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Tag: NHIN

SureScripts, A Defacto NHIN

Yesterday in New Orleans, SureScripts announced a new line of business: Clinical Interoperability. Leveraging their existing ePrescribing solution platform, currently serving over 200K physicians nationwide, and combining it with the technology stack of messaging solution provider Kryptiq, SureScripts will offer providers, EHR vendors, HIEs and other stakeholders the opportunity to securely share clinical information across town, the state, a region and the country. In this combination, SureScripts will provide the rails and Kryptiq will address the last mile of connectivity. This announcement has some pretty big implications for the HIE market.  Chilmark was briefed prior to this announcement by both SureScripts and Kryptiq, following is what we learned.

Details:
SureScripts primary focus has been to provide the network that would support physicians transition to ePrescribing. Therefore, SureScripts has been focused on transmitting NDP data and not clinical notes. SureScripts got into the transmission of clinical summaries from one of its larger customers, MinuteClinic wanted to send clinical summaries of patient visits directly to primary care providers. In the past year SureScripts has facilitated the movement of over 0ne million patient summaries for MinuteClinic to primary care physicians using CCR. Seeing an opportunity, SureScripts sought a partner that could take this capability to the next level.

Kryptiq, a company profiled in Chilmark’s forthcoming HIE Market Trends Report due out next month, can be characterized as vendor of HIE capabilities that allow for the organic growth of an HIE without the overhead. Kryptiq has worked behind the scenes for a number of EHR companies to provide secure, structured messaging services within these EHRss ecosystems of customers connecting them to one another as well as to other systems, including SureScripts to facilitate care coordination.

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Making Sense of the NHIN

By NIHN

The National Health Information Network (NHIN), which was the previous ONC head’s (Kolodner) top priority, or at least seemed that way is a concept that has its advocates and detractors.  To date, we have been more of a detractor as the original NHIN was a very heavy, top down approach by the federal government to establish a national Health Information Exchange (HIE).  Certain federal agencies loved the idea (e.g., Social Security Administration which has an embarrassing 18 month backlog of disability claims), but those in the field (local hospitals, RHIOs, HIEs, etc.) were not such a big fan of the concept.  Heck, we can’t even get RHIOs established, let alone an NHIN.  Adding to NHIN woes was its platform, built by beltway bandits with technology ill-suited to create a flexible, lightweight transport mechanism for the exchange of health information.

Thankfully, a new administration has come on board, new people have joined ONC and the bloated NHIN of recent history is getting a major rework – actually being split with NHIN referring more to the policy constructs that will define information exchange (the DURSA – Data Use and Reciprocal Support Agreement) and NHIN Direct, a much lighter weight technology stack to enable point to point communication.Continue reading…

In ONC I Trust …

It’s my nature to question authority.

Whether it’s religion, politics, or even my local administrative leadership, authority figures must earn my trust.

Earning that trust is not easy. As folks who work closest with me know, I believe that much of Dilbert is based on true case studies.

Over the past year, I’ve worked very closely with many people at ONC – David Blumenthal, John Glaser, Judy Sparrow, Farzad Mostashari, Chuck Friedman, Carol Bean, Doug Fridsma, Chris Brancato, Jonathan Ishee, Arien Malec (on loan to ONC for 8 months), and Jodi Daniel. I’ve worked with HHS CTO Todd Park. I’ve worked with US CTO Aneesh Chopra.Continue reading…

The Health Internet vs. the NHIN — A Matter of Control, Cost, and Timing

David KibbeThere is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.

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The Health Internet vs. the NHIN

There is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.Continue reading…

Health Internet – The New Consumer-Friendly NHIN

Consumer directed HIE will become the most visible aspect of health IT stimulus and could lead a shift to consumer-directed health plans, increased interest in wellness programs and family-centered collaboration for the young, old and seriously ill.

At a recent Boston meeting on health records infrastructure, key stakeholders recognized the potential of patient control as a strategy to address privacy concerns that could otherwise limit ongoing health networking initiatives. MedCommons proposes one possible approach to making the national health information network (NHIN), currently conceived as a provider-to-provider exchange, consumer-friendly and consumer-accessible. We illustrate the need with a true story, propose a novel addition of independent identity service providers to the NHIN and then illustrate how this could be used to transfer the soldier’s CT to the US for a second opinion even as he’s being transported.

On the morning of the Boston meeting, a friend of mine called to say that his son was seriously wounded in Afghanistan and was being stabilized for transport via Germany to the US. He knew that his son had a CT in the field clinic and wanted to get it before the son was transported over four days through to Bethesda. Could the Health Internet be used to help this family?

The NHIN does not have to run like Big Brother. We propose a voluntary identity principle that distributes trust among multiple private and public institutions and gives consumers a choice of who controls their medical identity. Some might pick a particular hospital, others might choose their regional HIE while others could choose a private service such as a bank or telecom that is not a health care business at all.

The institution that manages a patient’s ID on the Health Internet is referred to as the IDP. To authorize health records exchange on the NHIN, an IDP would have to meet strict requirements and receive a NHIN Certificate. A NHIN Certificate is analogous to the SSL certificates issued to banks and other corporations on the Internet. Larger hospitals, military, VA and integrated delivery networks on the NHIN also hold a NIHN Certificate.

The issue and administration of NHIN Certificates could be handled by state or federal agencies or privatized to Verisign and similar services that already do this for the Internet.

We propose a Health Internet consisting of two kinds of certified entities, health care providers and identity providers. Both are chosen and trusted by the consumer but the identity providers are the key to effective competition and innovation.

Small group practices, insurance companies, web personal health records services and search engines would likely not carry NHIN Certificates and would participate in the Health Internet only under the control of the patient trough their IDP.

Substitutability, the central concept of the Boston platform meeting, is a key benefit of this proposal. An IDP that disappoints a patient could be swapped out without impacting the health care providers and a health care service that disappoints could be ignored or disconnected with a simple message to the IDP.

Public health and research users of the NHIN would not be affected since all entities that carry NHIN Certificates could still interact with each other directly under whatever rules and regulations the Certificates represent.

How would this have worked in the case of a soldier shot in Afghanistan and on his way to Bethesda?

– Before entering the service, the son might have picked Verizon as his IDP because they hold an HNIN Certificate and offer a family member override. He would have established the father, who also has a Verizon account as health care proxy.

– Upon induction, the health service saved the serviceman’s IDP selection (their Verizon health ID, possibly in OpenID format – see references below) along with the rest of his personal contact information.

– The father, when notified of the injury, is unsure which doctors will be available to consult on his son’s case, but needs to have the son’s CT scan at the ready as a first step.

– The father decides to do a transfer using a personally controlled health record service because it will give him control of the CT and make it easy to deliver the images to any physician that offers to help. Neither the father nor the health record service has a HNIN Certificate.

– The father goes to the military health service EHR portal. Without logging in, he goes to a form that requests his son’s Verizon health ID along with the MedCommons-type account ID where the CT is to be delivered.

– The EHR portal contacts Verizon for authorization on the basis of shared trust under the NHIN federation.

– When Verizon’s text message to the son goes unanswered, Verizon contacts the father as Health ID proxy. The father reviews the correctness of the familiar-looking MedCommons-type ID as a the destination and authorizes the transfer.

Note that the military health service does not actually know whether the son or the father actually authorized the request but they trust the transaction because the military health service knows that Verizon holds a valid NHIN Certificate.

In summary, the introduction of certified identity providers into the NHIN together with simple and commercially established OpenID protocol can transform the NHIN into the consumer-friendly Health Internet and bring simple regulation and market forces to bear on solving difficult privacy problems.

CODA: As of 10/4, the the soldier is stable, conscious and out of the ICU in Bethesda. A second opinion is in the works at a Boston hospital. The parents and collaborators are able to see and share 1.75 GB of imaging about their son. Let’s all hope for a good outcome and a speedy recovery.

Adrian Gropper is a physician and the CEO of MedCommons

References:

Patient ID on the Internet; October 12, 2007; Blog; http://agropper.wordpress.com/2007/10/12/patient-id-on-the-internet/

Web leaders initiate govt open identity pilot program; September 30, 2009; Health Imaging Editorial; http://www.healthimaging.com/index.php?option=com_articles&view=article&id=18927

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