The Office of the National Coordinator plans to release in the next two months a set of draft standards for "NHIN Direct," an abridged set of specifications for the National Health Information Network that would give providers a simple way to exchange health information securely over the Internet.
By October, the NHIN Direct team wants to test those specifications in a real-world environment. The timetable is aggressive so the tools can be ready for providers to use to perform the basic information swaps that will qualify them for meaningful use incentive payments by the end of 2011.
"The goal is not to produce software, but we need to make sure that we test this in the real world to get the specifications right," said Douglas Fridsma, MD, acting director of ONC's office of standards and interoperability at a March 24 meeting of the Health IT Standards Committee.
The plan for NHIN Direct is "to take a small piece of the exchange puzzle - secure routing - develop the services, standards and protocols, test it and then gradually expand it," Fridsma added.
NHIN Direct is an effort to provide "the best kind of customer service that we can for the purpose of interoperability," said David Blumenthal, MD, the national health IT coordinator.
"We think we need to make it possible to meet providers where they are -- not just where we'd like them to be in terms of their needs and capabilities," he said.
An example of a simple exchange would be when a primary care provider refers a patient to a specialist and sends a summary care record with the referral. To complete the transaction the provider would also expect a summary care record back from the specialist.
NHIN Direct is a way to "engage a lot of providers quickly and to whet their appetite for exchange," said Janet Corrigan, president of the National Quality Forum and a committee member. Providers will want to have more capabilities and go further with health information exchange, she said.
John Halamka, MD, vice chairman of the Health IT Standards Committee and chief information officer of Beth Israel Deaconess Medical Center, said NHIN Direct will consider existing business specifications for transport that are used across industries, such as Representational State Transfer (REST) and Service Oriented Architecture Protocol (SOAP).
The team would then "test them in various configurations and see if they meet the particular requirements," he said.
"NHIN Direct is simply a mechanism to solve some use cases for some participants in some circumstances," Halamka said.
ONC has contracted with Arien Malec, who had been working with RelayHealth, a health internetworking services provider, to coordinate participants in NHIN Direct development, Blumenthal said. Malec is a member of the Health IT Policy Committee's NHIN work group.
The project team held its first meeting March 23. Participation in discussions, wiki and blogs is open to those who want to help develop descriptions of the services.
