Formal approach to NwHIN 'rules of the road' goes by the wayside

The nationwide health information network (NwHIN), a set of standards, services and policies that enable healthcare organizations to share information securely via the Internet, will not base the process of "trusted exchange" on a formal governmental rulemaking process, according to the Office of the National Coordinator for Health IT (ONC). In response to feedback from industry stakeholders and the public, ONC has dropped pursuit of a regulation for establishing "rules of the road' for the NwHIN.

[See also: Information exchange requirements emphasized in 2014 EHR plans]

Comments made it clear that federal regulation could slow development of health information exchange just as those activities are starting to emerge and pick up steam, “perhaps more than is widely appreciated,” according to Farzad Mostashari, MD, national coordinator for health IT.

[See also: Information exchange requirements emphasized in 2014 EHR plans.]

ONC issued a request for information (RFI) in May to collect public comment on a possible approach for rulemaking to spell out “conditions of trusted exchange,” including safeguards and technical and business practices. ONC wanted to receive broad input before issuing a proposed rule, Mostashari said.

[See also: NwHIN prepares for broad rollout in October]

ONC also considered establishing a voluntary accreditation and certification process through which organizations would be approved as legitimate participants in NwHIN, somewhat similar to the procedures for certifying electronic health records for meaningful use functions.

“Based on what we heard and our analysis of alternatives, we’ve decided not to continue with the formal rulemaking process at this time, and instead implement an approach that provides a means for defining and implementing nationwide trusted exchange with higher agility, and lower likelihood of regret,” he wrote in a Sept. 7 blog.

ONC’s goal is that information follows the patient where and when it is needed, across organizational, vendor and geographic boundaries.

[See also: NwHIN prepares for broad rollout in October.]

The current state of information exchange and care coordination is far from that ideal. In addition to technical challenges with interoperability, “the absence of common ‘rules of the road’ may be hindering the development of a trusted marketplace for information exchange services,” Mostashari said.

However, voluntary governance bodies are now forming both for directed and query-based exchange. ONC wants to encourage the exchange activities that are gaining steam, “and not to hobble them,” he added, especially with the expectations for standards-based exchange in Stage 2 of meaningful use.

“And let me assure you that if systemic problems or market breakdowns emerge that might require regulatory action, we will again seek input from the public and our stakeholders, including the Health IT Policy and Standards committees,” Mostashari explained.

Participation in the NwHIN Exchange previously was limited to federal health agencies and primarily large healthcare organizations that contract with them or are federal grantees. Agreement on how to ensure conditions for trusted exchange will enable many more organizations to participate.

Among the actions that ONC will press for to promote trusted exchange are the following:
  • Identify and highlight good practices that support secure and interoperable exchange and provide a guide for evolving governance models.
  • Learn from and engage with groups in governance and oversight roles for exchange partners in order to foster models within and across communities.
  • Continue to use existing authorities and convening powers to create consensus and provide guidance and tools around specific barriers to interoperability and exchange.
  • Evaluate how and what consumer protections can be appropriately applied to health information exchange through existing regulations.
  • Monitor and learn from the wide range of activities that are occurring.

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