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Nationwide Health Information Network

Trial Implementations

John W. Loonsk, MD

Office of the National Coordinator for Health Information Technology

The Nationwide Health Information Network

Exchange of electronic health information to:

improve the quality / efficiency of health care
empower the individual patient
support public health, emergency preparedness, and research

Requires common elements:

minimum set of detailed standards - a shared network "dial tone"
support for consumer / inter-organizational trust
value of exchanging data exceeds the cost

NHIN Cooperative - 16 Members

Initial		New NHIEs
Carespark		Cleveland Clinic
Delaware HIN		Community Health Information Collaborative
Federal HIE		HealthBridge
Indiana University		HealthLINC (Bloomington Hospital)
Long Beach Network for Health		HealthLink RHIO (Wright State University)
Lovelace Clinic Foundation		Kaiser Permanente
MedVirginia
NCHICA
New York eHealth Collaborative
West Virginia HIN

Different Network Models

Network Type	Examples	Benefit	Challenge
Organizational	Integrated delivery systems, hospital chains	Effort of exchanging data internally is aligned with business outcomes	Extra-organizational exchange
Geographic	RHIOs, geographic HIEs	Support non-proprietary exchange	Achieving sustainable business models
Personally Controlled	Personally Controlled Health Record Support Organizations	Consumer access to, and control of, health information	Consumer and provider acceptance

The Nationwide Health Information Network

A graphical representation of the National Health Information Network appears as a ring that connects 'PHR HIE','HIE', 'Fed HIE', 'IDS HIE', 'Pharmacies', 'Labs', and 'GEO HIE RHIO'.
Health banks off shoots from 'PHR HIE'. State and Local Government and Community Health Centers off shoot from 'HIE'. CDC, DoD, SSA, VA, CMS, and FDA off shoot from 'FED HIE.'
Two 'H's' representing Hospitals along with two photos of doctors, to represent providers, off shoot from 'IDS HIE' and 'GEO HIE RHIO.'

Common Network "Dial Tone"

Data and technical specifications:

Provider has a patient but not their record

Common Network "Dial Tone"

Data and technical specifications:

Patient look-up and information retrieval

Common Network "Dial Tone"

Data and technical specifications:

Patient look-up and information retrieval
Updating health data where it is needed

Common Network "Dial Tone"

Data and technical specifications:

Patient look-up and information retrieval
Information routing and delivery

Common Network "Dial Tone"

Data and technical specifications:

Patient look-up and information retrieval
Information routing and delivery
Patient wants / doesn’t want information to be electronically released

Common Network "Dial Tone"

Data and technical specifications:

Patient look-up and information retrieval
Information routing and delivery
Exchange of consumer preferences

Common Network "Dial Tone"

Data and technical specifications:

Patient look-up and information retrieval
Information routing and delivery
Exchange of consumer preferences
Providing the best care and protecting the population

Common Network "Dial Tone"

Data and technical specifications:

Patient look-up and information retrieval
Information routing and delivery
Exchange of consumer preferences
Support for population data uses

Common Network "Dial Tone"

Testing – quantity of participants and quality of tests

Specific data and terms
The "envelopes" to hold the data
The query and responses that the software must support
Transport and security on top of the Internet

The Nationwide Health Information Network

A graphical representation of the National Health Information Network appears as a ring that connects 'PHR HIE','HIE', 'Fed HIE', 'IDS HIE', 'Pharmacies', 'Labs', and 'GEO HIE RHIO'.
Health banks off shoots from 'PHR HIE'. State and Local Government and Community Health Centers off shoot from 'HIE'. CDC, DoD, SSA, VA, CMS, and FDA off shoot from 'FED HIE.'
Two 'H's' representing Hospitals along with two photos of doctors, to represent providers, off shoot from 'IDS HIE' and 'GEO HIE RHIO.' The line between 'GEO HIE RHIO' to 'PHR HIE' and Health Bank is bolded in red.

Tools for Trust in a "Network of Networks"

Governance

Dynamic and legislated roles

DURSA

Common agreement

Accreditation

On site policies and procedures

Certification

Standards and capabilities

Consumer preferences

Steps to the NHIN

A graphical representation of the Step of the NHIN appears at the top of the slide. There is a square labled 'Prototype' with an an arrow leading to the Step Two square which is labled 'Specify and Test'. This square has and arrow leading from it to the Step Three box which is labled 'Production'.
The words Prototype Architectures,' 'Trial Implementations,' and 'Implementation Production Services' appears under boxes one, two and three respectively.

Input from other national agenda processes
Issues and obstacles help set agenda for other national agenda processes

Trial Implementations - 2008

May

Initial Core Specifications
Test data DURSA

July

Use case updates

August

Testing of Core

September

Demonstration of Core

November

Testing of use case update

December

Demonstration of core and use cases
Production level DURSA