The goal of the NHIN is to let physicians view health records on the same patients, even if those records were created by different doctors using different computer programs in separate locations. This would give physicians a more complete picture of each patients health history, hopefully leading to more accurate diagnoses. In addition, patients would save time and discomfort by avoiding unnecessary procedures. One report has estimated savings of billions of dollars.
However, privacy advocacy groups say the project is getting ahead of itself, creating the ability to bring data to different entities without building sufficient controls over who can see data when. For example, when a person changes health policies, the NHIN could facilitate moving health information from one insurer to another, though such transfers would require patients consent.
The AHIMA report (PDF) found that objectives for the NHIN consortia were still unclear, and the authors expressed concern that current efforts would be wasted unless contractors received funding for a second year. But a bigger problem was in how efforts are organized. "Currently, the NHIN process and the state-level HIE initiative are two independent projects when, in fact, if incentives were aligned correctly, the state-level HIEs can serve as existing sites for testing and implementation sites for rollout," the report said.
For example, working with Cisco and several other entities, IBM has connected seven hospitals and dozens of physicians across New York, North Carolina and Virginia. The health providers can now share medical and health information even across different applications. Another consortium including Accenture and Oracle is connecting health care providers in Kentucky, Tennessee, and West Virginia. A third consortium connects California, Indiana, and Massachusetts, and a fourth connects markets in California and Ohio.
But the report says that these efforts need more support and that greater effort must be made to align incentives for state-level health information exchanges and the federal NHIN.
For the next phase of the NHIN, federal contracts will be awarded to regional health information exchanges, parts of which will likely be subcontracted to members of the original consortia, said Ginny Wagner, project executive for the NHIN architecture prototype project, in Bethesda, Md.
The Office of the National Coordinator for Health Information Technology did have many contracts in different areas going forward simultaneously, she said. That made it hard for one group of contractors to take advantage of another groups work.
But, she said, the four consortia creating prototypes for the NHIN had worked closely together, with architects from each consortium coming together regularly in conference calls.
She said that the consortia had encountered similar barriers, even though the consortia were connecting different markets and were not yet connecting to each other. For example, she believes the NHIN will require health information network service providers, though exactly what form they will take is unclear.
Though the exchanges need not be identical, the report said, efforts to make the exchanges work together must be coordinated. "NHIN can accommodate these variations only if the implementations are based on the same set of HIE standards. The message is that the notion of a single NHIN infrastructure is not paramount and that more energy and resources should be committed for accelerating standards-based HIE development and deployment to support multiple levels of interoperability."
At the same time, the report said that state-level efforts should not need to replace current technology and infrastructure to accommodate national standards, and that stakeholders need to understand how "the current state-level HIE technology operations will coexist in the eventual NHIN."
Much of the problem is that efforts are too fragmented. Stakeholders universally believe that "standards harmonization, certification compliance, security and privacy collaboration, and NHIN prototyping all relate strategically to the acceleration of HIT adoption," said the report. "The disconnects among these tactical projects create the perception of multiple efforts directed at individual issues with no overarching strategic plan connecting them."