Federal NHIN Rulemaking Expected in 2011

The Office of the National Coordinator for Health Information Technology is launching formal rulemaking to govern the Nationwide Health Information Network (NHIN), an act to expand the government-developed HIE model to all healthcare providers.

Formal rulemaking will work out legal and policy questions that still hang over the NHIN, and allow small and large healthcare organizations and HIEs the ability to use the information exchange network without an official government contract.

A mechanism for official NHIN governance—which had been piecemeal and incomplete—was called for in the 2009 HITECH Act.

With established NHIN policies, “all the [NHIN] participants can have confidence that the exchange information has the right protections for confidentiality and security, that the information is being exchanged accurately and that it is used to improve health,” according to Mary Jo Deering, a senior policy advisor in ONC’s Office of Policy and Planning, quoted in an August 10 Government Health IT article.

The proposed NHIN rule is expected in early 2011, and ONC plans to finalize the regulation next summer.

Currently only organizations that hold a contact or grant with the federal government can apply to participate in the NHIN Exchange, an Internet-based health information exchange system now being used by groups like the Veterans Affairs and Defense Departments, Social Security Administration, Kaiser Permanente, and several others. Having a contract with the government gives entities certain legal rights within the NHIN Exchange that organizations without a contract would lack.

The governance rules would change this policy and open up NHIN Exchange to other healthcare providers, as well as provide certain legal rights to all participants.

Some rules already do govern NHIN Exchange, including the requirement organizations use the Data Use and Reciprocal Support Agreement (DURSA) when exchanging information. Since the rulemaking process will be open to the public, it is unclear how it will affect current restrictions and NHIN agreements.

ONC’s intention is to create a set of policies that protect the rights of NHIN Exchange participants while increasing their numbers, Deering said in the article.

“All this is subject to the process over the coming year to gather information about the best way to proceed,” she said. “It is safe to say that the intention is to permit a wave of exchange—with the assurances of both privacy and security on one side and interoperability on the other side.”

In related news, HHS awarded IT services provider Stanley a two-year, $6-million contract to provide operation and infrastructure support for the NHIN. Stanley will provide services to support the enrollment of participants into the NHIN Exchange, including the issuing of digital certificates, updating network directories, and providing help desk support.

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