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News Release

HHS Releases Report on Nationwide Health Information Exchange

Largest Compilation of Private-Sector Comments on Nationwide Interoperable Health Information Exchange to Date

The U.S. Department of Health and Human Services today released a report summarizing over 500 responses from individuals and private industry on interoperable health information exchange. The report, Summary of Nationwide Health Information Network Request for Information Responses, is a compilation of responses to a request for information (RFI) that sought input from the public on how to move forward on the development and adoption of a nationwide health information exchange.

�We asked the health care and IT sectors to tell us what we need to know to plan a health information exchange system that will work -- delivering health care records when and where they're needed, and strictly protecting their privacy and confidentiality," said HHS Secretary Mike Leavitt. "These ideas provide invaluable 'first specs' for a plan that will transform health care in America.�

Last year, President Bush called for the widespread adoption of electronic heath records (EHRs) for most Americans within 10 years and established the position of National Coordinator for Health Information Technology. In July of 2004, HHS issued a Framework for Strategic Action, outlining an approach toward nationwide implementation of interoperability. In order to gain broad input on the best mechanisms to achieve nationwide interoperability, HHS published an RFI seeking input on the development of a nationwide health information network (NHIN) � an Internet-based architecture that links disparate health care information systems together to allow patients, physicians, hospitals, community health centers and public health agencies across the country to share clinical information securely. Respondents were asked, among other things, to explore the role of the federal government and private industry in facilitating the deployment of a NHIN.

�The responses from the RFI yielded one of the richest and most descriptive collections of thoughts on interoperability and health information exchange that has likely ever been assembled in the U.S.,� said David J. Brailer, M.D., Ph.D., National Coordinator for Health Information Technology. �In reviewing these responses, we were able to take advantage of leading health IT expertise across the federal enterprise, a solid example of collaboration on health IT across the federal government.�

While the report is an illustrative summary of the RFI responses and does not attempt to evaluate or discuss the relative merits of any one individual response over another, it does provide some key findings. Among the many opinions expressed, significant support emerged for the following concepts:

• A NHIN should be a decentralized architecture built using the Internet, linked by uniform communications and a software framework of open standards and policies.
• A NHIN should reflect the interests of all stakeholders and be a joint public/private effort.
• A governance entity composed of public and private stakeholders should oversee the determination of standards and policies.
• A NHIN should be patient-centric with sufficient safeguards to protect the privacy of personal health information.
• Incentives will be needed to accelerate the deployment and adoption of a NHIN.
• Existing technologies, federal leadership, prototype regional exchange efforts, and certification of EHRs will be the critical enablers of a NHIN.
• Key challenges to developing and adopting a NHIN were listed as: the need for additional and better refined standards; addressing privacy concerns; paying for the development and operation of, and access to the NHIN; accurately matching patients identity; and addressing discordant inter- and intra-state laws regarding health information exchange.


Other overarching concepts that were espoused by many of the respondents included:


• There is a need for some form of implementation and harmonization at a regional level.
• Cooperation between the public and private sectors is essential for successful realization of a NHIN.
• The NHIN should evolve incrementally and include appropriate incentives, coordination, and accountability to succeed.
• The federal government plays a role in advancing a NHIN.

The RFI specifically asked for feedback on how a NHIN could be governed, financed, operated, and supported. Interested parties were encouraged to collaborate and submit unified responses to the RFI wherever possible. Comments from the public-at-large were also invited.

A variety of health care entities representing a cross-section of industry stakeholders as well as private citizens submitted responses totaling nearly 5,000 pages of information. In order to leverage the technical and operational expertise across the federal government on health information technology, more than 120 federal officials from over 17 departments and federal agencies participated in a federal government-wide RFI review task force led by HHS to analyze the responses from the public-at-large.

The report is available at http://www.hhs.gov/healthit/rfisummaryreport.pdf.