At the September meeting of the HIT Standards Committee, we’ll finalize the content, vocabulary and transport standards for Stage 2 of Meaningful Use.
I’ve written many posts and articles about the importance of specific implementation guides for transport standards. When every provider is connected to every provider, payer and patient, novel transactions will emerge and volume will increase perMetcalfe’s law.
The NwHIN Power Team, a subcommittee of the HIT Standards Committee, has been working all Summer to analyze the NwHIN Exchange (SOAP) and Direct (SMTP/SMIME) specifications specifications using a truly brilliant methodology. Each specification (10 Exchange, 2 Direct) was scored against the following criteria:
Need for specified capability
Maturity of the specification
Maturity of the underlying technology used in the specification
Deployment and Operational Complexity
Initial scores were assigned by the ONC, with inputs from the NeHIN Exchange Coordinating Committee and the National Institute for Standards and Technology (NIST). The Power Team reviewed and refined these scores through several iterations, most recently after hearing testimony from individuals with first-hand experience implementing the Exchange specifications for the DOD and VA. From these scores, they identified specifications for which the business need is low. They also identified those specifications that are in early or moderate stages of development, and that use technologies which are in the declining phase of their life-cycle. Finally, they evaluated the specifications on deployment/operational complexity and industry adoption.
They considered alternatives using the same criteria as those used for NwHIN and Direct specifications.
Their detailed analysis will be presented on September 28, but there are two interesting conclusions in the draft report that I’d like to share now.
Industry adoption of the NwHIN and Direct specifications for health information exchange between organizations is low. Pilots have been successful, but large scale adoption has not yet occurred. So the scalability and workflow compatibility of these specifications have yet to be proven.
RESTful interfaces such as those used by Google, Facebook, and Amazon are appealing. However, REST is not a standard, but a style that uses the HTTP to provide a simpler alternative to SOAP for accessing web services. Not all RESTful implementations are implemented in the same way and thus we need a specification for secure RESTful transport of healthcare information. Such an implementation guide would ensure that RESTful implementations for healthcare information exchange are predictable and secured.
The Power Team has one more meeting to finalize its recommendation, but I am confident that they will present a thoughtful path forward that embraces the existing NwHIN and Direct specifications for some use cases and suggests further development for other use cases if we want large scale adoption and ease of implementation.
I’m truly impressed by the work of this team and look forward to their final recommendations.
In addition to his CIO role at BIDMC, Dr. Halamka blogs at GeekDoctor.blogspot.com.