Health IT professionals are urging policymakers not to take too rigid an approach to governing the Nationwide Health Information Network (NHIN). Instead, they suggest models that allow local providers and stakeholders to maintain control over interoperable health information exchanges.
Flexibility, local governance and a willingness to adapt to changes will go further than a strong federal structure in promoting exchange, according to professionals who testified before the governance workgroup of the Health IT Policy Committee last week.
Health information exchange (HIE) cannot be driven at the federal level, said Jac Davies, director of Inland Northwest Health Services, a Beacon Community. Regional trust is the driving force.
Instead of mandates, Inland Northwest's health information exchange occurs through common frameworks for all providers and stakeholders in the community, Davies said, explaining that the exchange in the region of Spokane, Wash. is built on existing relationships and collaboration.
"This has helped us maintain active participation across a variety of organizations and interests," Davies said. "Consumers have been engaged as part of the existing advisory groups, and also through the creation of specific advisory groups on topics that have strong consumer interest, such as personal health records."
I think every HIE will have to examine its own community landscape.
Maggie Gunter, president and executive director, LCF Research
In addition to ensuring that everyone's interests are maintained, having advisory groups and a sense of trust allows information exchanges to be nimble, said Maggie Gunter, president and executive director of Albuquerque, N.M.-based LCF Research. The organization manages the New Mexico Health Information Collaborative , which was designated as that state's HIE under the stimulus legislation of 2009.
Each region comes with its own unique health delivery and cultural needs, and being able to respond to those quickly fosters better adoption, Gunter said. "I think every HIE will have to examine its own community landscape."
The governance workgroup is charged with developing recommendations for a structure to oversee information exchange through the NHIN; those recommendations then will be considered by the policy committee as it drafts suggestions for the Office of the National Coordinator for Health Information Technology, or ONC. The federal office expects to release a notice of proposed rulemaking for HIE governance in the first half of 2011. A separate federal initiative is examining the benefits of using a provider directory to list those who participate in information exchange.
The feedback from those testifying before the governance workgroup will be incorporated into its draft recommendations to the Health IT Policy Committee, said John Lumpkin, chair of the workgroup, as well as senior vice president and director of the health care group of the Robert Wood Johnson Foundation in Princeton, N.J.
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