Hie Direct For The Perplexed
The Government, through ONC, has awarded over $547 meg to diverse U.S.A. to create regional HIE (organizations). The fledgling novel State HIEs (the organizations) are busy screening together with purchasing HIEs (the platforms) together with defining the rules of their local HIE (the act). There are several HIE (platform) vendors, notably Medicity together with Axolotl (recently acquired past times Ingenix), but fifty-fifty Microsoft together with IBM are trying to brand inroads into this fairly novel market. In a parallel process, ONC is busy defining national standards together with regulations for HIE (the act).
There are 2 basic models for whatever information commutation together with HIE (the act) is no different.
The Centralized Model – All information creators/editors/contributors force their content to a centralized repository, preferably inward existent time, together with all users/readers line the information on need from said centralized repository. This is the infamous “database inward the sky” which houses every American’s medical records. Conceptually, this is the simplest model to understand. The Government volition purchase plenty hardware to educate clusters upon clusters of databases, define the exact information elements together with documents to live stored, assign a national identifier to all of us (physicians too) together with hold upwards discover specifications for pushing together with pulling information securely. Every EHR vendor together with medical information supplier (such every bit labs together with pharmacies) volition build the necessary spider web services together with integrate them inward their technology scientific discipline together with nosotros volition all alive happily e'er after. However, other than the obvious monumental technology scientific discipline challenges involved inward maintaining such infrastructure, Americans tend to sense meaning discomfort amongst the concept of Uncle Sam having unfettered access to therefore much personal information together with the obvious privacy issues it raises.
The Federated Model – Health information is maintained where it is created, live it physician offices, hospitals or other agencies of care. Contributors force content to users if they desire to together with readers line content from contributors when they necessitate to. The best way to retrieve close this is to compare it to telephony. You telephone phone me when you lot necessitate information from me or when you lot desire to part amongst me information you lot have, together with I do the same. This of course of pedagogy implies that nosotros beak the same linguistic communication together with know each other’s telephone number together with if nosotros don’t, nosotros have got a way to facial expression it upwards somewhere. It also implies that nosotros both have got an agreed upon method of identifying the people nosotros are discussing, e.g. cousin Jamie is my aunt Sarah’s daughter, non your uncle Bernie’s oldest boy. This model requires something akin to White together with Yellow pages for providers, every bit good every bit unique identifiers for patients, together with an agreed upon method to “make telephone calls” or force together with line information.
And then, of course, you lot tin dismiss have got multiple hybrid models, which are somewhat centralized together with somewhat federated. The Government funded State HIEs (the platforms) could live regional databases inward the sky, or regional telephony networks amongst associated directories, both serving every bit federated super nodes on a national network of networks. The advocates of patient controlled medical records would propose that PHRs should live the basic units of a federated model together with nobody gets to gossip close cousin Jamie except cousin Jamie, who at my asking volition say you lot every bit much every bit he/she chooses to say you.
So what are nosotros edifice out there? We are definitely non edifice the centralized national database, that’s for sure, but nosotros appear to live engaged inward edifice a trivial chip of everything else, together with nosotros are non starting from scratch.
Pre-HITECH HIE (the act)
Before Meaningful Use became a capitalized term, in that place where all sorts of HIEs (the acts) going on. Providers amongst halfway decent exercise management systems (most providers) were sending out almost all claims electronically, receiving electronic remittance together with checking wellness conception eligibility for patients inward existent time. Most accomplished this wondrous HIE (the act) through claim clearinghouses, such every bit Emdeon, RelayHealth or Gateway EDI, which have got built really sophisticated national HIEs (platforms). On the clinical side, anyone amongst a Surescripts certified ePrescribe module could shipping prescriptions to most whatever chemist's shop inward the nation, have refill requests together with consummate medications lists for insured patients, all electronically amongst a click of a button. Just similar the claim clearinghouses, Surescripts created a national HIE (the platform), consummate amongst provider directories together with algorithms to position patients. The national reference laboratories were non far behind together with most physicians amongst an average EHR could shipping lab orders together with have results electronically from LabCorp together with Quest. Influenza A virus subtype H5N1 host of regional labs were chop-chop next suit together with hospitals were non far behind. The newest tendency consisted of electronic clinical summaries inward CCR or CCD standard. These were starting to gain some traction every bit a agency of communication amongst PHRs, such every bit Google Health together with Microsoft HealthVault together with hither together with in that place files were exchanged betwixt EHRs. It is of import to bill that clearinghouses charged physicians solely a nominal fee (some were free), Surescripts was gratuitous to doctors together with therefore were reference lab interfaces.
Enter HIE (the organization)
Although HIE (the act) was occurring, it wasn’t spreading fast plenty to consider the 2014 goals, therefore the Government decided to sow the seeds for organized regional HIE (the act). The get-go gild of concern for these State HIE (organizations) is to enable HIE (the act) of prescriptions, structured lab results together with patient summaries, which are all requirements for Meaningful Use. Why would they necessitate to do that when physicians are expected to adopt certified EHRs which already have got those abilities? For a spell at in i trial I’ve been puzzled past times the National Institute of Standards together with Technology (NIST) requirements for ONC certification of EHRs. Unlike the comprehensive CCHIT certification, NIST does non require that a certified EHR live connected to Surescripts together with it does non require criterion capabilities to interface amongst national labs. Why not? Because the Government funded State HIEs (organizations) are intended to insert themselves betwixt the physician EHR together with Surescripts or LabCorp together with after in all likelihood claim clearinghouses every bit well. What used to live a uncomplicated point-to-point spider web service, only turned a chip to a greater extent than complicated, together with what used to live gratuitous to physicians, volition live therefore no to a greater extent than because HIEs (the organizations) must larn sustainable businesses together with volition accuse fees for transactions.
Perhaps it is all worthwhile if these newfangled HIE (organizations) tin dismiss somehow foster comprehensive national HIE (the act). While State HIEs (organizations) are selecting together with deploying diverse HIE (platforms), using diverse privacy together with security policies together with a multitude of directory structures (which may or may non live shared) together with diverse standards of communications, it is expected that all volition larn federated nodes inward the overarching Nationwide Health Information Network (NHIN) which is itself nether construction. [I sympathize that the NHIN is only an incomplete laid of specifications, but for some reason, I have got this vision of thick, dark security cables crisscrossing the country.] In the meantime, a to a greater extent than nimble sibling of NHIN, namely NHIN Direct, is also taking shape past times proposing to role a completely dissimilar together with much simpler addressing together with carry construct, similar to email, which volition allow physicians to shipping unstructured information to i another, presumably exterior the HIE (organization) scope. Concurrently, the historical clearinghouses together with Surescripts networks maintain to flourish together with business office every bit before. In add-on to the official State HIE (organizations), in that place are other individual HIE (the act) efforts sprinkled roughly hither together with there, which may or may non live inclined to connect to State HIE (the organizations), together with some large EHR vendors are starting to run their ain proprietary peer-to-peer networks across organizations. Every HIE (platform & organization) is promising “seamless” integration of all these conflicting initiatives.
Epilogue
Long agone together with far away, inward the miraculous province of Shinar, all of humanity decided to build a tower therefore tall that it volition plow over heaven. Recognizing that people united past times skillful communications are certain to succeed, the Almighty, who opposed this item venture, disrupted travel past times fragmenting the i accepted criterion of communications. Since the StarTrek Universal Translator was non inward being at that time, humanity became confused together with the mighty tower was never completed. Thus, to this day, humanity is wondering roughly this populace perplexed at their inability to build tall plenty towers.
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