David Blumenthal, MD, MPP, national coordinator for health information technology for the Department of Health and Human Services

A natural evolution in National Health Information Network (NHIN) capabilities to support a variety of health information exchange (HIE) needs is being reinforced by trends that are leading toward widespread multi-point interoperability, stated David Blumenthal, MD, MPP, National Coordinator for Health IT, in a statement last week.

“The federal government is working to enable a wide range of innovative and complementary approaches that will allow secure and meaningful exchange within and across states, but all of our efforts must be grounded in a common foundation of standards, technical specifications and policies,” Blumenthal stated. The Office of the National Coordinator for Health IT’s (ONC) NHIN is not a network per se, but rather a set of standards, services and policies that enable the internet to be used for the secure exchange of health information to improve health and healthcare, according to Blumenthal.

Current NHIN exchange capabilities are the result of a broad and sustained collaboration among federal agencies including the Veterans Health Administration and the Social Security Administration, large provider organizations and a variety of state and regional health information organizations, Blumenthal wrote. Based on this work, a subset of these organizations is now actively exchanging information and experiencing several key attributes, including the:

• Ability to find and access patient information among multiple providers;
• Support for the exchange of information using common standards; and
• Documented understanding of participants, enabling trust, such as the Data Use and Reciprocal Support Agreement (DURSA).

Blumenthal noted that not every organization and provider needs this kind of HIE today nor do the 2011 meaningful use requirements set forth by the Centers for Medicare and Medicaid (CMS) in the recent proposed rule require it. “Broadening the use of the NHIN to include a wider variety of providers and consumers who may have simpler needs for information exchange, or perhaps less technically sophisticated capabilities, is critical to bolstering HIE exchange and meeting our initial meaningful use requirements.”

ONC is currently exploring the expansion of NHIN capabilities to find solutions that will work across different technologies and exchange models, according to Blumenthal.

The newly launched NHIN Direct Project is designed to identify the standards and services needed to create a means for direct electronic communication between providers. It is meant to enhance, not replace, the capabilities offered by other means of exchange.

Acknowledging the aggressive timeline to define specifications and standards and test them within real-world settings by the end of 2010, Blumenthal remarked that the model for exchange will meet current provider needs within the broader healthcare community and complement existing NHIN exchange capabilities while strengthening efforts toward comprehensive interoperability nationwide.

“Ultimately, simple exchange will be part of a package of broader functions that allows any provider, and ultimately consumers, to exchange information over the internet, enabled by NHIN standards, services and policies.”

Blumenthal directed interested parties towards the NHIN Direct Project’s transparent development encouraging participants to utilize the community wiki, blogs and open source implementation already available. “Lessons learned from the NHIN Direct Project and the exchange group will inform the evolution of the NHIN as new uses and users come forward, and as continued innovation occurs to meet the growing needs of our community.”

“As we head into the next stage in the development of nationwide HIE, we should all take a moment to reflect on how far we have come and evaluate our plans for the future,” concluded our National Coordinator. “We have done a great deal of work in the short period of time since the passage of the HITECH Act.  We appreciate your willingness to stay engaged and involved in every step of our journey, and we look forward to our continuing collaboration to improve the health and well-being of our nation.”