Healthcare IT News - September 2008 - (Page 30) 30 The HIMSS Insider s September 2008 www.himss.org I Interoperability Contracts n 2007, Pat Gibbons of the Mayo Clinic and three layers of interoperability described in others at Health Level Seven (HL7) “Coming to Terms.” The nationwide health advanced a definition of interoperability information network (NHIN) projects, on the occurring at three layers: technical, semantic other hand, are being forced to address the and workflow (process). “Coming to Terms: other two: business and policy interoperability. Scoping Interoperability for Health Care,” a This is a point of contrast between HIPAA white paper available at and the current NHIN efforts. www.hl7.org, defines technical STANDARDS The HIPAA transactions awere interoperability as the capability primarily point-to-point for sinof two systems to exchange gle, known purpose (e.g., claim data; semantic interoperability is submittal or authorization). defined as the capability of the Clearinghouses acted as routers systems to understand and use and translators but not repositoby Ed Larsen the data; and workflow (process) ries from which secondary actors interoperability is defined as supporting user- could come and query. In the NHIN model, friendly operation and sequencing. data transmitted from a node provider can be In the March 2007 Standards Insight, I sug- stored, shared and queried for multiple purgested the need for at least two other layers poses by multiple entities. above this computer science definition of Rather than creating point-to-point cominteroperability, which I termed business inter- panion trading partner agreements necessary operability and policy interoperability. The for- for HIPAA implementations, the NHIN projmer is defined by the essential purpose of one ect is creating a data use and reciprocal suporganization transacting with another. In port agreement (DURSA). The DURSA is healthcare, business purpose certainly includes designed as an overarching business associate clinical care, administration, finance and reim- and trading partner agreement to govern the bursement, and required reporting (one might exchange of patient and other data among recall the HIPAA categories for sharing nationwide health information exchange parpatient information). Above healthcare organ- ticipants. These include the node entities, such izations is the realm of policy, shorthand for as providers, as well as the HIE services, such the legal and societal norms for participating as repositories, and their gateways to sharing in healthcare activities. with other HIEs. Once data is transmitted The HL7 EHR System interoperability from a node system, its use, disclosure, promodel, Healthcare Information Technology tection and sharing are all governed by the Standards Panel interoperability specifications terms of the DURSA. This is an extremely and the Certification Commission for complex undertaking given the need to adhere Healthcare Information Technology network to federal and state laws, provide some level of certification primarily address the first two or privacy and confidentiality to consumers, and INSIGHT assure minimal levels of information integrity, security and management. All this occurs before one addresses technical, semantic and workflow interoperability. The DURSA, established at a point in time, must accommodate change, new participants, new business requirements and new application functions In the June Standards Insight, we discussed service-oriented architecture in healthcare and noted the work going on in HL7. Its Architecture Review Board(ArB) has continued to work on their services aware enterprise model. Central to their work is the concept of trading partner agreements or interoperability contracts that define the governance, business function, published interface, semantic content and behavior (processes) of a service. Conformance can be asserted and measured at each of these levels. More powerfully, the ArB is attempting to extend the concept of interoperability contracts to messages and documents. This would standardize DURSAs as contracts at the level of messages, documents and services–greatly increasing their use and reuse within different exchange settings. Interoperability, particularly between enterprises, can no longer be defined in terms of technical, semantic and workflow. We must address policy and business interoperability through governance, conformance and interoperability contracts. s For the complete article, see the September Standards Insight on the HIMSS Member start page. Ed Larsen is an independent strategy consultant who tracks interoperability standards for HIMSS. Comments or questions can be sent to erlarsen@erlinc.com. PUBLICATIONS STAFF VICE PRESIDENT, COMMUNICATIONS Fran Perveiler MANAGER, PUBLICATIONS Nancy Vitucci SENIOR MANAGER, CORPORATE COMMUNICATIONS Joyce Lofstrom SENIOR MANAGER, PUBLIC POLICY COMMUNICATIONS Sharolyn Rosier Hyson SENIOR EDITOR Matt Schlossberg COORDINATOR, COMMUNICATIONS Cari McLean BOARD OF DIRECTORS CHAIR Charles E. Christian, FCHIME, FHIMSS Director, Information Systems/ Chief Information Officer Good Samaritan Hospital VICE CHAIR Liz Johnson, RN, MSN, FHIMSS Vice President, Applied Clinical Informatics Tenet Healthcare Corp. CHAIR ELECT Barry P. Chaiken, MD, MPH, FHIMSS Chief Medical Officer DocsNetwork, Ltd. VICE CHAIR ELECT Liz Johnson, RN, MSN, FHIMSS Vice President, Applied Clinical Informatics Tenet Healthcare Corp. John H. Daniels, FACHE, CPHIMS, CHPS, FHIMSS Chief Information Officer Evolvent Technologies Inc. David Finn Vice President/Chief Information Officer/ Privacy and Information Security Officer Texas Children's Hospital C. Martin Harris, MD, MBA, FHIMSS Chief Information Officer and Chairman, IT Division The Cleveland Clinic Foundation Executive Director eCleveland Clinic Joy G. Keeler, MBA, FHIMSS Principal Health Information Technology The MITRE Corp. Holly D. Miller, MD, MBA, FHIMSS Vice President and Chief Medical Information Officer University Hospitals Carol R. Selvey, MHSA, FHIMSS Principal The Revere Group Jay Srini, FHIMSS Chief Innovation Officer UPMC Insurance Services Division Jonathan M. Teich, MD, PhD, FHIMSS Chief Medical Informatics Officer Elsevier Health Sciences Charlene S. Underwood, MBA, FHIMSS Director, Government and Industry Affairs Siemens Medical Solutions ADVISORY BOARD MEMBERS WoHIT 2008 Pre-Conference Symposia examine technologies for improved global healthcare delivery D uring the World of Health IT Conference & Exhibition 2008, Nov. 4-6 at The Bella Center in Copenhagen, Denmark, education, networking events and an exhibition offer a forum for exploring today's critical issues from the perspective of clinicians, directors and other professionals in Europe's healthcare information communications and technology (HICT) community. On Nov. 3, the day before the general conference, pre-conference symposia offer thought-provoking education offerings and best-practice exchange. Both symposia, to be held at Copenhagen's Herlev Hospital, will include observation of a simulation demonstration at the Danish Institute for Medical Simulation and of a health IT system in the IT Exploratorium. Nursing Informatics Symposium For practicing nurses and nursing students, dialogue during the Nursing Informatics Symposium: What Can Technology and Informatics Do for You examines how to use technology and informatics to improve global patient-care delivery. Designed by nurse leaders, this program covers the impact of HICT on the nursing education field. eHealth Planning and Management Symposium During eHealth: A Challenge for Interdisciplinary Healthcare Planning and Management Symposium, attendees learn ways to plan, build, deploy and manage eHealth systems for advancement of integrated healthcare. The program is designed for executives and managers working in ministries of health, regional health boards and hospital groups, competence centers, health insurance and healthcare provider organizations and associations representing eHealth stakeholders. Mike McGill, PhD Internet2 Howard A. Burde, Esquire Blank Rome LLP A. John Blair, III, MD President and CEO Taconic IPA Sunny Sanyal Chief Operating Officer McKesson Provider Technologies PHOTO COURTESY OF VISITCOPENHAGEN.COM. Physicians' IT Symposium The Physicians' IT Symposium: From EHR to PHR–The Challenges of Patient and Physician Empowerment explores utilization of PHRs in patient care and ways to improve patient safety from the perspective of clinicians in both large healthcare systems and small medical practices. This program offers live demonstrations from recognized experts in emergency medicine, oncology, radiology and more. Registration and Additional Information For additional information and to register, visit www.worldofhealthit.org. Space is limited for symposia, so anyone wishing to participate in these unique educational experiences is advised to book early. s FHIMSS, has been LnamedtrainingMOL,enterprisefor the Mayo director of revenue cycle systems, and process esley King, s Newsmakers Tivoli–Main Entrance Errata The August 2008 HIMSS Insider featured an article highlighting the recipients of the June 2008 Spirit of HIMSS Award, including the 2008 PA HIT Advocacy Day Planning Committee. Comprised of Delaware Valley Chapter and Western Pennsylvania Chapter representatives, the committee planned and organized the 1st Annual Advocacy Day in the state of Pennsylvania on May 12. The article listed the members of the committee, but omitted the following two members: Stephanie Hackett, RHIA, PhD, and Diane Blazek. The Insider apologizes for the omission. s Clinic Enterprise. This enterprise-level role is one of four new director positions across the unified organization at Mayo Clinic in the financial services area. In her new role, Ms. King will serve as a part of the revenue cycle leadership team with Mayo staff located in Rochester, Minn., Jacksonville, Fla., and Scottsdale, Ariz. She has wo http://www.himss.org http://www.hl7.org http://VISITCOPENHAGEN.COM http://www.worldofhealthit.org
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