Nationwide Health Information Network (NHIN): Key Info and Site Map
With revamped organization of NHIN information on Office of National Coordinator (ONC) for Health IT Web site, this post includes excerpts from NHIN Overview page and Limited Production Exchange page (accessed April 1, 2010) as well as a site map to key NHIN and NHIN Direct material. The NHIN Limited Production Exchange is being overseen by two committees–Coordinating Committee and Technical Committee–which were granted authority under DURSA (Data Use and Reciprocal Support Agreement) .

Nationwide Health Information Network (NHIN): Overview
“The Nationwide Health Information Network (NHIN) is a set of standards, services and policies that enable secure health information exchange over the Internet. The NHIN will provide a foundation for the exchange of health IT across diverse entities, within communities and across the country, helping to achieve the goals of the HITECH Act. This critical part of the national health IT agenda will enable health information to follow the consumer, be available for clinical decision making, and support appropriate use of healthcare information beyond direct patient care so as to improve population health.

“The NHIN Work Group, part of the Health IT Policy Committee, is currently developing recommendations for extending the secure exchange of health information using NHIN standards, services and policies to the broadest audience possible. Activities of the NHIN Work Group and Health IT Policy Committee can be found at http://healthit.hhs.gov/policycommittee.

“A group of federal agencies, local, regional and state-level Health Information Exchange Organizations (HIOs) and integrated delivery networks, formerly known as the NHIN Cooperative, has been helping to develop the NHIN standards, services and policies. Today, these organizations are demonstrating live health information exchange through the NHIN Limited Production Exchange. By the end of 2010, it is expected that approximately a dozen entities will be securely sharing live health information as part of this Exchange. For more information about the NHIN Limited Production Exchange, please visit NHIN Limited Production Exchange.

“Based on initial recommendations from the NHIN Work Group, a new initiative, the NHIN Direct Project, is being launched to explore the NHIN standards and services required to enable secure health information exchange at a more local and less complex level, such as a primary care provider sending a referral or care summary to a local specialist electronically. For more information about the NHIN Direct Project, please visit http://nhindirect.org/.

“Moving forward, the NHIN will continue evolving to meet emerging needs for exchanging electronic health information securely over the Internet. This evolution will be driven by emerging technology, users, uses, and policies.

“The Office of the National Coordinator for Health IT (ONC) believes that with broad implementation, the secure exchange of health information using NHIN standards, services and policies will help improve the quality and efficiency of healthcare for all Americans.”

NHIN Limited Production Exchange
“Today, the Nationwide Health Information Network (NHIN) is operating as the NHIN Limited Production Exchange. This Exchange connects a diverse set of federal agencies and private organizations that need to securely exchange electronic health information. These entities currently include the Social Security Administration, MedVirginia, the Department of Veterans Affairs, the Department of Defense, and Kaiser Permanente. 

“Entities participating in the Limited Production Exchange have:

• Completed an application for participation (which are available through the sponsoring Federal agency)
• Executed a trust agreement called the Data Use and Reciprocal Support Agreement (DURSA)
• Completed required testing / validation procedures
• Been accepted by a Coordinating Committee – which supports operation of the NHIN Limited Production Exchange

“Today, non-federal agencies can only participate in the Exchange through a federally-sponsored contract that pertains to NHIN implementation. NHIN-related contracts currently include:

• SSA – just awarded contracts to 15 organizations 
• Virtual Lifetime Electronic Record (VLER) – VA, DoD, KP, others TBD
• Beacon Communities
• State HIE Cooperative Agreements
• CDC
• Other federal programs that focus on the NHIN exchange

“Federal agencies are assessing and prioritizing their rollout strategy and will prioritize their expansion over the next 12 to 18 months.

“Entities that are interested in exchanging data with the NHIN Limited Production Exchange should:

1. Determine whether the existing functionality meets its needs:
   • Does the organization have a need to exchange summary patient records for care coordination?
   • Does the organization need to submit state public health reporting information to CDC? 
   • Does the organization wish to provide summary records to SSA for disability determination purposes?
      
2. If the organization requires any of the functionality listed above, does it have a contract with one of the sponsoring federal agencies noted above?
   • If so – the organization should coordinate through the sponsoring agency.
   • If not, the organization should pursue one of those contracts or partner with one of the existing recipients (such as SSA awardees, state HIEs, Beacon Communities, etc.)

“The NHIN specifications, testing resources, legal agreements and accountability measures are available to the public to stimulate implementation of secure electronic health information exchange.  These helpful resources are available below as well as on the Resources page in the left column, and entities are encouraged to review them if they plan to engage in the NHIN limited production exchange in the future. 

“The work products of the NHIN Coordinating Committee, including policies and procedures and meeting notes, are available by clicking HERE.”

“It is important to note that the NHIN will continue to evolve to support additional information exchange models – ranging from less complex to more robust. For more information about the evolving vision of the NHIN please visit” the Ongoing Development Activities Page.

“For more information about the NHIN, please revisit” the NHIN site regularly for updates.

NHIN Limited Production Exchange – Committee Resources
“NHIN Limited Production Exchange participants elected to use two committees – a Coordinating Committee and a Technical Committee – to help oversee the production exchange. These two committees were granted authority under the DURSA to serve these functions for the exchange. Parties that sign the DURSA agree to Committee process.

“The Technical Committee is responsible for determining priorities for the NHIN production exchange and creating and adopting specifications and test approaches for that exchange. The Technical Committee works closely with the Coordinating Committee to assess the impact that changes to the specifications and test approaches may have on NHIN exchange participants.

“The Coordinating Committee is responsible for accomplishing the necessary planning, consensus building, and consistent approaches to developing, implementing and operating the NHIN exchange, including playing a key role in NHIN exchange breach notification; dispute resolution; exchange membership, suspension and termination; NHIN exchange operating policies and procedures. In addition, the Coordinating Committee informs the Technical Committee when proposed changes for interface specifications have a material impact on exchange participants.The Coordinating Committee uses a set of operating procedures to guide its activities and will conduct self assessments to refine the committee process over time. These documents, along with minutes of Coordinating Committee meetings, are available” on the NHIN Limited Production–Exchange Committee Resources page.

NHIN Site Map
NHIN: Overview
NHIN Limited Production Exchange
NHIN Limited Production Exchange – Committee Resources
NHIN Ongoing Development Activities
NHIN Inventory of Tools
NHIN Resources  Includes NHIN Limited Prodcution Exchange Committee Resources, Coordinating Committee Policies & Procedures, Meeting Notes, 2010 NHIN Final Production Specs, Materials related to Data Use and Reciprocal Support Agreement (DURSA), NHIN Validation Plan, Trial Implementations, past NHIN Forums.
NHIN History and Background with links to Phase 1: Prototype Architectures and Phase 2: Trial Implementations

NHIN Direct Project:    http://nhindirect.org
NHIN Direct Blog
NHIN Direct FAQs
For additional information on NHIN Direct, see a previous post on e-Healthcare Marketing.