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Architecture: A Plan for How Parts of a Structure Fit Together to Achieve its Purpose

Explore the architectural challenges and implications for the technical approach in developing the National Health Information Infrastructure (NHII). Learn about the time-line for its evolution and the importance of communication, data mining, and visualization in software development.

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Architecture: A Plan for How Parts of a Structure Fit Together to Achieve its Purpose

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  1. Architecture: A Plan for How Parts of a Structure Fit Together to Achieve its Purpose William W. Stead, M.D. July 1, 2003 • Components of the NHII • Where They Live • How They Communicate Vanderbilt University Medical Center

  2. Architectural Challenges of the NHII • Scale and scope • National scale, local implementation • Multiple dimensions, e.g. public health, health care, personal actions and records • Both short and long term horizons • Permit significant benefit in 3-5 years • Doing things in a way that achieves the ultimate vision in 20-25 years • In an environment of constant change • Explosion in biomedical knowledge • Innovation in health practice and policy Vanderbilt University Medical Center

  3. Software Development Technical Reality 18 16 14 12 10 PERFORMANCE Information Technology 8 6 4 2 0 Yr 1 Yr 2 Yr 3

  4. Implications for technical approach • Communication • Data Mining • Visualization Data Processing

  5. Implications for role of standards Prescriptive standards specifying exactly what must be done in a designated situation Reference standards requiring • That each term (or block of information) has an explicit mapping to related terms • A definition that may be understood by computer programs

  6. Straw Person Architecture for the NHII • NHII is an information infrastructure, not information system • NHII sits beside the legacy systems of providers, payers, etc. • Reduces local implementation barriers while making the meaning of content in local systems increasingly explicit with time • Facilitates direct access to external information if permitted by patient consent • Facilitates incorporation of practice guides • NHII evolves to decouple the management of information about patients from the systems that automate practice Vanderbilt University Medical Center

  7. Time-line for evolution of the NHII Near Term • Computable reference standards applied at point of manufacture • Terms for reimbursement contracts • Drug substance, drug form • Applicable elements of LOINC for tests • Single source to computer readable information standards together with tools to ease incorporation in local system implementations • Eligibility queries via APIs • Clinical data exports as text reports with tags according to a document architecture Vanderbilt University Medical Center

  8. Time-line for evolution of the NHII Intermediate Term • Patient ID and visit record via smart card • Self charting tools • Export de-identified data for surveillance and quality monitoring • APIs for clinical document queries • Publish practice guides with tags according to a documented architecture Vanderbilt University Medical Center

  9. Time-line for evolution of the NHII Long Term • Authentication services • Consent services • Digital rights technology to protect clinical content • Application components Vanderbilt University Medical Center

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