Monday, December 21, 2009

The push for ‘push’ technology for the NHIN

At this link, an article titled "New technology a 'push' toward EHR future" discusses how "…push messaging, a likely first step in rolling out a proposed national health information network in time for healthcare organizations to use electronic health-record systems in a 'meaningful manner' and qualify for federal EHR subsidy payments under the American Recovery and Reinvestment Act of 2009."

The article discusses how:
David Blumenthal, head of the Office of the National Coordinator for Health Information Technology at HHS called for pause in the planning of the NHIN…[as the government wait for an] outline of a "lighter" NHIN than has been the focus of much planning and development work in the past.
…[T]he new emphasis on so-called 'push technologies"—for example, the movement of a care summary "pushed" from a primary-care physician's EHR to a specialist—could come to the fore. The tools and techniques needed for these sorts of messages are less complex and will be far more readily available to a broader range of providers than so-called "pull" technologies, an example of which would be the system required for an emergency room physician to search for and pull copies of a patient's medical records scattered across many provider organizations via a query placed to through a regional health information organization.
It goes on to explain how a health internet of …
"health nodes" [reference]…would create a platform for basic messaging between its registered users, but would allow for growth, such as accommodating e-mail attachments, which "opens up the opportunity for health e-mail messages to be used for intersystem communications, such as receiving structured lab results, transmitting CCDs [continuity of care documents] from one practice to another and transmitting information to vaccination or chronic care registries."
And although it's not meant to close out pull technology…
it's hard to foresee what this new federal push toward push technology will mean or how it eventually will fit into a broader national healthcare communications scheme…"the drive to an alternate pathway is because docs need to by 2011 to be able to talk to one another to satisfy meaningful use"…[because it] is just sending a report or a document to another physician via e-mail and fax, only it will be more secure."
This is wonderful news!!! We've been promoting a peer-to-peer publish/subscribe node network architecture since 2002, which operates securely, inexpensively, durably, and conveniently using push technology (such as encrypted e-mail attachments). Unfortunately, few took us seriously. Instead, the mainstream focus has been on developing complex, expensive, monolithic, centralized, pull-based architectures that have serious security, scalability and interoperability concerns (e.g., see this link. While such centralized systems have a useful place within large organizations, they are simply not a sensible way to connect all parties via the NHIN (National Health Information Network)! It does my heart good to see a rational, open-minded dialogue finally taking place!

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