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NHIN Direct aims to speed adoption of electronic health data exchange

The National Health Information Network Direct's standards for health data exchange are simpler than the broader NHIN standards. That should entice smaller practices, officials say.

En route to developing the National Health Information Network Direct subset of the broader NHIN health data exchange standard, the Office of the National Coordinator for Health IT might refer to NHIN Direct by a variety of names. One thing the ONC won't call it, however, is "NHIN Lite."

"'Lite' gives you the impression that for some reason, it's less than what the current NHIN offers -- and I don't think that's the case," said Dr. Doug Fridsma, acting director of ONC's Office of Interoperability and Standards. "NHIN Direct is going to have the same security and privacy protections that are afforded people using the current NHIN exchange model. So, there's nothing 'lite' about the privacy and security that NHIN Direct will achieve."

The goal of NHIN Direct is to let solo and small-practice physicians implement health data exchanges that are simpler than its big NHIN brother allows. But larger providers -- such as hospitals already using NHIN for health data exchange -- will likely find uses for NHIN Direct too, Fridsma said. User stories, which are spurring the discussion about NHIN Direct, as well as its development, suggest the potential for data exchange among primary care providers, specialists and public health agencies, as well as between hospitals and those entities.

The primary goal for NHIN Direct is to enable solo and small-practice physicians (and the consultants who serve them) to begin electronic health data exchange more quickly than is possible with the more complicated NHIN. It might be simpler to incorporate NHIN Direct protocols with currently installed electronic health record systems than the full-boat NHIN. While such data exchange is just one piece of the meaningful use puzzle, using NHIN Direct can help providers qualify for meaningful use certification, which makes them eligible for federal health IT financial incentives.

NHIN Direct is going to have the same security and privacy protections that are afforded people using the current NHIN exchange model.

Dr. Doug Fridsma, acting director, ONC Office of Interoperability and Standards

The original concept for NHIN Direct came from NHIN Workgroup member and former Certification Commission for Health Information Technology Commissioner Wes Rishel, who convinced ONC that a less complicated health data exchange standard would help physicians move to electronic standards. Fridsma envisions providers using NHIN Direct in place of NHIN in some cases, and in other cases, using both in parallel -- depending on who will receive the health data transmissions. In still others, NHIN Direct could be a stop on the way to full NHIN implementation.

"For some providers, it's a steppingstone," Fridsma said. "As they begin to exchange information, they may realize there are other kinds of exchange they want to be able to participate in," such as state information exchanges. "People might find this to be an easy way to begin exchanging information electronically, and then begin wanting to do more complex or robust ways of exchanging information."

ONC hopes to complete NHIN Direct's set of standards, services, and policies by late fall or the end of the year, Fridsma said, after it tests software using the specifications in actual examples of use-case scenarios the agency collects.

The agency tapped Arien Malec, former RelayHealth vice president, to serve as NHIN Direct coordinator and head up the NHIN Direct Web community, which provides input on project development. Malec's NHIN Direct blog is where hospital IT leaders and solo physicians can keep up with news about the standard under development, as well as learn about the latest NHIN Direct ideas brought up in NHIN Workgroup meetings.

Let us know what you think about the story; email Don Fluckinger, Features Writer.

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