Blumenthal's remarks came more than three hours into the March 24 meeting of the Health IT Standards Committee. The committee is a federal panel created under the American Recovery and Reinvestment Act of 2009, also known as the stimulus law, to advise the ONC on matters concerning health IT standards.
Just before Blumenthal spoke, ONC staffer Doug Fridsma completed two lengthy presentations, followed by group discussions. One talk was on NHIN Direct, an ONC open-development project that had its startup meeting the day before.
NHIN Direct aims to develop specifications for simple information exchange tasks to afford less technologically advanced healthcare practitioners the means to perform basic clinical information-sharing required under a federal electronic health-record subsidy program, part of the meaningful-use criteria of the stimulus law.
Fridsma's other, related presentation—and the subsequent discussion—was on the National Information Exchange Model, or NIEM, which the ONC is testing with development of NHIN Direct. The NIEM is a framework to achieve consensus among healthcare industry data-exchange participants on selection of tasks, or “use cases,” and for standards harmonization and the development of implementation specifications around those use cases.
Fridsma is the acting director of the Office of Interoperability and Standards at the ONC.
Blumenthal followed Fridsma and began with a plea for cooperation and assistance from members of the Health IT Standards Committee and from the audience attending the meeting or listening in via telephone or Web conference.
“There have been a number of pointed questions put to Doug about how are we going to do this, how are we going to do that,” Blumenthal said. “I want to remind us all, that you are what we are depending on to help us figure out how to do this.”
“We cannot succeed unless you mobilize your knowledge to help us answer some of the questions that you are asking us,” he said. “And Doug, here, is carrying the world on his shoulders, but he is really only trying to do the work that you all are advising him to do. So, if there is a better model for harmonizing across standards, please share it with us.”
“If you have a better model than NIEM—or it shouldn't be called a model—whatever it is called, please share it with us,” Blumenthal said. Someone offered that the NIEM, despite its name, should more aptly be described as a framework, and Blumenthal repeated that term, “a framework.”
“But we are trying to do our best under impossible—difficult—time constraints. We have 2011 meaningful use now about eight months away. We have a meaningful-use NPRM for which standards, implementation specifications and certification criteria are needed. It has to work,” he said, referring to the notice of proposed rulemaking, issued by the CMS in December.
“We're trying to keep open different options because we don't know, we're not clairvoyant, we don't know exactly what's going to work,” Blumenthal said. “And you all collectively are at the edge of this field. You were appointed because of your collective knowledge. I guess I'm asking for you to help us with these tough problems.”
Then Blumenthal addressed the issue of the use and purpose of the NIEM, which was developed by the Justice Department, in conjunction with the Department of Homeland Security.
“The other thing I wanted to clarify—it didn't come up here, but it's been circulating in the blogosphere—has to do with some speculation about whether NIEM is some kind of Trojan horse for government control over health information,” Blumenthal said. “That is, because it is a government-developed mechanism for generating standards and implementation specifications, might it make it easier for health information to be transmitted, or might it make it inevitable that it is transmittable to the Department of Justice, the Department of Homeland Security, the CIA, the NSA—I don't know where else.
“And the answer to that question is absolutely no,” Blumenthal said. “I just want to say that for the record, absolutely no. And the Office of the National Coordinator would not participate in a standards development process that led to that.
“So, I say that because we want to make every opportunity, take every opportunity, to set the record straight on that. And wanted to know, let everyone who is listening in on this know, that that is the case.”
While initially a collaboration between the Justice and Homeland Security departments, the NIEM now has broader usage, which still maintaining its pedigree in law enforcement and national security.
For example NIEM implementations today include the New York City Health & Human Services agency, winner of a 2009 “Best of NIEM” award, as well as multiple state and regional law enforcement and anti-drug agency information exchanges.
In the “intelligence domain” the NIEM “is designed to be the standard of choice for the exchange of intelligence among any federal, state and local agencies on a foreign or domestic basis,” according to a description at the NIEM Web site.
The ONC would not make Blumenthal available for an interview about his statement, or about who had made the allegations about a possible connection between the NIEM, the national health information network and various law enforcement and national security agencies, but an ONC public affairs spokeswoman did arrange an interview with Fridsma.
“There has been some chatter on the blogosphere about the NIEM in relationship to the NHIN,” Fridsma said. He described the NIEM as “a framework” but also a “process for developing specifications for interoperability.”
According to Fridsma, the negative blog traffic, “I think, relates to the confusion between the model and the process. That's the fundamental issue.”
For example, Recovery.org, an online program to enable both government entities and the public to track stimulus law-funded projects, was developed using the NIEM process, not the NIEM model.
“That process is the part that we're interested in,” Fridsma said.
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