The use of the National Information Exchange Model (NIEM) to promote health information exchange represents a major shift of direction by policymakers working on expediting use of the Nationwide Health Information Network.The NIEM (pronounced "NEEM") is a working model for standardizing information exchange that has been operating among federal, state and local government agencies in areas such as emergency management and law enforcement.
Up to now, its use has been driven by the need – especially in the post 9/11 world – to share information in a common format rapidly among agencies and across jurisdictions. It has been used successfully to enable information sharing among disparate federal, state and local law enforcement agencies.
The same NIEM processes that have driven interoperability and secure data sharing in homeland security scenarios can also be repurposed to promote information exchange in the critical area of health care – and not just among all levels of government. The NIEM process can help promote standardized data exchange between the public and private sectors.
The idea is to apply these same principles in the health care community, through the use of a common and transparent process known as the Standards and Interoperability Framework (referred to as the S&I Framework).
It is important to note that in its application to health care, NIEM and the S&I Framework are not going to be run as a Department of Homeland Security (DHS) program. Instead, NIEM would be used in an entirely separate context for healthcare, with some parts of the NIEM process reused and others not. There is no validity to the idea that NIEM would be used in a way that allows for patient record access, as it is simply cannot be done technically.
In health care, the use of NIEM would provide a set of standardized information exchange packages that could be used by Nationwide Health Information Network participants in a wide variety of settings. The result would dramatically expand the number of clinicians and public health officials actively sharing electronic health information using the Nationwide Health Information Network.
With NIEM, a physician would be able to exchange clinical records among Nationwide Health Information Network participants, but do so in a standardized way so that the information can be processed quickly. The model is versatile – capable of being used for day-to-day information exchange of lab results or clinical summaries, but also for emergency use cases and population health analysis. More importantly, the process used to develop NIEM information exchange packages can allow tailoring of information exchanges for a multitude of health care-specific contexts.
NIEM standardization is based on information exchange, not on underlying health care standards. Currently health care information exchange can be done in a standardized way, but this type of standardization is primarily focused on the kind of content that is being sent. In contrast, NIEM is based on standardizing health information exchange according to the business context of its participants.
Information exchange packages developed under NIEM would reuse existing health care standards, such as the Continuity of Care Document (CCD) or LOINC, a dataset of lab and clinical identifiers, to support records sharing among Nationwide Health Information Network participants. They could also reuse much of the existing Healthcare Information Technology Standards Panel (HITSP) standards harmonization effort.
The information exchanges would also be coordinated with existing standards development organizations (SDOs) to ensure that any health care standards needed by the Nationwide Health Information Network are being developed in support of its business requirements. This process could also help SDO's identify gaps and overlaps within existing healthcare standards.
The benefits of this approach would be a robust inventory of reusable information exchanges that could be shared among providers and organizations using the Nationwide Health Information Network. The standard exchanges could also be improved or simplified based on the business context and requirements of participants.
Using the NIEM paradigm is an innovative development in the evolution of the Nationwide Health Information Network and represents a sea change in health information exchange. While it will require a change in thinking and approach, the NIEM process promises to promote reuse, transparency, and innovation to increase health information exchange.
-- Erik Pupo is a senior advisor to the Office of the National Coordinator for Health Information Technology for the Federal Health Architecture program and health interoperability architect for Vangent Inc.
