Webinar: NHIN implementation is on the cusp
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The webinar was the third in NeHC’s NHIN University series.
“NHIN isn’t a thing per se,” said Doug Fridsma, MD, PhD, acting director at the Office of Standards and Interoperability at the Office of the National Coordinator for Health IT (ONC), “but it’s the active using of the standards and services within a framework that establishes the policies sand the like for health information exchange (HIE) to occur on a nationwide basis.”
The NHIN is part of a larger effort by the ONC to establish standards, security and trust mechanisms for HIE, according to Rich Kernan, the ONC’s NHIN specifications factory lead.
The NHIN specifications were published at the end of January and implemented in March, so “we are literally on the very cusp of the NHIN launch and expansion,” Kernan said. “In the future, you’ll see evolution of the existing NHIN specifications to allow more and more functional use cases.”
The NHIN Limited Production Exchange (LPE) is one of the first instantiations to expand NHIN scope and functionality, according to Kernan. Developed under contract to ONC, the NHIN LPE is in use by the NHIN Cooperative, a private/public collaborate organization that builds, tests and demonstrates core capabilities to enable basic exchange of health information between different HIE networks, patients and other stakeholders.
The NHIN Cooperative—which includes Kaiser Permanente, the Department of Veterans Affairs and the Department of Defense, among others—established and implemented NHIN specifications and signed the Data Use and Reciprocal Support Agreement (DURSA) that allocates responsibilities and accountability to protect the information that is exchanged, according to Kernan.
For example, a Social Security Administration (SSA) program that uses NHIN to determine medical disability has been in production for more than a year with MedVirginia, and will add 15 more health information organizations throughout 2010, he said. Organizations such as Beacon Communities, SSA grantees and state-wide HIEs will likely become future participants and will expand the NHIN LPE, Kernan said.
NHIN’s discovery and information exchange services include:
- Patient Discovery – Provides a means for a NHIN node to query another to determine if it is a source of information for a specific patient;
- Document Query & Retrieval – An exchange pattern that allows NHIN nodes to locate and retrieve patient-specific clinical documents held by other NHIN nodes;
- Health Information Event Messaging – A publish/subscribe exchange pattern that allows a NHIN node to establish a subscription to information available from another for periodic exchange;
- Document Submission – A push mechanism that allows an initiating NHIN node to send one or more documents for a given patient to a receiving node; and
- Services Registry Interface – Provides a means for NHIN nodes to obtain information on other nodes and service endpoints.
The “push and pull” mechanisms are in pilot testing, Kernan said.
To ensure that HIEs are compatible with other exchanges, the ONC’s Federal Health Architecture used NHIN standards and governance in developing CONNECT, an open-source software for setting up HIEs and sharing data using U.S. interoperability standards, said David Riley, ONC’s CONNECT lead. He said the software was initially developed by federal agencies to support their health-related missions, but is now available to all organizations.
CONNECT has three major components: the gateway, which implements NHIN specifications; an enterprise service platform composed of an adaptor service bus that includes enterprise service components and tools for integrating edge systems; and a universal client framework, which focuses on the end-user experience.
Another ONC-sponsored NHIN initiative is the temporary NHIN Direct project, which enables the direct and secure transport of patient health data over the internet in support of meaningful use, according to Kernan. NHIN Direct seeks to examine authentication, message delivery protocols, directories, trust framework and security, he said.
The NHIN Direct project will draft additional specifications and services that address simple, direct communications between known participants, said Fridsma. “At the end of the day, those specifications, as a result of the NHIN Direct project, will become part of the suite of tools [available] within these different specifications, and we hope people will begin to … exchange information using that set of specifications and software under a policy framework.”
Specifications and standards from the project will be defined and in “real-world implementation” by late 2010, said Fridsma.
For more information about NHIN, click here.