NHIN Direct Focus Is Health Data Exchange Specs

The Nationwide Health Information Network (NHIN) Direct project unveiled last month will coexist with and not replace the federal government's ongoing vision for a robust, secure, and comprehensive national health data exchange, said a top government official.

NHIN Direct aims to develop interoperability specifications for simple, direct one-on-one data exchange between healthcare providers.

Earlier this month, the U.S. Department of Health and Human Services' Office of National Coordinator (ONC) for Health IT unveiled the NHIN Direct Project, an initiative to develop specifications and easy processes for local healthcare providers to exchange health data directly with other providers -- such as labs exchanging data with a doctor's office, or a primary care physician electronically sending a patient referral to a specialist.

While NHIN Direct specifications could help healthcare providers meet meaningful use data exchange requirements that begin in 2011 and 2012, development continues on broader NHIN programs and state health information exchanges that support more complex data exchanges, such as public health and quality metrics reporting, said Dr. Doug Fridsma, acting director of the office of interoperability and standards within ONC, and leader of the NHIN project.

Based on feedback ONC has gotten so far on the "open government" NHIN Direct wiki set up by HHS for public discussion, some players in the healthcare community think that NHIN Direct will replace the need for larger statewide and regional health information exchanges.

But that's not the case, said Fridsma. "Interoperability isn't one size fits all," he said in an interview with InformationWeek.

"There are all kinds of exchange," Fridsma said. The federal government and its various healthcare industry stakeholders are continuing work developing the broader set of standards, services, and policies that will enable secure health information exchange over the Internet for more complex data sharing.

Right now there are about 20 participants -- including representatives from e-medical record vendors, state health information exchanges, large integrated health delivery networks, and participants in larger NHIN projects -- working on the development of interoperability specifications for NHIN Direct, Fridsma said.

The ONC's NHIN Direct wiki discussion is an opportunity for individuals to offer up comments and feedback as part of the Obama administration's "open government" initiative for transparency and collaboration with the public.

"That's the way we do our business at the ONC," Fridsma said. The goal is to have a draft of NHIN Direct specifications ready "in one or two months," he added.

While the specifications for NHIN Direct aims to address the simple, secure data exchange between healthcare providers, the effort doesn't replace the larger vision of the federal government's more comprehensive, nationwide health information network, nor the evolution of state and regional health information exchanges, he said.

"It's not an either or," he said. "NHIN Direct will solve one part of the puzzle -- secure routing of information between providers and labs, or doctors and an ER department," he said.

However, the grander vision for NHIN -- and state and regional information exchanges that will interoperate with NHIN--is to help facilitate the exchange of data for quality metrics reporting, public health reporting, coordination of care for chronically ill patients, and even nationwide queries by ER doctors treating unconscious patients.

It would be "increasingly challenging to use a simpler NHIN Direct" for those kinds of more robust, complex information exchanges, Fridsma said.