1. NHIN Perspectives for the Framework Review Working Group
DRAFT
October 22, 2008
Craig Miller

2. Overview Understanding NHIN/HITSP Divergence
Cornerstones of the NHIN Platform
Harmonization Issues
Additional NHIN Services for 2009
Longer Term Opportunities

3. Understanding NHIN/HITSP Divergence
Why do significant discrepancies exist between HITSP interoperability specifications and NHIN service specifications?
HL7 v2 (HITSP) vs HL7v3 (NHIN)
MLLP (HITSP) vs Web Services (NHIN)
Standards Specification (HITSP) vs. Service Development (NHIN)
Intra- (HITSP) vs. Inter- (NHIN) domain focus
Gaps in HITSP specifications
Lack of high-level collaboration

4. Cornerstones of the NHIN platform
Web Services (WS-*)
PKI (x.509/WS-Security)
HL7 v3 Messaging /CDAr2

5. Some Current Harmonization Issues
Subject Discovery (PIX/PDQ)
Document Hashing (XDS.b)
Population Health

6. Some Additional NHIN Service Needs for 2009
Data versus Documents
Current NHIN specifications focus on document-based information exchanges but many health organizations are data-based (e.g. RDBMS)
Expanding Discovery
Current NHIN enables discovery of patients and HIEs, but not of other significant entities (providers, PHRs, pharmacies, labs, etc)
Messaging Platform Enhancements
Need to support reliable messaging for population health and other uses
Message targeting (e.g. narrowcast vs broadcast)
End to end security
Message-level encryption support
Federated trust
Revocation

7. Longer Term Opportunities
Grid computing
Distributed query
Presence services
Terminology and Ontology Services
Semantic mapping
Code set transformations