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

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

3. 3 HITSP – enabling healthcare interoperability 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. 4 HITSP – enabling healthcare interoperability Cornerstones of the NHIN platform Web Services (WS-*) PKI (x.509/WS-Security)HL7 v3 Messaging /CDAr2

5. 5 HITSP – enabling healthcare interoperability Some Current Harmonization Issues  Subject Discovery (PIX/PDQ)  Document Hashing (XDS.b)  Population Health

6. 6 HITSP – enabling healthcare interoperability 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. 7 HITSP – enabling healthcare interoperability Longer Term Opportunities  Grid computing –Distributed query –Presence services  Terminology and Ontology Services –Semantic mapping –Code set transformations