[NHII Pre-Conference Report]
Tuesday evening July 20th, 2004, the day before the NHII “Cornerstones for Electronic Healthcare” conference at the Washington DC Convention Center, William Yasnoff, MD, PhD, provided a two hour tutorial on the National Health Information Infrastructure (NHII). Dr. Yasnoff is Senior Advisor to the NHII project at the US Department of Health and Human Services.
The NHII is a work in progress which imagines, in Yasnoff’s words, “anywhere, anytime health care information and decision support.” The NHII is *not* a central database of medical records. It is a decentralised, federated architecture building upon interoperable regional networks.
Under the NHII, Personal Health Information (PHI) will reside where it does now, primarily with hospitals and healthcare providers. The new NHII element is an index of pointers to the location of patient information, but which contain no PHI (or at least only enough to uniquely identify the patient). The index knows where records are, not what is in them. Decisions about sharing information are made at the edges of the network by patients and providers together on a case by case basis. When needed, the PHI is assembled at the point of care by querying the network.
Individual EHR systems are *not* the NHII; they are the building blocks queried by the NHII tools to provide truly portable access to PHI. The NHII will be assembled from smaller building blocks known as the Local Health Information Infrastructure (LHII). The use of open standards for PHI data exchange allows connectivity between LHIIs and the NHII.
Dr. Yasnoff outlined components of the NHII that are not yet complete:
+ Full MPI correlation solutions are still in development
+ We need a standard EHR data interchange format
+ More cost benefit data is needed
+ Confidentiality agreements are still in development
After the presentation, Dr. Yasnoff fielded questions. Three separate times he answered “Why don’t we just issue medical smart cards to everyone?”. Short answer: because the cards would just be a backup of data stored elsewhere, so why not build in ubiquitous access to the records in real time rather than download their contents onto devices that are ealisy lost of damaged.