A Network For Everyone

On top of all the regional and local health information exchanges, the federal government has a national exchange in the works. The Nationwide Health Information Network is a set of standards, services, and polices to enable secure sharing of health data over the Internet.

NHIN, being developed by the Department of Health and Human Services with input from the healthcare industry and others, aims to let health information follow patients as they move among caregivers and institutions locally and around the country. The ability to electronically exchange data is expected to be one of the requirements healthcare providers have to meet to demonstrate "meaningful use" of e-health records and qualify for federal incentive money.

NHIN, originally called the National Health Information Infrastructure project, was started in 2002 with the goal of tying together regional health information organizations. Today, it's also bringing together state- and community-based HIEs and even individual providers.

The original vision of NHIN as a network of regional networks made it difficult for individual doctors with limited IT resources to be a part of the national exchange, says Bob Steffel, CEO of HealthBridge, a nonprofit that runs a large HIE around Cincinnati. The new approach provides more flexibility, Steffel says. "When NHIN was originally conceived, we scratched our heads and wondered how are they going to pay for this," he says.

Small practices as well as individuals can download open source software called Connect to access NHIN and even set up their own HIEs. Connect, originally developed to let federal agencies share health data, includes a core services gateway, enterprise service components, and a universal client framework that lets users develop applications using the enterprise service components. NHIN Direct is an offshoot of Connect that includes additional standards and specifications to support point-to-point interactions between organizations, such as labs and physicians' offices.