The Office of the National Coordinator of Health IT (ONC) lays out its 2012 strategy for health information exchange in a new Health Affairs paper.
ONC plans to continue to develop the building blocks required for three types of information exchange: directed exchange, which enables providers to send clinical data to each other electronically; query-based exchange, which permits providers to search for data that could help them diagnose and treat a patient; and consumer-mediated exchange, which gives patients access to their own health information.
"Based on the work of Office of the National Coordinator and its many collaborators over the last year," the ONC paper says, "the building blocks required to initiate all three forms of exchange are complete, tested and available today. These standards are already in use by private networks and electronic health records vendors to exchange documents within their own networks."
One such foundational element, ONC notes, is the Direct protocol for secure clinical messaging, which 35 vendors have imbedded in their EHRs and 40 states are using in their statewide HIEs. ONC has also created specifications for exchanging data at transitions of care and for receiving lab results.
This year, ONC will focus on closing three gaps in standards for health information exchange. First, it will specify standards and policies for provider directories that can be used to locate providers and their electronic addresses. Second, it will establish guidelines for digital certificate discovery and management to protect the security of personal health information. And third, it will work on a common set of rules for the governance of HIEs, which it sees as lacking in most of the country.
ONC's first step in that direction will be to establish a governance mechanism for the Nationwide Health Information Network (NwHIN), including standards and policies to establish a framework for trust and interoperability. According to the paper, ONC will continue to work with the federal agencies and private organizations that are using the NwHIN for both direct and query-based exchange.
The exchange, which ONC plans to turn over to a public-private nonprofit organization next fall, is already being used by more than 500 hospitals and 4,000 physician practices.
Query-based exchange today is generally accomplished through private or public HIEs. In addition, ONC recently launched a New York City pilot of a project called Query Health that will help public health agencies obtain patient data from HIEs.
ONC notes that consumer-mediated access, which has been facilitated by the government's Blue Button campaign, is also being promoted through the State Health Information Exchange program, the Beacon Communities program and the health IT regional extension centers.