Can HIEs and NHIN Direct Co-exist?

When the Office of the National Coordinator announced the development of NHIN Direct, many involved with creating state-level health information exchanges (HIEs) wondered where it left their organizations. NHIN Direct, expected to begin testing this summer, will offer secure, point-to-point information exchange over the Internet for simple transmissions that may currently be handled via fax or mail, such as referrals.

The proposal, coming from a workgroup of the Health IT Policy Committee, which advises ONC, is intended to help providers quickly meet data exchange requirements within the federal “meaningful use” EHR incentive program.

However, as an article in the current issue of the Journal discusses, some HIE developers question whether NHIN Direct will undermine the services they offer—or plan to offer—providers.

“Every state in the country got money from ONC to develop state-level HIEs, and all of them now are scratching their heads saying, ‘So, how does NHIN Direct work with all of this?” said Micky Tripathi, co-chair of ONC’s Health Information Exchange Workgroup and president/CEO of the Massachusetts eHealth Collaborative, quoted in the article.

The workgroup does not intend for NHIN to “undercut” HIEs, Tripathi said, but it recognized the needs of providers who “would literally have nothing right now.”

Doug Fridsma, director of the office of interoperability and standards at ONC, stresses that NHIN Direct is not intended to meet all the varied, complex services that providers need. Direct will handle the small stuff and give providers a way to initially meet meaningful use requirements, he said in the article. The state HIEs would handle large-scale exchanges and services.

HIEs can offer provider look-up services when providers need to access a patient’s record from an unknown provider, according to Fridsma. They can offer services related to public health reporting, data aggregation, patient consent management, identity proofing and authentication, health data analysis, and quality measure reporting.

“I imagine there are many circumstances in which those kinds of services would be valuable and that people would be willing to join with the state HIE and pay for the ability to have that kind of service,” Fridsma said.

NHIN Direct is being built in the public eye of the Internet on the NHIN Direct wiki. Interested parties have a chance to watch its progress, comment on specifications, voice concerns, and ask questions.

What do you think? Will NHIN Direct undermine the efforts of the state HIEs? Will it distract the industry from pursuing more complex types of information exchange? Or will Direct help jumpstart meaningul use and introduce providers to the wider services that HIEs offer?

Post your comments below.

1 Comment

  1. It’s too early to tell.

    While there has been a lot of chatter on the net, the necessary decisions have not been made yet. In addition, harmonization work to bridge the NHIN Direct and NHIN Exchange needs to follow those decisions.

    I am deeply concerned about the almost singular focus on the network protocol. It is not clear to me that there is a path to satisfy the scope of functionality and usability requirements for the wide range of end-users. Until that is defined, the choice of protocols and the means to bridge them seems premature.

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