to build the specifications from the NHIN project into their standard offerings.
“The vendors are going to be obliged to adhere to interoperability specifications, largely due to meaningful use,” Kuperman said. “Meaningful use will require vendors to adopt some of these specifications. In the past, the market forces haven’t been there to require vendors to move in a particular direction, and some of that may change over the next few years due to government regulations.”
Various government organizations are working to together to ensure the NHIN is properly established. The Health IT Standards Panel (HITSP) constructs served as a “suitable starting point” for the development of content specifications for interoperability, according to the authors. The successful testing of the HITSP content constructs in this framework “has increased the confidence that HITSP constructs will be able to address a broad set of requirements,” the authors wrote.
ONC commissioned HITSP in 2005/2006 for this purpose, and it needs to remain in place, according to Kuperman, because there is “still a tremendous amount of work to be done to evolve the specifications.”
Also, the HIT Panel Committee is making recommendations about which standards should be adopted and accepted. Meanwhile, the HITSP working groups are filling in a lot of the details, overseeing the implementation and the HITSP standards committee sets the direction for the necessary structures.
All these working components are working together in the goal of creating the strongest possible structure to allow for the future, successful deployment of the NHIN—which may seem slightly more probable after this project.