Peer-to-Peer HIE
Steve Beller wrote the blog post “A Novel Way to Exchange Patient Health Information”, an interesting take on the NHIN, HIE, and research data warehousing world. It is further evidence of the coming convergence between HIE functions and healthcare data warehousing.
I prefer the decentralized peer-to-peer (P2P) thinking of the proposed solution as well as the simplicity of using Microsoft Office as a platform to share continuity of care document (CCD) messages between physicians. P2P is now infamous from Napster, and is an ideal way to exchange content without central hubs or repositories because it scales quickly and quietly by participants. The general idea of an HIE system involves P2P data exchange, but most architectures of today utilize big hubs.
The Microsoft Office-style exchange may work best for small practices, but not for large integrated health networks. EMR implementations such as EPIC and heterogeneous application systems across hospitals and outpatient facilities require centralized interface engines and CCD factories to consolidate interoperability.
A new twist in the development of a national patient identifier is the use of biometrics. This would avoid reliance on patient reported information which is often inconsistent and the cause of privacy issues. Although I personally like the idea, patient privacy folks may not be pleased with the notion of each office keeping a biometric imprint of their patients with the intention of sharing data.
The thought of universal biometrics reminds me of the movie Gattaca. I find it difficult to imagine every hospital and clinic registration system adding a fingerprint swipe or retinal scan to their hardware and software infrastructure. However, it is a clever idea to address the daunting challenge of uniquely identifying patients amongst a few hundred million people before providing medical facts.
I like the idea of adding de-identified feeds at a patient-level into the mix of the NHIN/HIE/RHIO frameworks for the purpose of public health and research. This is the first time I’ve heard of that idea and it might work for some applications. It may only scale for certain applications, because a warehouse is needed to query complex questions such as cohort size estimations. That being said, ePCRN doesn’t differ much from this approach.
Thanks for the thoughtful posting!
Dan Housman
Managing Director, Analytical Applications
I prefer the decentralized peer-to-peer (P2P) thinking of the proposed solution as well as the simplicity of using Microsoft Office as a platform to share continuity of care document (CCD) messages between physicians. P2P is now infamous from Napster, and is an ideal way to exchange content without central hubs or repositories because it scales quickly and quietly by participants. The general idea of an HIE system involves P2P data exchange, but most architectures of today utilize big hubs.
The Microsoft Office-style exchange may work best for small practices, but not for large integrated health networks. EMR implementations such as EPIC and heterogeneous application systems across hospitals and outpatient facilities require centralized interface engines and CCD factories to consolidate interoperability.
A new twist in the development of a national patient identifier is the use of biometrics. This would avoid reliance on patient reported information which is often inconsistent and the cause of privacy issues. Although I personally like the idea, patient privacy folks may not be pleased with the notion of each office keeping a biometric imprint of their patients with the intention of sharing data.
The thought of universal biometrics reminds me of the movie Gattaca. I find it difficult to imagine every hospital and clinic registration system adding a fingerprint swipe or retinal scan to their hardware and software infrastructure. However, it is a clever idea to address the daunting challenge of uniquely identifying patients amongst a few hundred million people before providing medical facts.
I like the idea of adding de-identified feeds at a patient-level into the mix of the NHIN/HIE/RHIO frameworks for the purpose of public health and research. This is the first time I’ve heard of that idea and it might work for some applications. It may only scale for certain applications, because a warehouse is needed to query complex questions such as cohort size estimations. That being said, ePCRN doesn’t differ much from this approach.
Thanks for the thoughtful posting!
Dan Housman
Managing Director, Analytical Applications
Labels: Biometrics, Data Warehousing, Privacy
2 Comments:
I thank you, Dan, for your thoughtful comment!
The P2P pub/sub architecture I describe is not meant to replace the big hub centralized architectures currently in use by large integrated health networks. Nor am I saying that centralized EMR implementations should be scrapped for an MS Office-style exchange. Instead, the architecture I’m discussing would compliment them. This can be done by adding a node to the hub that has access right to the central database, thereby enabling communication and information exchange with other nodes outside the network (beyond the VPN). This is ideal for connecting disparate networks (including RHIOs and HIEs) with one another, as well as connecting clinician to clinician, clinician to patient, patient to patient, and authorized individuals outside a network to those inside that network.
Regarding the biometrics, the imprint will be converted to a unique alphanumeric string (a biometric index ID). Neither the string nor the actual biometric imprint will ever be exposed--neither at rest nor in transit--as it will be stored in secure databases and encrypted files.
Steve
The Peer-to-Peer Network is part of the OntarioMD Transition Support Program. The goal of the Peer-to-Peer Network is to encourage EMR adoption.
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