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Operationizing For example, some users of healthcare informatics (for example, physicians) work in clinical medicine or medical research, where the term medical informatics is commonly used. Other users work in nursing, where nursing informatics is the commonly recognized term. Some users work in dentistry (dental informatics). Clinical informatics is a more general term that has gained acceptance. It applies to a variety of clinician users, including physicians, nurses, pharmacists, clinical laboratory scientists, and therapists. Even consumer informatics is beginning to be used as computer information systems begin to connect individuals and their healthcare providers. Consequently, the generic term healthcare informatics is seen as the broader domain, which stresses the interdisciplinary nature of the discipline and underscores the need to involve all healthcare professionals and consumers (patients) in developing, using, and maintaining effective computer information systems. NHIN The Nationwide Health Information Network (NHIN; formerly known as the National Health Information Infrastructure [NHII]) is a government-sponsored initiative designed to improve the effectiveness, efficiency, and overall quality of health and healthcare in the United States by developing a comprehensive, interconnected, knowledge-based network of interoperable information systems among all sectors of the healthcare industry. It is also referred to as the Medical Internet, which allows providers of care to electronically exchange data among all electronic health records so that a complete, electronic health record can be assembled whenever and wherever a patient presents for care. The NHIN was mentioned first by the IOM in its seminal report, “ The Computer-based Patient Record: An Essential Technology for Health Care” (Dick and Steen 1991). A decade later, the NHIN was defined further by the NCVHS in its report, “ Information for Health: A Strategy for Building the NHII” (NCVHS 2001). Following September 11, 2001, and the much publicized anthrax attacks, the NHIN gained national attention in both public and private sectors when the need for enhanced public health surveillance and response became more visible and immediate. Consequently, the IOM’s fourth quality report, “ Patient Safety: Achieving a New Standard for Care, ” additionally asserted that a NHIN “ should be the highest priority for all healthcare stakeholders” (IOM 2003). HHS provided initial guiding principles and requirements for this national network. Based on these and other requirements, in 2004, the Center of Information Technology Leadership determined that over the 10 years required to build a national system of healthcare information exchange a hefty $276 billion would be spent, with another $16. 5 billion per year in operating costs (2004). However, a fully implemented and standardized NHIN, consisting of machine-interpretable data (that is, structured messages, standardized content or data) would deliver national savings of $77. 8 billion per year. This savings takes into account interface and system costs, including acquisition and maintenance, as well as savings primarily due to decreased redundancy and administrative time. Savings from improved patient safety and quality of care are not considered in this number (Walker et al. 2005, 16). (See table 3. 1.) Significant barriers to achieving the NHIN by 2014 exist. Such barriers include a lack of standards allowing for interoperability and data sharing, insufficient funding, a lack of ongoing economic incentives needed to sustain infrastructure operations, and public concern over privacy. In late 2004, the HHS Office of the National Coordinator for Health Information Technology (ONC) published a request for information (RFI) to seek public comment about how to develop the NHIN–more than 500 responses were received. A summary report was released in 2005. The interoperability and data-sharing strategies available to support the NHIN are fundamentally no different from those available to individual healthcare provider organizations. However, to develop the NHIN, healthcare organizations must carefully weigh public concerns over privacy as well as cross, multi-organizational concerns over the continued ownership, control, and competitive business advantage their existing data provide them. Consequently, in late 2004, HHS stipulated that the NHIN must be built incrementally from collaborative, local, and regional efforts in the public and private sectors. As a result, today’s NHIN focus is to begin with a network of connected, public and private regional health information organizations (RHIOs; formerly known as local health information infrastructures [LHIIs]) or health information exchanges (HIEs), each facilitating exchange of health information in a “ region. ” NHIN activities on the national level focus on the development and adoption of standards and economic incentives that will promote the growth of these regional, health information exchange infrastructures.

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