I wanted to provide a little more clarity on my post yesterday relating to the IHE Implementation. My hope at the outset was to provide a mechanism whereby a Document Consumer IHE actor (see IHE ITI TF-1-10) could also be an edge system for the transactions we are working on with the NHIN Direct project.
That would allow an EHR, say, who implemented the full IHE XCA profile to participate in patient discovery and information access as a Document Consumer actor to use the same transactions to participate in secure transaction routing. The benefits clearly would be that an EHR could implement once and the providers would get access to a wide range of functionality.
I still would like to see that happen, even if we need to put the core transactions through some reasonable alterations (for example, a transaction modeled after Registry Stored Query that only retrieved the requestor's routed documents, with some optional parameters that modeled similar capabilities to the SMTP+POP3/IMAP and REST transactions. On top of that, the REST and SMTP+POP3/IMAP transactions provide some simple functionality to note messages as read or ACK'd such that subsequent queries don't show them by default, and we'd have to model that behavior as well.
Again, we may go through that process and decide that it's more work than it provides benefits. Again, there's no implied document registration or repository functionality associated with XDR, and we might well conclude that these are two important but unrelated transactions.
On the other side of this, the functionality of an address with an associated messaging inbox could be used in, say, a medical home model, to implement a sort of publish/subscribe system in conjunction with a document repository. In that model, a provider could subscribe to the information feeds for her medical home patients such that updates to patient information, with consent, get pushed to the medical home provider. Lots of policy implications to think through here, and there's some clear overlap with HIEM.
We'll work through both the vision and details of robust HIE interoperability over the next couple of weeks. Expect more thoughts and ideas to come. In the meantime, please post comments to the IHE Implementation page.