# Presentation: 469261

## Nationwide Health 

**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
- Carespark
- Delaware HIN
- Federal HIE
- Indiana University
- Long Beach Network for Health
- Lovelace Clinic Foundation
- MedVirginia
- NCHICA
- New York eHealth Collaborative
- West Virginia HIN

- New NHIEs
- Cleveland Clinic
- Community Health Information Collaborative
- HealthBridge
- HealthLINC (Bloomington Hospital)
- HealthLink RHIO (Wright State University)
- Kaiser Permanente

## 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 |

## Common “dial tone” and “chain of trust”

- The Nationwide Health Information Network

**Labs**

**Pharmacies**

**Community Health Centers**

**State and Local Gov**

**Health****Bank**

**PCHR Support**
**Organization**

**Common**** “dial tone” and “chain of trust”**

## 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

## Common “dial tone” and “chain of trust”

- The Nationwide Health Information Network

**Labs**

**Pharmacies**

**Community Health Centers**

**State and Local Gov**

**Health****Bank**

**PCHR Support**
**Organization**

**Common**** “dial tone” and “chain of trust”**

## 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

- Step 1

- Step 2

- Step 3

- Prototype
- Architectures

**Trial **
**Implementations**

- Implement
- Production Services

- 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

## Slide 19