Federal health IT policymakers yesterday okayed a set of recommendations to recast the National Health Information Network (NHIN) as a set of broader, more practical services designed to help providers meet fast approaching deadlines for qualifying as meaningful users of health IT.
In a Jan 13th meeting of the Health and Human Service Department's Health IT Policy Committee, experts said that the original plan for the NHIN, conceived almost a decade ago, may no longer be equal to the current demands on healthcare providers to digitize their practices.
Instead, policymakers recommended a new focus on the NHIN as a more basic set of services designed to expedite meaningful use, including an emphasis on "˜push' transactions, electronic directories, a reliance on secure transport services via the Internet and practices for authenticating information handling.
Dr. David Blumenthal, the national health IT coordinator, conveyed a sense of urgency in moving ahead with the new framework. "Given the timeframes to meaningful use, if there are new investments, new policies or aspirations we have to verbalize and communicate, we have no time to lose," he said.
The administration's meaningful use proposal, released last week, requires physicians and hospitals to begin showing by 2011 that they can perform various electronic hand-offs, including e-prescribing, sending out patient reminders, and transmitting records to other clinicians.
Many of the requirements imply the availability of various transport services capable of moving data between patient care team members or organizations. Kicking off the discussion with members of the Committee's NHIN workgroup, Blumenthal asked whether the original NHIN concept was "a sufficient and necessary approach to build a backbone" for providing these services, or "should we be thinking more broadly?"
The original NHIN was often described as a wired network providing points of access to hospitals via health information exchanges, much like switches in the old public telephone network. David Lansky, chairman of the NHIN work group and CEO of the Pacific Business Group on Health, said the panel wanted to remake that model.
"We are not conceptualizing the (NHIN) as a thing or as a particular set of servers or wires being accessed by hundreds of millions of people," Lansky said. Instead, he described the NHIN as a set of "policies, standards and services that allow the Internet to be used for meaningful exchange to improve health and health care."
In arriving at its recommendations, the NHIN panel explored policies and services used in other industries and agencies, including directories for locating patients and authentication schemes for verifying the identities of people sending and receiving data.
"There are hundreds of thousands of people who need to be accessible to this information exchange process, and we don't know where they all are," Lansky said. "We don't know how to talk with their EHRs and find them with confidence."
The recommendations focus on critical services that will assist providers to become meaningful users of electronic health records in 2011, Lansky said.
These include transport over the Internet; directories that help locate recipients of messages; the means to authenticate and demonstrate the identity of the sender and recipient; and a "trust fabric" made up of common rules, pre-existing business relationships and accountability mechanisms.
The types of information transmittals required for 2011 will likely be simple "push" messages, where someone sends a packet of data, such as patient summary data, to a recipient, Lansky added.
Blumenthal said that the original NHIN scheme might be compatible with the some of the recommendations, but it does not necessarily encompass all of them. "So we may need to supplement the traditional NHIN with something else if we are going to get to meaningful use in 2011," he said.
The ONC, which has distributed hundreds of millions of dollars in health IT infrastructure grants this year, will also underwrite testing some of the new schemes. "ONC will try to begin some tests or pilots to develop the applications and implications that flow from these recommendations," Blumenthal said.
