INTEROPERABILITY FOR THE
NATIONAL HEALTH INFORMATION NETWORK

Approved by the IEEE-USA
Board of Directors (11 Nov. 2005)

IEEE-USA believes that “interoperability”[1] is one of the most critical concepts confronting the adoption and implementation of enhanced electronic information technologies into our national healthcare infrastructure.  Creating an efficient effective National Health Information Network (NHIN) is dependent upon proper implementation of this concept. The word “interoperability” has become ubiquitous in usage, but remains vague in its definition.

In healthcare, the ability “to use the information that has been exchanged” means not only that healthcare systems must be able to communicate with one another, but also that they must employ shared terminology and definitions. This latter emphasis places a much greater burden upon system designers and electronic engineers to make the information truly usable in the distributed clinical setting of our healthcare environment.  NHIN should be identified as a key asset of the nation's healthcare critical infrastructure, and this should be taken into account while developing requirements.

To facilitate adopting and implementing electronic information technologies into the national healthcare infrastructure, IEEE-USA makes the following recommendations:

1.      NHIN interoperability should be based on open standards, rather than proprietary standards.  This distinction is made so that copyrights and trademarks will not become issues for shared use of protocols used in developing NHIN core network capabilities and operating parameters.  (See background for details on these standards.)

2.      Approval of NHIN standards and interoperability certification should be the responsibility of  public/private collaboration, with regulatory oversight provided by federal agencies as appropriate for each standard.

3.      The Centers for Disease Control and Prevention (CDC), the Department of Homeland Security (DHS), the Federal Emergency Management Agency (FEMA), the Environmental Protection Agency (EPA), the Department of Defense (DOD), the Veterans Administration (VA), the Food and Drug Administration (FDA), the Department of Energy (DOE), and the Department of Agriculture (USDA) must work to make their internal IT systems interoperable, and also to create full interoperability among their respective agencies and among healthcare facilities, state and local health departments, and emergency first-responders so they can effectively manage both natural and man made disasters.

4.      Action should be taken to ensure full interoperability among communications systems used by emergency first responders and healthcare agencies, in the event of natural disaster or bioterrorism attack.

5.      Reliability standards for identified NHIN functions should be developed.

This statement was developed by IEEE-USA's Medical Technology Policy Committee and represents the considered judgment of a group of U.S. IEEE members with expertise in the subject field.  IEEE-USA is an organizational unit of the Institute of Electrical and Electronics Engineers, Inc., created in 1973 to advance the public good and promote the careers and public policy interests of the more than 220,000 electrical, electronics, and computer engineers who are U.S. members of the IEEE. The positions taken by IEEE-USA do not necessarily reflect the views of IEEE or its other organizational units.

BACKGROUND

Specifically, IEEE-USA supports the following:

1. Work to expand SNOMED-CT vocabularies to ensure full semantic interoperability for the NHIN is continuing.  In particular, mappings to Minimum Data Set (MDS) 3.0, ICD10, and CPT should be completed. Such maps should be made publicly available through the United Medical Language System (UMLS) at the National Library of Medicine and should become a standard component of any EHR system.
    

2. Harmonization of HL7 CDA and ASTM CCR document architectures and XML implementations should be undertaken to ensure interoperability of longitudinal EHR.
    

3. In healthcare, Semantic Interoperability, or shared terminology, is as important as System Interoperability, or shared functions, and must occur to achieve maximum benefit for the use of information that has been exchanged. 
    

4. The following set of Consolidated Health Informatics Initiative (CHI)-approved standards should form the core interoperability standards for the NHIN:

·         Standardized Nomenclature for Medicine - Clinical Terminology (SNOMED-CT) -- the world's most comprehensive clinical terminology database

·         Logical Observation Identifier Names and Codes (LOINC) -- universal identifiers for laboratory and clinical observations

·         Clinical Document Architecture (CDA) -- a document markup standard that specifies the structure and semantics of clinical documents for purposes of exchange, developed by Health Level 7 (HL7)

·         HL7 Messaging Standard -- a messaging standard for electronic health records developed by Health Level 7 (HL7)

·         Health Insurance Portability and Accountability Act (HIPAA) Transaction Sets -- enables healthcare providers to conduct transactions directly with insurers using standard electronic data interchange (EDI) formats

·         Digital Imaging and Communications in Medicine (DICOM) -- a standard for medical imaging, developed by the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA)

·         IEEE 1073 -- a set of medical device communications standards developed by the IEEE Standards Organization that communicates patient data from medical devices typically found in acute- and chronic-care environments

·         National Council for Prescription Drug Programs (NCPDP) SCRIPT -- a standard that supports communication of prescription information between prescribers and pharmacies

5. The following set of additional standards should be included in NHIN interoperability standards, subject to completion and approval:

·         International Classification of Diseases, 10th Revision (ICD10) -- provides classification of morbidity and mortality information for statistical purposes

·         Current Procedural Terminology (CPT) -- a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians

·         HL7 Functional Model -- provides a reference list of functions that may be present in an Electronic Health Record System (EHR-S)

·         American Society for Testing Materials (ASTM) Continuity of Care Record -- intended to assure health information transportability when a patient is transferred to another provider

·         HIPAA Privacy Final Rule -- provides general rules for using and disclosing protected health information for healthcare facilities and other covered entities

·         HIPAA Security Final Rule -- a security standard that covers all healthcare entities that maintain or transmit electronic health information

·         Electronic Business using eXtensible Markup Language (ebXML) draft standard for trial use (DSTU) -- Web Services transport specification

·         Web Services draft standard for trial use (DSTU) -- Web Services transport specification

·         World Wide Web Consortium (W3C) Hypertext transfer protocol (HTTP) and secure hypertext transfer protocol (HTTPS) standards

·         W3C -- standards for Extensible Markup Language (XML), Hypertext Markup Language (HTML), Web Services Description Language (WSDL), and Simple Object Access Protocol (SOAP)

·         Organization for the Advancement of Structured Information Standards (OASIS) -- standards for ebXML and Universal Discovery Description and Integration (UDDI)

·         Web Services Interoperability (WS-I) -- Basic Security Profile

·         Internet Engineering Task Force (IETF) standards for Transport Control Protocol/Internet Protocol (TCP/IP) Version 6 (V6) -- to meet the updated standards for security and interoperability required by government

The Institute of Electrical and Electronics Engineers, Inc.--United States of America
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Last Update:  28 Nov. 2005
Staff Contact: Deborah Rudolph