New Public-Private community aims to help build NHIN

Two years after the Office of the National Coordinator of Health IT (ONC) released an open-source version of its CONNECT software for linking to the National Health Information Network (NHIN), a new nonprofit organization--the Alembic Foundation--is assembling a private-public community to start building a critical mass of CONNECT users. This week, Alembic's Aurion Project will release the latest version of the CONNECT application, Aurion 4.0, and participants in the Aurion community will finalize a charter and a governance structure.

In the long run, this project may have a considerable impact on the development of the NHIN. And, if it does, it will be in large measure because of its emphasis on collaboration between the public and private sectors.

Fifteen private-sector organizations and a consortium representing 26 federal agencies helped create CONNECT in 2007 and 2008. David Riley, chair of the Alembic Foundation, was one of the outside consultants who worked on this project; Vanessa Manchester, Alembic's chief operating officer, was another.

Following a successful demonstration of the software in December 2008, some of the federal agencies decided to use the "specs" to build CONNECT gateways to the NHIN. The Social Security Administration was the first go to live, using CONNECT to exchange data with MedVirginia, a private health information exchange.

The NHIN exchange now includes five federal agencies and five private-sector organizations, according to Riley. Besides Social Security, the government agencies include the Department of Veterans Affairs, the Department of Defense, the Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid Services. CMS has performed several CONNECT pilots, and now is going into production, Riley tells FierceHealthIT. The private sector organizations include MedVirginia, the Indiana Health Information Exchange, and Kaiser Permanente, he adds.

Following the public release of the CONNECT software, ONC brought in Brian Behlendorf--primary developer of the Apache web server and chief technology officer of the World Economic Forum--to help set up an open-source community. (Behldendorf is now an Alembic board member.) CONNECT training sessions and "codeathons" were held across the country, attracting far more interest than expected.

"By September 2010, we were up to 2,000 unique organizations that were either participating in training seminars or codeathons or downloading software or [that] told us they were implementing CONNECT," Riley says.

In November, he and Manchester took leave of ONC and, a few months later, set up Alembic as a nonprofit organization. Alembic will serve a "custodial" function as the community develops CONNECT, Riley says. Among the companies that are now sponsoring Alembic's activities are CollabNet, Mirth Corp., Harris Corp., and Agilex Corp.

There seems to be widespread interest in the Aurion Project. Federal agencies, hospitals, health information exchanges, software developers, service providers and integrators reportedly participated in a town hall meeting that Alembic held on April 12.

The primary difference between Aurion 3.1 (identical to CONNECT 3.1) and the 4.0 version, Riley says, is that it will be "more modular and easier to fit into existing products. So if you're an EHR vendor that wants to add HIE functionality, it's now an imbeddable library and easier to manage in your code base."

Nevertheless, he adds, providers don't necessarily have to wait for their vendors to incorporate Aurion into their products. He cites a small regional hospital in Nebraska that downloaded CONNECT and created its own HIE, using Mirth Corp. for integration work.

Within the next six months, Riley expects that the community will incorporate the Direct Project--a protocol for secure clinical messaging--into one of the next versions of Aurion. Riley envisions providers being able to choose between the Direct and Aurion protocols, depending on whether they just want to "push" data to another entity or use the software to create bidirectional exchanges. - Ken