# Presentation: 037619

## NHII 03ArchitectureGroup A

**Consensus findings reported by:**
**Henry C. Chueh, MD, MS**
**Massachusetts General Hospital**

- This presentation does not necessarily reflect the views of the U.S. Government or the institution of any participants

## Architecture A: Current Status(what we all know)

**Paper-based process**
**Disconnected proprietary systems and networks**
**Health data scattered, unlinked**
**Slow, limited knowledge transfer**
**Lack of governance for proposal and adoption of standards and technology**

## Architecture A: Desired State

**IP (Internet protocol) based process**
**Connected using robust standards**
**Index to health information - “virtual health record”**
**More timely, effective knowledge transfer**
**Transparent, active governance process**

## Architecture A: Key use cases

**Shared clinical care and knowledge across physical and organizational boundaries**
**Consumer / patient centered access to health information resources and records**
**Population-based health information collection for public health and research**

## Architecture A: Attributes of an NHII Architecture

**Scalable nationally and beyond**
**Can grow incrementally from a basic model (e.g., “Model T”)**
**Technologically simple to access and use**
**Low barriers to entry (effort, $$)**
**Adaptive**
**Non-proprietary**

## Architecture A: Attributes of an NHII Architecture (cont.)

**Valuable (supports desired use cases)**
**Distributed / federated systems**
**Standards-based**
**Interoperable security**
**Confidential**
**Reliable and responsive**

## Architecture A:Short Term Recommendation 1

**Seed and facilitate the creation of a ****NHII Task Force****,  an IETF-like self-organizing governance and working body consisting of voluntary participation from all stakeholders.  Appoint a Steering Group and detail the working structure and process.**
**Federal government**
**NHII**
**Stakeholders**

## Architecture A:Short Term Recommendation 2

**Establish an Architecture working group to:**
**Specify a communications ****protocol**** open to diverse interaction models (push, pull, subscribe, etc.)**
**Specify a basic “****envelope****” for diverse information types**
**Specify a basic API for the above**
**Initiate a simple but *****widespread***** demonstration project available to unrelated participants**
**NHII Task Force Steering Group**

## Architecture A: Straw man

- Consumers

- Public Health

- Providers

***“******presence of information”***

## Architecture A:Short Term Recommendation 3

**Proceed immediately *****without***** a national health identifier, but review all potential mechanisms for uniquely identifying patients nationally**
**NHII Task Force**
**Architecture working group**
**Privacy organizations**
**Federal government**

## Architecture A:Short Term Recommendation 4

**Commit**** to adoption of key standards where applicable; e.g., SNOMED, LOINC, HL7, NCPDP, DICOM, others**
**Federal government**
**NHII Task Force Steering Group**

## Architecture A:Medium Term Recommendation 1

**Initiate, enable and facilitate projects that embody attributes previously identified:**
**MPI (i.e., DNS for people)**
**Provider MPI**
**Seminal document types**
**Vocabulary services**
**Interoperable security services**
**NHII Task Force Architecture Working Group**

## Architecture A:Medium Term Recommendation 2

**Publish reference material for all architectural initiatives to facilitate active participation**
**NHII Task Force Architecture working group**

## Architecture A:Medium Term Recommendation 3

**Facilitate, create incentives for the implementation of key standards and technology by all stakeholders**
**Federal government**
**Vendors**
**Health care organizations**

## Architecture A:Other Gr’oup Observations

**Easy to miss the good for the perfect**
**Ensure public health information needs get continued attention as the process continues**
**Have had enough regional / partner-based demonstration projects, need something broader**
**What will happen going forward from this event?**