Game Of Interoperabilities

In 2004 President Bush created the Office of the National Coordinator for Health Information Technology (ONC), introducing the notion that Health Information Technology (HIT) should last nationally coordinated. One of the firstly endeavors of ONC was the planning as well as pattern of a National Health Information Network (NHIN) equally a way to facilitate the telephone substitution of electronic wellness information amidst providers as well as Health Information Exchange (HIE) entities. This was, as well as nonetheless is, a grand vision of an interconnected wellness tending ecosystem, inclusive of all governmental agencies as well as all stakeholders who inwards whatever shape or cast construct a living or a turn a profit from servicing the wellness tending needs of the nation (see icon below).

To prime number the heart for plenty electronic information to last exchanged, the novel ONC made grants to the American National Standards Institute (ANSI) for the creation of a Health Information Technology Standards Panel (HITSP) to get together standards for the exchange, as well as to RTI to attain the Health Information Security as well as Privacy Collaborative (HISPC) to piece of occupation amongst line of piece of occupation concern stakeholders at a State level. Both these committees are defunct now, but HITSP had a rattling productive as well as highly visible lifespan, attracting sponsorship from authorities contractors as well as merchandise associations. In addition, ONC also awarded a grant to a novel entity, the Certification Commission for Health Information Technology (CCHIT), which was pulled together past times the American Health Information Management Association (AHIMA), the Healthcare Information as well as Management Systems Society (HIMSS) as well as the National Alliance for Health Information Technology (NAHIT). Both AHIMA as well as HIMSS are flourishing these days, but NAHIT voluntarily dissolved itself (and removed its website). The funding for CCHIT was aimed at creating a certification computer program for Electronic Medical Records (EMR), including interoperability capabilities. In 2006, CCHIT began certifying EMR software as well as was the sole authorities designated Recognized Certification Body (RCB).

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Source: CONNECTing to the Nationwide Health Information Network (NwHIN): The Road Ahead

In 2009 President Obama injected much needed stimulus dollars as well as empowering legislation into the ONC. The HITECH Act opened a novel era of prosperity for all things HIT. The prolific HITSP as well as the less stellar HISPC were replaced past times 2 construct novel Federal Advisory Committees, an HIT Policy Committee as well as an HIT Standards Committee to construct recommendation to the reinvigorated ONC inwards its efforts to implement the Meaningful Use incentives program. CCHIT lost its unique certifier seat as well as became only i of several authorities sanctioned certifiers of Meaningful Use compliant Electronic Health Records (EHR). The NHIN, at nowadays portion of the Federal Health Architecture (FHA), acquired a novel opened upward root gateway called CONNECT NHIN Direct, intended to facilitate wellness information telephone substitution through something equally elementary as well as equally ubiquitous equally e-mail attachments (encrypted, of course).

For i argue or another, NHIN changed its refer to the much hipper NwHIN (Nationwide Health Information Exchange) as well as NHIN Direct dropped its NHIN refer affiliation to stand upward on its ain equally the Direct Project. The ONC hence initiated a major force to attain got its diverse grantees (e.g. State HIE, Regional Extension Centers, as well as Beacon Communities) telephone substitution wellness information through the Direct Project flavor of secure email. Most HIT vendors complied as well as implemented the Direct Project specifications inwards their products. In 2011, the ONC created the Standards as well as Interoperability (S&I) Framework, “a collaborative community of participants from earth as well as someone sectors who are focused on providing the tools, services as well as guidance to facilitate the functional telephone substitution of wellness information”. Started amongst iii initiatives, the S&I Framework at nowadays includes dozens of projects as well as workgroups, managed past times authorities contractors presumably on a volunteer basis, as well as the Direct Project has been folded into this novel framework, as well as shortened its refer to Direct.

In the meantime exterior the confines of ONC, interoperability players tin describe their pedigree to 1997 when HIMSS as well as the Radiological Society of North America (RSNA) created an organisation named Integrating the Healthcare Enterprise (IHE) to railroad train frameworks as well as specifications (profiles) for wellness information exchange. IHE has been rattling active as well as rattling prolific over the years. In 2011, the EHR/HIE Interoperability Workgroup (IWG), a consortium of U.S. as well as HIT vendors, amongst a destination of “increasing the adoption of EHRs as well as HIE services”, was created past times the New York eHealth Collaborative (NYeC), an organisation amongst extensive ties to ONC, founded inwards 2006 to facilitate HIT adoption as well as wellness information telephone substitution inwards the State of New York. Leveraging IHE work, the workgroup created guidelines as well as specifications “to promote a scalable approach that allows for rapid deployment at an affordable price, thereby expanding marketplace opportunities for vendors”. Around the same time, Mayo Clinic, Geisinger, Kaiser Permanente, Intermountain Healthcare as well as Group Health formed the Care Connectivity Consortium (CCC) to “demonstrate that effective as well as timely wellness information telephone substitution using the latest national information technology standards is possible inwards a secure surroundings as well as amidst geographically disparate wellness tending providers”. Things were starting fourth dimension to oestrus up.

In May 2012, the ONC requested world comments on its strategy for governing wellness information telephone substitution through its NwHIN. The ONC envisioned a laid of Network Validated Entities (NVEs), similar to the Direct e-mail intermediaries, Health Internet Service Providers (HISPs), specifically built for, or specializing in, the telephone substitution of wellness information, as well as it outlined policies as well as regulations to last adhered to past times participants inwards information telephone substitution equally “conditions for trusted exchange” (CTE). By Oct 2012, the ONC decided to transition the NwHIN community management to a novel public-private entity named Healtheway as well as rename it eHealth Exchange. Almost immediately, Healtheway formed a Coalition amongst the NyeC spawned IWG to combine harmonization of standards as well as marketplace share. The side past times side stride was an announcement that the Coalition selected CCHIT to “certify that the interfaces betwixt the HIT as well as HIEs are consistent across multiple states as well as systems”. 2012 also saw the creation of DirectTrust, an entity whose destination is to “to develop, promote and, equally necessary, help enforce the rules as well as best practices necessary to keep safety as well as trust inside the Direct community, as well as to foster widespread world confidence inwards the Directed telephone substitution of wellness information”. In December, ONC announced its intention to supply grant funding to “entities already involved inwards governance of wellness information exchange” as well as forgo its ain regulatory plans.

During the 2013 HIMSS season, the Coalition announced a collaboration understanding amongst the CCC to attain got wages of the CCC “advanced services that address the complexities of patient matching, consent management and, eventually, population care”, as well as CCHIT announced iii novel certifications, i for EHRs connecting to HIEs, i for HIE to HIE connectivity as well as i for Direct users. Across town, DirectTrust, inwards partnership amongst the Electronic Healthcare Network Accreditation Commission (EHNAC), announced its Direct Trusted Agent Accreditation Program, DTAAP, for HISPs, Certificate Authorities, as well as Registration Authorities, which may or may non last EHR or HIE vendors. Also at the HIMSS extravaganza, a novel Alliance, consisting of several rattling large EHR vendors, named CommonWell entered the interoperability fray, announcing its plans “to promote as well as certify a national infrastructure amongst mutual standards as well as policies” as well as to “ensure that products that display the CommonWell Health Alliance seal attain got been certified to piece of occupation on the national infrastructure”.

It is of import to greenback that, all the organizations described hither (except the government, of course) are non for turn a profit corporations as well as most are supported past times authorities grants to for certain degrees.  They all charge, or programme on charging, some kind of membership and/or subscription fee, as well as past times my terminal count at to the lowest degree iii of them programme on offering, as well as charging for, certifications of software products used to telephone substitution wellness information inwards whatever way. Also interesting is the fact that HIT vendors are participating inwards multiple organizations, hence for illustration an EHR vendor tin last portion of both the Coalition as well as the Alliance, or portion of none. Fortunately though, most leaders of these novel entities, are currently, or were inwards the past times as well as presumably volition also last inwards the future, involved inwards the diverse ONC regulatory as well as technology scientific discipline specification activities.
The factions described hither are past times no way the exclusively actors inwards the wellness information telephone substitution game. Such revered standards organizations equally HL7, NCPDP as well as ASC X12, who attain got been supporting practically all wellness tending interoperability efforts on their ain for many years, or the diverse international opened upward standards groups, or the hot novel BlueButton initiative, are non actually contenders for what’s at stake here, but should last acknowledged for completeness sake. 

So terminal week, ONC picked its favorites as well as granted less than one-half a i thou k dollars, separate betwixt DirectTrust as well as the IWG, as well as their partners, to bolster their existing attempts at governing the national telephone substitution of wellness information. Congratulations to both.

What does this all mean? I am non sure. Season thirteen looks promising, as well as your justice is equally adept equally mine. I only similar watching the cute fiddling flame-throwing dragons…