Nationwide Health Information Network Architecture in the United States and the United Kingdom: Solutions for Developing Countries

Authors
Hassan Ebrahimpour Sadagheyani 1
hamid bouraghi 2
Ali mohammadpour pour 2
Esmayil Zeynali 3
Kamelia Saremipour 4
1 Department of Health Information Technology, School of Para medicine, Neyshabur University of Medical Sciences, Neyshabur, Iran
2 Department of Health Information Technology, School of Para medicine, Hamadan University of Medical Sciences, Hamadan, Iran
3 Department of Islamic Teachings, Khoy University of Medical Sciences, Khoy, Iran
4 M. tech Computer Networks and Information Security
Abstract
Introduction

The National Health Information Network (NHIN) is a network through which all healthcare providers exchange health information. Since the architecture of such a network is one of the most important factors involved in the design of NHIN; this study aimed to explore the experiences of leading countries in the development of NHIN architecture and providing solutions to developing countries.

Materials and Methods

In this descriptive-comparative study, the nationwide health information networks of the United States and the United Kingdom were reviewed. A researcher-made checklist was used to collect information. Then, according to the aspects of NHIN architecture, the NHIN documents of the countries under study were analyzed and the findings were presented in comparative tables.

Results

The NHIN architecture in the US, which involves connecting regional health information networks, had a bottom-up approach. The network N3 of the National Health Information Technology Program of the UK with a centralized structure had a top-down approach.

Conclusion

Each of the approaches used in the NHIN architecture in the studied countries has advantages and disadvantages. Developing countries should use one of these approaches or a combination of them to design the NHIN architecture, given the centralization or decentralization of their health systems.
Keywords
Nationwide Health Information Network
National Health Information System
Health Information Systems
Health Information Exchange
1. WHO. Issues in Health Information: National and Subnational Health Information Systems. 2005.
2. WHO. Country health information systems: a review of the current situation and trends. Geneva: WHO. 2011.
3. IT ONCH. Nationwide Health Information Network Exchange [Cited 2017 Nov 8]. Available from: https://www.healthit.gov/sites/default/files/pdf/fact-sheets/nationwide-health-information-network-exchange.pdf.
4. HHS-ONC.NHIN and direct overview [Cited 2017 Nov 8]. Available from: www. docslide.us/.../nhindirectoverviewverddocx-nhin-direct-overview.html.
5. Bouhaddou O, Bennett J, Cromwell T, Nixon G, Teal J, Davis M, et al., editors. The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network exchange in San Diego: patient selection, consent, and identity matching. AMIA Annual Symposium Proceedings; 2011: American Medical Informatics Association.
6. Tsiknakis M, Katehakis DG, Orphanoudakis SC. An open, component-based information infrastructure for integrated health information networks. International Journal of Medical Informatics. 2002;68(1-3):3-26.
7. Hill JW, Langvardt AW, Massey AP, Rinehart J. A proposed national health information network architecture and complementary federal preemption of state health information privacy laws. Am Bus LJ. 2011;48:503.
8. Moghaddasi H, Hosseini A, Asadi F, Ganjali R. Infrastructures of the system for developing electronic health record. 2011.
9. USA DOHHS. Nationwide Health Information Network (NHIN) Exchange Architecture Overview v. 0.9. 2010.
10. Khosrow-Pour M, Khosrowpour M. Encyclopedia of information science and technology: IGI Global Snippet; 2009.
11. Dajsuren Y. Defining Architecture Framework for Automotive Systems. Automotive Systems and Software Engineering: Springer; 2019. p. 141-68.
12. Organization WH. Framework and standards for country health information systems. 2008.
13. Rishel W, Riehl V, Blanton C. Summary of the NHIN prototype architecture contracts. Washington, DC: US Department of Health and Human Services. 2007.
14. Stead WW, Kelly BJ, Kolodner RM. Achievable steps toward building a national health information infrastructure in the United States. Journal of the American Medical Informatics Association. 2005;12(2):113-20.
15. Towards Adopting Nationwide Health Information Network (NHIN): promises and challenges. AMCIS 2008 Proceedings, Paper 86 2008 [Cited 2017 Nov 10]. Available from: http://aisel.aisnet.org/amcis2008/68.
16. Jha AK, Doolan D, Grandt D, Scott T, Bates DW. The use of health information technology in seven nations. International Journal of Medical Informatics. 2008;77(12):848-54.
17. Development OfEC-oa. Strengthening Health Information Infrastructure For Healthcare Quality Governance: Good practices, New opportunities and Data Privacy Protection Challenges. OECD Publishers; 2015.
18. Health UDo, Services H. Summary of nationwide health information network (NHIN) request for information (RFI) responses. Washington, DC: US Department of Health and Human Services Office of the National Coordinator for Health Information Technology. 2005.
19. Protti D. US regional health information organizations and the nationwide health information network: any lessons for Canadians? Healthcare quarterly (Toronto, Ont). 2008;11(2):96-101, 4.
20. IT OotNCfH. The CONNECT Open Source Solution: A Gateway to the Nationwide Health Information Network In: Services DoHaH, editor.
21. Campion-Awwad O, Hayton A, Smith L, Vuaran M. The National Programme for IT in the NHS. A case history. 2014.
22. NHS. The National Programme for IT Implementation Guide 2005.
23. Office NA. The National Programme for IT in the NHS: an update on the delivery of detailed care records systems. The Stationery Office Norwich; 2011.
24. Read I. N3 Network User Guide v1.3 2010 [Cited 2017 Nov 15]. Available from: http://studyres.com/doc/8041860/n3-network-user-guide.
25. wireless Ca. A QUICK GUIDE TO THE GSi FRAMEWORK Paving the way to PSN 2011 [Cited 2017 Nov 15]. Available from: https://www.networks.nhs.uk/nhs-networks/common-assessment-framework-for-adults-learning/caf-lessons-learnt/technical-approaches/n3-gcsx-lpsn/n3-gcsx-lpsn-evidence-from-caf-programme/Gsi-Framework-Quick-GuideV2.pdf/at_download/file.
26. NHS. PSN for Health high level Requirement 2013 [Cited 2017 Nov 15]. Available from: https://www.yumpu.com/en/document/view/30977980/psn-for-health-high-level-requirements-pdf-3229kb-nhs-/9. .
27. Health Do. N4 Design Options.2012-2014 [Cited 2017 Nov 15]. Available from: https://community.jisc.ac.uk/system/files/515/N3%20to%20N4%20transition.pdf.
28. Deslock. The UK government secure intranet(GSI) [Cited 2017 Nov 15]. Available from: download.deslock.com/download/docs/compliance/GSi_Guide.pdf
29. LMCs L. The Information Governance Statement of Compliance (IGSoC) for practices – important advice 2008 [Available from: https://www.lmc.org.uk/visageimages/guidance/2008/igsococtober08.pdf.
30. Coiera E. Building a national health IT system from the middle out. Journal of the American Medical Informatics Association. 2009;16(3):271-3.
31. Mudaly T, Moodley D, Pillay A, Seebregts CJ, editors. Architectural frameworks for developing national health information systems in low and middle income countries. Proceedings of the First International Conference on Enterprise Systems: ES 2013; 2013: IEEE.
32. Targowski A. Towards the National Health Information Network in the United States of America. 2011.
33. Coiera EW. Lessons from the NHS National Programme for IT. Medical journal of Australia. 2007;186(1):3-4.