Health information technology standards and guidelines may have something to learn from Internet practices.
Two weeks ago, I wrote about a strawman for embracing internet-based standards to support the provider directory services needed by health information exchanges.
Wes Rishel wrote a blog post about a related approach to creating provider directories and exchange certificates using microformats embedded in web pages that are protected by Extended Validation Certificates to provide assurance that the information is trustworthy.
As we prepare for the next HIT standards committee meeting, many people are thinking about the best approach for building an industry-wide provider-directory capability using simple web standards. A guiding principle of the HIT Standards Committee is to “Keep it simple; think big, but start small; recommend standards as minimal as possible to support the business goal and then build as you go” . This eliminates most complex implementation guides based on assembling esoteric, seldomly implemented, non-internet friendly standards.
The committee will find use of generalized internet standards such as DNS and simple XML tagging structures such as microformats very appealing.
Is there a combination of the approach I suggested on my blog and the approach suggested by Wes that works?
I think so.
As Wes notes in his blog, exchanging health information using Direct requires a “Direct Address.” Nationwide Health Information Network (NwHIN) enterprises other than those using Direct have no common addressing scheme. Creating a .HEALTH Top Level Domain with an entry for each entity participating in health information exchange would create an easily recognizable addressing scheme for the industry. These addresses could point to highly trusted microformatted web pages containing directory information and certificate data, creating a directory solution without changing existing business models or processes. This could be a winning approach.
Direct has chosen DNS for certificate distribution and although the DNS standard supports this function, no one other than Direct has used this approach for certificate management. Indeed, not all Direct participants use this approach.
The NwHIN, including but not limited to Direct participants, requires routing information to exchange information between entities.
Would it be much cleaner to have a top level domain that encompasses all entities which exchange health information, including but not limited to NwHIN Exchange and Direct participants, and that provides an index of secure microformatted web pages containing certificates and other directory information for all participants in health information exchange?
We'll have several calls and meetings on this subject over the next few weeks. Expect a convergence and recommendations soon.
In addition to his CIO role at BIDMC, Dr. Halamka is dean for technology at Harvard Medical School. He blogs at GeekDoctor.blogspot.com.