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NHIN Gets Technical

September 1, 2006
by David Raths
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Stakeholders review NHIN prototypes in the first meeting of its kind in Bethesda, Md.

Late June's stormy weather and regional flooding couldn't dampen the spirits of more than 500 attendees of the first Nationwide Health Information Network Forum. Orchestrated by the Office of the National Coordinator for Health Information Technology (ONCHIT), the meeting was held June 28-29 at the National Institutes of Health in Bethesda, Md.Don mon

The forum's mission was not to grapple with policy issues, but instead to work toward a list of technical requirements necessary to make a national health information network (NHIN) a reality.

"Our goal was not to come up with consensus or a prioritization, but to increase awareness of the complexity and challenges and to offer commentary on gaps and refinements that could be made," says John Loonsk, M.D., director of ONCHIT's Office of Interoperability and Standards.

The meeting highlighted the fact that although prototype networks are being tested, NHIN's developers are still molding a general architectural framework. "We're coming up with simple, declarative statements. It needs to do this or that," Loonsk says.

Before the conference began, the four consortia submitted their initial combined set of more than 1,100 "functional requirements" regarding topics such as security, data transmission and information location. An example of a functional requirement would be: "The record locater shall return pointers that enable retrieval of patient records from data sources and repositories."

The presentations by consortia leaders Accenture (New York), Computer Science Corp. (El Segundo, Calif.), IBM (Armonk, N.Y.) and Northrop Grumman (Los Angeles) made it apparent that their approaches have a lot in common, Loonsk says, although there are some architectural differences. "It's good for people to see the practical process of manifesting the complexities of the architectural requirements in software," he adds. "I think it's a real positive to state the design needs and then show the practical aspects of making it go forward into reality."

Lively breakout sessions dealt with issues of confidentiality and security as well as data normalization and mapping. Each session leader prepared a summary of the main points brought up. Individuals also had the opportunity to write their own proposed functional requirements. That material and transcripts of the forum will be submitted to a panel of the National Committee on Vital and Health Statistics, which will streamline the list of functional requirements this fall.

That narrower list is expected to help the Health Information Technology Standards Panel's efforts to define interoperability specifications and provide input for the Certification Commission for Health Information Technology's compliance certification criteria.

Don Mon, vice president, practice development, for the American Health Information Management Association, Chicago, says the forum gave many people in the industry their first look at the various models the consortia are working on. "It also provided the first time people could feel engaged and provide input," adds Mon, who led two breakout sessions at the conference.

Consumer privacy was a hot topic, he says, and not just among consumer advocacy groups. "All the stakeholders understand that this whole thing could crumble if privacy and confidentiality aren't done right," Mon stresses.

One forum attendee, Lammot du Pont, senior manager of Manatt Health Solutions in Washington, D.C., believes the public input will be valuable. "It's unwieldy, but there's a chance to build a consensus behind a common architecture." Du Pont, who used to be an ONCHIT staffer, says working on standards organizations can be mind-numbingly technical and the procedures can at times seem Byzantine, "but I didn't get that impression here. I think people were pleased. There was a perkiness to the group."

As Loonsk sees it, people have been working on these issues for a long time and seemed happy to have the opportunity to give their input. "I think they are excited about moving forward to the next step."

Author Information:

David Raths is a Portland, Maine-based freelance writer.