The Office of the National Coordinator for Health IT (ONC) has issued a request for information (RFI) on the mechanisms required for governance of the Nationwide Health Information Network (NwHIN), which ONC plans to spin off as a private, nonprofit entity next fall.
In a May 11 webinar of the National eHealth Collaborative (NeHC) University, Steven Posnack, director of ONC's federal policy division, outlined the RFI. The objectives of creating a NwHIN governance structure, he said, include:
- Making it more efficient for entities to exchange health information
- Avoiding potential conflicts between the disparate governance structures of state health information exchanges (HIEs)
- Laying the foundation for future stages of Meaningful Use
- Guiding the evolution of interoperability standards in the HIE marketplace
The RFI seeks comments in the following areas:
- Establishing a set of conditions of trusted exchange (CTEs), or rules of the road
- Setting up a validation process for entities that want to show conformance with CTEs
- Establishing a process to measure the readiness of evolving standards of interoperability
- Updating and retiring CTEs
- Approaches for monitoring and oversight
The three classes of CTEs in the ONC schema address the security of personal health information (PHI), technical standards for information exchange, and required business practices such as providing open access to directory services.
The RFI specifies preconditions for allowing organizations to become NwHIN-validated entities (NVEs). Among the entities that ONC anticipates will attain that status are electronic health record developers, integrated delivery networks, regional, state and local HIEs, health information service providers, and state and federal agencies.
Following the same arms-length process used in approving the entities that certify EHRs for Meaningful Use, ONC would select an "accreditation body" to appoint "validation bodies" that would validate the NVEs.
Besides ONC and its affiliated bodies, NwHIN governance would be subject to oversight by the Federal Trade Commission and the U.S. Department of Health & Human Services' Office of Civil Rights, which also enforces HIPAA regulations. So, despite ONC's stated intention to make NwHIN a nongovernmental organization, it appears that it will be closely supervised by the government.
NwHIN already includes more than 500 hospitals and 4,000 practices, but most of those providers are participating in a pilot of the Virtual Electronic Lifetime Record (VLER) of the Department of Defense and the Department of Veterans Affairs, according to a recent article in InformationWeek Healthcare.