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{{short description|Initiative for the exchange of healthcare information}}
The ] awarded contracts totaling $18.6 million to four groups of health care and health information technology organizations to develop prototypes for a Nationwide Health Information Network (NHIN) architecture. The contracts awarded to these four consortia are hoped to move the nation toward the ] goal of personal electronic health records by creating a uniform architecture for health care information that can follow consumers throughout their lives.
{{lowercase title}}
{{Update|date=March 2017}}
The '''eHealth Exchange''', formerly known as the '''Nationwide Health Information Network''' ('''NHIN''' or '''NwHIN'''), is an initiative for the exchange of healthcare information. It was developed under the auspices of the U.S. ] (ONC),<ref name=what_is_NHIN>{{cite web|title=What is the NHIN?|url=http://www.healthit.gov/sites/default/files/what-Is-the-nhin--2.pdf|website=HealthIT.gov|publisher=Office of the National Coordinator for Health Information Technology (US)|accessdate=6 September 2014}}</ref> and now managed by a non-profit industry coalition called Sequoia Project (formerly HealtheWay).<ref>{{Cite web|title = About Us, Our Initiatives and Collaboration|url = http://sequoiaproject.org/about-us/|website = The Sequoia Project|access-date = 2016-02-09|language = en-US}}</ref> The exchange is a web-services based series of specifications designed to securely exchange healthcare related data. The NwHIN is related to the ]{{citation needed|date=August 2012}} which uses a secure email-based approach. One of the latest goals is to increase the amount of ] information about the NwHIN to prospective vendors of health care systems.{{citation needed|date=August 2012}}


The Office of the National Coordinator for Health Information Technology has been facilitating development of the NwHIN, which will tie together health information exchanges, integrated delivery networks, pharmacies, government, labs, providers, payors and other stakeholders into a "network of networks."{{citation needed|date=September 2012}}
The four consortia are led respectively by ], ] (CSC), ] (IBM) and ]. Each consortium is a partnership between technology developers and health care providers in three local health care markets. Each group will develop an architecture and a prototype network for secure information sharing among hospitals, laboratories, pharmacies and physicians in the three participating markets. Additionally, all four consortia will work together to ensure that information can move seamlessly between each of the four networks to be developed, thus establishing a single infrastructure among all the consortia for the sharing of electronic health information.


A health care system participating in the NwHIN acquires an ] (OID).{{citation needed|date=August 2012}} The OID, issued by the ONC, allows the individual health care system or vendor to receive and send messages to trusted entities within the NwHIN through an interface such as ] or a custom-built ] ].{{citation needed|date=August 2012}} The NwHIN is built on ] code utilizing the Java platform.{{citation needed|date=August 2012}} This creates a need for technical information sharing among ] with the ONC also making information available.{{citation needed|date=August 2012}}
Each of the four consortia will design and implement a standards-based network prototype during the coming year. The prototypes will test patient identification and information locator services; user authentication, access control and other security protections and specialized network functions, as well as test the feasibility of large-scale deployment. The work of the consortia will inform the deliberations of the American Health Information Community (the Community), a new federal advisory committee chaired by Secretary Leavitt, which is charged with providing input to HHS and the industry on how to make health records digital and interoperable.


According to former ] ] ] the NwHIN would be a public-private venture, and {{as of|2009|lc=y}} the ], ] and ] were funding research and demonstration projects.<ref>{{cite web|website=National Health Information Network News |title=The Business Case: Key Resources |url=http://www.nhinwatch.com/performSearch.cms?channelId%3D6 |accessdate=September 28, 2009 |url-status=dead |archiveurl=https://web.archive.org/web/20090813211557/http://www.nhinwatch.com/performSearch.cms?channelId=6 |archivedate=August 13, 2009 }}</ref>
The consortia will share ideas and information about the architecture and prototypes with each other and with the public in order to accelerate secure and seamless exchange of health information across the nation. Once created, the architecture design for each of the networks will be placed in the public domain to stimulate others to develop further innovative approaches to implementing health information technology.


The NwHIN is funded through the ], the ], the ], the ], the ], and the ].<ref>], Section 3011.</ref>
The NHIN consortia will work closely with other HHS partners, including the Health Information Technology Standards Panel established by the American National Standards Institute, the Certification Commission for Health Information Technology, and the Health Information Security and Privacy Collaboration established by RTI and the National Governor’s Association.

==Participants==
The stakeholders that participate in the NwHIN will be four broad classes of organizations:
*Care delivery organizations (CDOs) that use ]s (EHRs).
*]s that operate ]s (PHRs) and other consumer applications.
*]s (HIEs): multi-stakeholder entities that enable the movement of health-related data within state, regional or non-jurisdictional participant groups.
*Specialized participants: organizations that operate for specific purposes including, but not limited to, secondary users of data such as public health, research and quality assessment. The specialized nature of these organizations means that they may require only a subset of the shared architecture (standards, services and requirements), processes and procedures used by the other participants.<ref>{{cite web|author1=United States Department of Health and Human Services|title=Nationwide Health Information Network (NHIN) Exchange: Architecture Overview, Draft v.0.9|url=http://www.healthit.gov/sites/default/files/nhin-architecture-overview-draft-20100421-1.pdf|website=HealthIT.gov|publisher=Office of the National Coordinator for Health Information Technology (US)|date=21 April 2010}}</ref>{{Rp|9}}

===Health Information Service Providers===
Some organizations may lack the necessary technical or operational competencies to conform to the architecture and provide the core services. Instead, they may choose to use the services of a Health Information Service Provider (HISP). A {{dfn|Health Information Service Provider}} is a company or other organization that will support one or more NwHIN participants by providing them with operational and technical health exchange services necessary to fully qualify to connect to the NwHIN.<ref name="healthit.hhs.gov">{{cite web |title=What is the NHIN? |publisher=U.S. Department of Health and Human Services |date=23 July 2009 |url=http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_877368_0_0_18/WhatIsTheNHIN.pdf |accessdate=September 28, 2009 |url-status=dead |archiveurl=https://web.archive.org/web/20100603062542/http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_877368_0_0_18/WhatIsTheNHIN.pdf |archivedate=June 3, 2010 }}</ref>

==Access process==
The business, trust and technical arrangements that will enable the NwHIN generally will be local and between organizations. Nonetheless, the primary users of the NwHIN will be people: healthcare providers, healthcare consumers and those who use the data in the NwHIN for public health, quality assessment or other purposes. These people will have several ways to take advantage of the information exchange available through the NwHIN.

Access Paths to the System:<ref name="healthit.hhs.gov"/>
*For healthcare providers:
#Providers may use features of the electronic health record (EHR) systems of their own practice or hospital to connect to an HIE, and the HIE, in turn, will support information exchange with other EHRs or PHRs on that HIE or on other HIEs through the NwHIN;
#They may not have an EHR, so they may use the Web to access a portal operated by the HIE to access information.

*For healthcare consumers:
#They may use features of a PHR that they designate as the repository of their personal health record, and that PHR may be connected to an HIE which, in turn, will provide a connection to the NwHIN;
#They may use features of a multi-regional PHR that will participate directly in the NwHIN;
#If they do not have access to a PHR, they may achieve some limited functionality by using the services of an HIE through its portal.

==Related projects==
===CONNECT software===
An open source software package is available that implements the NwHIN architecture from CONNECT. The CONNECT software is the outcome of a 2008 decision by federal agencies to begin work on connecting their health IT systems into the NwHIN. Rather than individually build the software required to make this possible, the federal agencies collaborated through the Federal Health Architecture program to create a single solution that can be reused by each agency within its own environment.<ref>{{cite web |title= 'CONNECTing' to the Nationwide Health Information Network|url=http://www.connectopensource.org/display/Gateway/About+CONNECT |accessdate=September 28, 2009 |url-status=dead |archiveurl=https://web.archive.org/web/20091007005817/http://www.connectopensource.org/display/Gateway/About+CONNECT |archivedate=October 7, 2009 }}</ref> Twenty-two Cooperative members, including seven federal agencies using the CONNECT gateway, participated in testing and demonstrations in 2008.<ref name=what_is_NHIN/>

===Direct project===
The Direct project,<ref name="Direct project">{{cite web |url=http://wiki.directproject.org/ |title=Home |website=wiki.directproject.org}}</ref> which has been termed a scaled down version of the NwHIN,{{By whom|date=September 2016}} allows two trusted entities (for instance, a physician and a referred specialist) to share medical records.<ref name=directOverview>{{cite web |title=The Direct Project Overview |date=11 October 2010 |website=The Direct Project |url=http://wiki.directproject.org/file/view/DirectProjectOverview.pdf |access-date=16 September 2016 |url-status=live |archive-url=https://web.archive.org/web/20161013185405/http://wiki.directproject.org/file/view/DirectProjectOverview.pdf |archive-date=2016-10-13 }}</ref>{{rp|4}} In this way, the patient's electronic record could be viewed by two trusted entities. These entities may not have access to the NwHIN in a product like the CONNECT software.<ref name=directOverview/>{{rp|9}} However, they would have a trusted email address issued by the ONC.{{Citation needed|date=September 2016}}

==Future direction==
The NwHIN, as an operational entity, is moving from public (ONC-backed) operations, to a non-profit public-private structure. Under this model, the ONC will maintain overall responsibility for the governance of the NwHIN.<ref name=what_is_NHIN/> and the NwHIN operational entity will be known as the eHealth Exchange which will be facilitated by the non-profit Sequoia Project (formerly Healtheway), Inc. a membership-based corporation.<ref>{{Cite web|title = The Sequoia Project|url = http://healthewayinc.org|website = The Sequoia Project|access-date = 2016-02-09|language = en-US}}</ref>

==References==
{{reflist}}


==External links== ==External links==
* official website.
*
* official wiki.
*
* (formerly ''NHINWatch''), by ] Media.
*Health Information Technology Standards Panel
*
* by
*{{cite web|url=http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-network-nwhin|title=Nationwide Health Information Network (NwHIN)|website=HealthIT.gov|publisher=ONC}}
]
*{{cite web|title=Nationwide Health Information Exchange (HIE) Resources|url=http://www.healthit.gov/policy-researchers-implementers/nationwide-health-information-exchange-hie-resources|website=HealthIT.gov|publisher=ONC}}
* Nurse Barb Clark's web-site on NHIN]

]
]
]

Latest revision as of 11:19, 26 September 2023

Initiative for the exchange of healthcare information
This article needs to be updated. Please help update this article to reflect recent events or newly available information. (March 2017)

The eHealth Exchange, formerly known as the Nationwide Health Information Network (NHIN or NwHIN), is an initiative for the exchange of healthcare information. It was developed under the auspices of the U.S. Office of the National Coordinator for Health Information Technology (ONC), and now managed by a non-profit industry coalition called Sequoia Project (formerly HealtheWay). The exchange is a web-services based series of specifications designed to securely exchange healthcare related data. The NwHIN is related to the Direct Project which uses a secure email-based approach. One of the latest goals is to increase the amount of onboarding information about the NwHIN to prospective vendors of health care systems.

The Office of the National Coordinator for Health Information Technology has been facilitating development of the NwHIN, which will tie together health information exchanges, integrated delivery networks, pharmacies, government, labs, providers, payors and other stakeholders into a "network of networks."

A health care system participating in the NwHIN acquires an Object identifier (OID). The OID, issued by the ONC, allows the individual health care system or vendor to receive and send messages to trusted entities within the NwHIN through an interface such as Mirth Connect or a custom-built Java UI. The NwHIN is built on open source code utilizing the Java platform. This creates a need for technical information sharing among programmers with the ONC also making information available.

According to former Health and Human Services Secretary Michael Leavitt the NwHIN would be a public-private venture, and as of 2009 the Markle Foundation, Robert Wood Johnson Foundation and California HealthCare Foundation were funding research and demonstration projects.

The NwHIN is funded through the Office of the National Coordinator for Health Information Technology, the Health Resources and Services Administration, the Agency for Healthcare Research and Quality, the Centers of Medicare and Medicaid Services, the Centers for Disease Control and Prevention, and the Indian Health Service.

Participants

The stakeholders that participate in the NwHIN will be four broad classes of organizations:

  • Care delivery organizations (CDOs) that use electronic health records (EHRs).
  • Consumer organizations that operate personal health records (PHRs) and other consumer applications.
  • Health information exchanges (HIEs): multi-stakeholder entities that enable the movement of health-related data within state, regional or non-jurisdictional participant groups.
  • Specialized participants: organizations that operate for specific purposes including, but not limited to, secondary users of data such as public health, research and quality assessment. The specialized nature of these organizations means that they may require only a subset of the shared architecture (standards, services and requirements), processes and procedures used by the other participants.

Health Information Service Providers

Some organizations may lack the necessary technical or operational competencies to conform to the architecture and provide the core services. Instead, they may choose to use the services of a Health Information Service Provider (HISP). A Health Information Service Provider is a company or other organization that will support one or more NwHIN participants by providing them with operational and technical health exchange services necessary to fully qualify to connect to the NwHIN.

Access process

The business, trust and technical arrangements that will enable the NwHIN generally will be local and between organizations. Nonetheless, the primary users of the NwHIN will be people: healthcare providers, healthcare consumers and those who use the data in the NwHIN for public health, quality assessment or other purposes. These people will have several ways to take advantage of the information exchange available through the NwHIN.

Access Paths to the System:

  • For healthcare providers:
  1. Providers may use features of the electronic health record (EHR) systems of their own practice or hospital to connect to an HIE, and the HIE, in turn, will support information exchange with other EHRs or PHRs on that HIE or on other HIEs through the NwHIN;
  2. They may not have an EHR, so they may use the Web to access a portal operated by the HIE to access information.
  • For healthcare consumers:
  1. They may use features of a PHR that they designate as the repository of their personal health record, and that PHR may be connected to an HIE which, in turn, will provide a connection to the NwHIN;
  2. They may use features of a multi-regional PHR that will participate directly in the NwHIN;
  3. If they do not have access to a PHR, they may achieve some limited functionality by using the services of an HIE through its portal.

Related projects

CONNECT software

An open source software package is available that implements the NwHIN architecture from CONNECT. The CONNECT software is the outcome of a 2008 decision by federal agencies to begin work on connecting their health IT systems into the NwHIN. Rather than individually build the software required to make this possible, the federal agencies collaborated through the Federal Health Architecture program to create a single solution that can be reused by each agency within its own environment. Twenty-two Cooperative members, including seven federal agencies using the CONNECT gateway, participated in testing and demonstrations in 2008.

Direct project

The Direct project, which has been termed a scaled down version of the NwHIN, allows two trusted entities (for instance, a physician and a referred specialist) to share medical records. In this way, the patient's electronic record could be viewed by two trusted entities. These entities may not have access to the NwHIN in a product like the CONNECT software. However, they would have a trusted email address issued by the ONC.

Future direction

The NwHIN, as an operational entity, is moving from public (ONC-backed) operations, to a non-profit public-private structure. Under this model, the ONC will maintain overall responsibility for the governance of the NwHIN. and the NwHIN operational entity will be known as the eHealth Exchange which will be facilitated by the non-profit Sequoia Project (formerly Healtheway), Inc. a membership-based corporation.

References

  1. ^ "What is the NHIN?" (PDF). HealthIT.gov. Office of the National Coordinator for Health Information Technology (US). Retrieved 6 September 2014.
  2. "About Us, Our Initiatives and Collaboration". The Sequoia Project. Retrieved 2016-02-09.
  3. "The Business Case: Key Resources". National Health Information Network News. Archived from the original on August 13, 2009. Retrieved September 28, 2009.
  4. HITECH Act, Section 3011.
  5. United States Department of Health and Human Services (21 April 2010). "Nationwide Health Information Network (NHIN) Exchange: Architecture Overview, Draft v.0.9" (PDF). HealthIT.gov. Office of the National Coordinator for Health Information Technology (US).
  6. ^ "What is the NHIN?" (PDF). U.S. Department of Health and Human Services. 23 July 2009. Archived from the original (PDF) on June 3, 2010. Retrieved September 28, 2009.
  7. "'CONNECTing' to the Nationwide Health Information Network". Archived from the original on October 7, 2009. Retrieved September 28, 2009.
  8. "Home". wiki.directproject.org.
  9. ^ "The Direct Project Overview" (PDF). The Direct Project. 11 October 2010. Archived (PDF) from the original on 2016-10-13. Retrieved 16 September 2016.
  10. "The Sequoia Project". The Sequoia Project. Retrieved 2016-02-09.

External links

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