Medicare Compliance & Reimbursement

National Health Information Network up and running.

If the multifaceted nature of health information technology (IT) systems gives you headaches, a recent report on a new organization could spell relief. 

The Office for the National Coordinator for Health Information Technology (ONC) has released its Summary Report of the NHIN (Nationwide Health Information Network) Prototype Architectures. The report, prepared by Stamford, CT-based research firm Gartner, Inc., provides an update on how the NHIN is taking shape. 

Here's what you need to know about the project and its major players.

What is it? The NHIN is a national "network of networks," designed to securely connect consumers, health care providers, and others who use health information and services.  

The stakeholders participating in the NHIN fall into four categories:

• Care delivery organizations (CDOs) that use electronic health records (EHRs).

• Consumer organizations that operate personal health records (PHRs) and other consumer applications.

• Health information exchanges (HIEs), which HHS defines as "multi-stakeholder entities that enable the movement of health-related data within state, regional or non-jurisdictional participant groups." 

• Specialized participants, including "secondary users of data" such as those in public health, research and/or health care quality assessment. 

How would it work? Participants in the NHIN will:

• Use a shared architecture.

• Adhere to a set of agreed-upon standards.

• Provide certain core services.

The ONC stresses that the NHIN will not have a centralized data center at the national level, just shared architecture (which will consist of common "services, standards, and requirements") and "processes and procedures to interconnect health information exchanges and the users they support," according to the report.

Fail-safe: If organizations aren't able to maintain certain technical or operational "competencies," they will be able to use a health information service provider (HSP), which will support one or more NHIN participants with the exchange services necessary to qualify for participation.

Who are the key participants? The ONC awarded four contracts for developing the NHIN prototype architectures to Accenture, Computer Sciences Corporation, IBM and Northrop Grumman in November 2005. Each collaborator was asked to produce a prototype NHIN architecture and demonstrate its efficacy by connecting three communities.

Some of the collaborators' major concerns while working on the architectures have included:

• Scale

• Complexity

• Protecting privacy

• Working with existing IT systems and ensuring that the NHIN approach doesn't unnecessarily hamper innovation in healthcare IT

What the report says: The four contractors have identified specific functions that HIEs must provide, including:

• Supporting secure operation in all activities related to the NHIN;

• Protecting the confidentiality of protected health information (PHI) on the NHIN;

• Reconciling patient and provider identities without creating national indices of patients;

• Enabling access to a local registry which may be used, when authorizations permit, to find health information about patients;

• Supporting the transfer of information from one covered entity to another to facilitate effective collaborative care;

• Supporting secondary uses of data while protecting the identity of patients.

Accomplishments: In 2006, the contractors provided regular updates on the "functional requirements" of the NHIN, security models, areas where standards are needed, the proposed overall architecture, and business models, according to the report.

The collaborators also performed live demonstrations of the prototypes for NHIN architecture at the NHIN Prototype Architecture Project Third NHIN Stakeholder Forum, in January.

Resource: You can view the full report on the HHS Health Information Technology Web site www.hhs.gov/healthit/.