Wes RishelMany people have contacted me about getting started with Simple Interop. I have been lining up some Web resources to host a series of “birds of a feather” discussions. The goal was to encourage groups to form up and try it.
ONC has followed this topic and offered many favorable comments. As it works out they will be announcing an effort under the rubric “NHIN Direct” at HIMSS. This effort appears to be directed at exactly what the “birds of a feather” might have accomplished, to create a spec using an open process, provide an opportunity for those interested in trying it to do so and coordinate their experiences.
Rather than have two parallel efforts, I am hoping that our friends frocked in familiar feathers will participate in NHIN Direct, as I most definitely will. Who knows, if ONC sees quick uptake and actual usage might we see that reflected in meaningful use or certification Stage 2 regulations? Dare we hope? I think we can have such hope. A consistent theme of Stage 1 regulations has been to back away from elaborately orchestrated specifications. Also, one of the recommendations from the HIT Standards Committee Implementation Work Group has been to start simple.
Risks
Our group, their group, what does it matter? Some folks have expressed the concern that the influence of government will lead once again to gold-plated specifications and approaches that cannot be rapidly deployed. That is a real concern, but frankly, there are some areas where Simple Interop needs to have an evolutionary path higher scale and use cases not enabled by HIPAA authorizations. Attention to these issues, as evolutionary concerns, can be very helpful.
Some folks have also expressed the concern that a few highly vocal and well-funded participants might dominate the process and the outcomes. Something like this clearly engendered dissatisfaction with HITSP deliverables. It might have been easier to keep a birds of a feather approach “under the radar.”
Risk Mitigation
Might expanding the requirements to work with other NHIN programs jeopardize the simplicity? Might some standards-group bullies show up? Sure, it could happen. It’s up to us to use our participation in NHIN Direct to avoid that. If it is truly open and has reasonable governance we should be effective.
So let’s all look forward to the HIMSS announcement and devote some quality time to making Simple Interop the cornerstone of NHIN Direct.
One Regret
As a child of the ’60s I was getting a big kick out playing the role of Speaking Truth to Power. Here was my chance to stick it to “the man,” taunt him with reality. It is nonplussing to have “the man” say, “right, good idea, let’s do it.”
Now I’ve got to find some other way to rebel.
Category: Interoperability Vertical Industries Tags: EHR, EMR, Health Internet, Health IT, Healthcare Interoperability, Healthcare Providers, Meaningful Use, open source, Stimulus
1 response so far ↓
1 Charles Parisot February 27, 2010 at 12:08 pm
Wes,
Simple interop as you described it, may not be that new. As you discussed in your earlier blogs, the real hard work to do is in term of associated policies, scope and creation/use/maintenance of directories, as well as certificate management. I would like to suggest reusing extensive prior technical specification work in that area.
We have a very simple spec for point-to-point push, nothing gold plated, it is called IHE-XDR (if you want it Web Services) and IHE-XDM (if you want it e-mail based). Both have been reviewed and adopted by HITSP.
IHE-XDR is the point-to-point that has been specified by NHIN, for their point-to-point push. It is also adopted by Continua, Implemented by about 40 systems in the HIMSS interop showcase. So pretty good traction.
I would definitively focus on the policy/directory/security infrastructure, because those may appear simple, but experience has shown that these become extremely complex for large point-to-point configurations. It has however a role to play when we have a small number of a-priori known remote parties. Considering this as a nation-wide scheme may not be wise.
Let see what ONC has in mind and further discuss at HIMSS. See you there.
Charles