VHA, Kaiser, DoD Health Information Exchange Using NHIN

As announced in Healthcare IT News, VHA, DOD, and Kaiser will exchange health information using the NHIN Connect solution. VHA and Kaiser will be first out of the gate, with DOD expected to join in early calendar year 2010. Initial exchange will focus on a HITSP compliant c.32 document.

http://www.healthcareitnews.com/news/va-kaiser-plan-link-electronic-medical-records

EHR, EMR, PHR, PHMT, CPR, HIE, RHIO Confusion Reigns

Consumers and healthcare professionals remained confused about the meanings of healthcare information technology terms, despite HHS/ONC for Healthcare IT funding “official definitions” from the National Association for Healthcare IT.   It is important that all come to consensus on what is meant by the many healthcare information technology terms.

Standard definitions by the National Alliance for Health Information Technology (which recently ceased operations shortly after delivering its healthcare IT terminology report):

Electronic medical record: Information on a patient that can be created, gathered, managed and consulted by authorized clinicians and staff in one health care organization.

Electronic health record: Information on a patient that conforms to nationally recognized interoperability standards. It can be created, managed and consulted by authorized clinicians and staff across more than one group.

Personal health record: Information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources. It is controlled by the patient.

Health information exchange: Electronic movement of health information among organizations according to nationally recognized standards.

Health information organization: A body that oversees and governs the exchange of health information among organizations according to nationally recognized standards.

Regional health information organization: A body that brings together health care stakeholders within a defined geographic area and governs health information exchange among them to improve health and care.

See also http://healthit.hhs.gov/portal/server.pt?open=512&objID=1256&parentname=CommunityPage&parentid=8&mode=2&in_hi_userid=10741&cached=true

Back in 2005, Gartner defined the term EHR as the larger government led effort to consolidate all health information into a longitudinal health record.

Note that the Gartner Term, “Computerized Patient Record” (CPR) was not addressed by the HHS group.  Gartner defined CPRs as large hospital-based systems that integrate clinicals and financials.  Examples are Epic, Cerner, GE Centricity, Eclypsis, Meditech.  Gartner defined functionalites necessary for various generational levels of the CPR.

Other glossaries:

Primer on RxNorm

http://www.clinicalarchitecture.com/rxnorm-basics—screen-cast/

15 minute video on RxNorm from ClinicalArchitecture.com

Critical for health information exchange and pharmacovigilance.

NHIN 2.0 Gateway Code Released

I recently attended an outstanding NHIN connect training conference, attended by over 1200 representatives from government, industry and academia.

I have worked with many of the key individuals in the companies in the HIE space.

The momentum for actually establishing the NHIN is high.

There are many new cutting edge technologies and standards involved.

The latest NHIN 2.0 code can be found at:  http://www.connectopensource.org/display/NHINR2/

Release+2.0+Home;jsessionid=C2640BB1D07CF4D900963717596B3BE2

If you need independent, objective advice or implementation assistance regarding the NHIN, please e-mail me or call.

Robert E. Connors, FACHE, PMP, CEO, E-Health Designs, LLC to attend NHIN Connect Training, 29 and 30 June 2009

Robert E. Connors, FACHE, PMP, CEO, E-Health Designs, LLC will attend NHIN Connect Training, 29 and 30 June 2009, and is available to meet with clients in the evenings.

NHIN CONNECT Enterprise Service Component (ESC) Code and SDK Released!

As previously reported at http://www.ehealthdesigns.com, the HHS ONC for healthcare IT announced the release of open source NHIN CONNECT Code and SDK at the 2009 annual HIMSS conference. The code may be used under a government BSD, non viral license.  LCDR Steve Steffensen, MC, USN, and Captain (Sel) Emory Fry, MC, USN, were instrumental in working with the FHA to develop the adapter layer and common access layer, which will allow the NHIN gateway and enterprise service components to connect to back end federal and commercial EHRs.

The NHIN 2.0 gateway download site is http://www.connectopensource.org/display/NHINR2/Release+2.0+Home;jsessionid=C2640BB1D07CF4D900963717596B3BE2.  This is a significant advance towards the national goal of exchanging interoperable healthcare data, in that the code and SDK will allow software developers to connect federal agency back-end government and commercial healthcare systems to the NHIN.

Per the CONNECT website:

“If the Nationwide Health Information Network (NHIN) is the information highway for health data exchange, CONNECT is the universal on-ramp for federal agencies. CONNECT is a software solution that lets federal agencies securely link their existing systems to the NHIN. More than 20 federal agencies collaborated to build CONNECT through the Federal Health Architecture (FHA), and as a result, agencies are heading down the road toward interoperability.

The Office of the National Coordinator for Health Information Technology (ONC) has been facilitating development of the NHIN, which will tie together health information exchanges, integrated delivery networks, pharmacies, government, labs, providers, payors and other stakeholders into a “network of networks.” The NHIN provides a mechanism for previously disconnected systems and exchanges to connect to each other and share data using nationally recognized interoperability standards, specifications, participation agreements and policies. The ability to share data electronically among organizations will provide a wide range of benefits to citizens, among them: having up-to-date records available at the point of care; enhancing population health screening; and being able to collect case research faster to facilitate disability claims.

The CONNECT software is the outcome of a 2008 decision by federal agencies to begin work on connecting their health IT systems into the NHIN. Rather than individually build the software required to make this possible, the federal agencies collaborated through the Federal Health Architecture program to create a single solution that can be reused by each agency within its own environment. The agencies built CONNECT in open source in order to keep costs low when it is deployed in each organization. An additional benefit of developing the offering in open source is that CONNECT has now been made available to the healthcare industry at large. CONNECT will act as an accelerant to promote NHIN adoption and additional innovation in the industry.

The CONNECT Gateway is built on open source technologies and will be made available to the public in March of 2009. Three primary elements make up the CONNECT Gateway:

• The NHIN Gateway implements the core NHIN services enabling such functions as locating patients at other health organizations within the NHIN, requesting and receiving documents associated with the patient, and recording these transactions for subsequent auditing by patients and others. Other features include authenticating network participants, formulating and evaluating authorizations for the release of medical information, and honoring consumer preferences for sharing their information.

• The Enterprise Service Component (ESC) provides default implementations of many critical enterprise components required to support electronic health information exchange, including a Master Patient Index (MPI), Document Registry and Repository, Authorization Policy Engine, Consumer Preferences Manager, HIPAA-compliant Audit Log and others. Agencies are free to adopt the default enterprise component implementations packaged in the CONNECT ESC or to plug in existing agency implementations of these service components. This component also includes a software development kit (SDK) for developing adapters to plug in existing systems such as electronic health record solutions to turn on information flows to support the secure exchange of health information across the NHIN. This makes CONNECT a platform for participation in health information exchanges.

• The Universal Client Framework enables agencies to develop end-user applications using the enterprise service components in the ESC. This makes CONNECT a platform for innovation.”

As of 8:00 AM on 7 April 2009, there was very high demand for the software, and HHS put a limit on the number of downloads.  If you cannot get into the download site, keep trying!  E-Health Designs, LLC has subsequently learned that in order to get the code, one must register first with a user name, password, and valid e-mail address.  Upon registration, an e-mail is sent back to the user and he/she must validate that address prior to moving to the next step and being able to actually download the software.  As of 9 April 2009, I was still waiting on the e-mail to arrive so I could validate it.  I presumed that this was an automated process similar to other web sites, however, an FHA representative confirmed to me this afternoon that there is a human involved in the process to send the e-mail, and he/she is back-logged.  FHA is looking to an alternative solution so as to make the downloads more available.

NHIN 2.0 Adapter/Enterprise Service Bus Code and SDK To Be Released

During HIMSS next week, the ONC for Healthcare IT will make a major announcement regarding the release of open source NHIN code and a System Development Kit (SDK).  

The code and SDK will be released under an open-source government BSD license, that will allow government and civilian back-end healthcare databases to connect to the NHIN gateway. 

This code provides for an adapter/enterprise service bus which provides patient identity management services, discovery services, orchestration services, and HITSP C.32 document management services. 

It was developed in Java Glassfish and uses GELLO. 

It is probable that new services will be added to the bus over time, such as terminology mediation services, semantic search, clinical decision support, the ability to connect patient education content to a document, and perhaps natural language processing (text to facts). 

U.S. Army TATRC may be instrumental in shaping the services that go into the NHIN adapter/bus, through the use existing and future Congressional Special Interest dollars, and will continue to work with the FHA

David Riley’s Presentation on NHIN and CONNECT

David Riley, FHA CONNECT Lead, gave an excellent presentation today on NHIN and NHIN Connect.

See attached slides.

connect_cfw_eseminar_slides_final3

The adapter/bus components are all open source and will be released under a government BSD license on 31 March 2009.

As of 1 April my sources indicate that the code and SDK location will be announced during HIMSS.

The bus will allow federal back end systems like VISTA and AHLTA to connect to the NHIN.

Civilian EHRS and EMRs can also use the adapter/bus to connect to the NHIN.

CDR Emory Fry, MC, USN, and LCDR Steve Steffensen, MC, USN, were instrumental in the development of this adapter.

NHIN 5th Trial Implementation Work Products Now Available

HHS reports that work products from the NHIN 5th Trial Implementation are now available at:  http://www.hhs.gov/healthit/healthnetwork/forums/forum5agenda.html