For years healthcare has hoped for a single communications system could securely convey all of our clinical, administrative and public health information between hospitals, clinics, labs, governments and insurance companies. After all, VISA provides a global infrastructure for credit cards, the Federal Reserve Banks provide a national system for banks to exchange financial information, so why can’t health care develop a similar, secure system?

Healthcare has been trying to develop a standard network for years. First we started with the concept of CHINs (Community Health Information Networks), which attempted to put all health care information in a region into centralized computing systems. This centralized concept scared many people away from the entire concept of connecting disparate health care clinical information.

Instead, efforts turned to standardizing healthcare billing that is exchanged between doctors and insurance companies. The biggest effort was the familiar passage (in 1995) of the HIPAA legislation. HIPAA standardized healthcare billing by requiring all doctors to use a single set of standardized electronic billing formats, defined by the American National Standards Institute (ANSI). HIPAA has done a good job in moving everyone to national standards for billing messages. But what about a similar system for exchanging medical and clinical information?

The development of NHIN is a modern effort to standardize and simplify the exchange of medical/clinical information between doctors, hospitals, public health and government entities. The effort started in April 2004 when President Bush signed an Executive Order mandating that most Americans should have electronic medical files, or electronic health records (EHRs) within ten years. This order created a new government office, called the National Coordinator for Health Information Technology – now referred to as the Office of the National Coordinator, or ONC. A very nice timeline of the NHIN effort can be found here: http://www.worldprivacyforum.org/NHIN_timeline.html

NHIN is not a physical network, like the telephone system. Neither is it a private network, such as used by Medicare. Instead it is an Internet-based system that is defining standardized ways to communicate securely (over the Internet) to solve specific business problems, or “Use Cases” in the vernacular of computer science. The NHIN standards include a very modern security system that ensures communications stay private and prove who is on the other end of the line (Think of it like caller-ID that can’t be spoofed). Using the Internet and standardized security and communication services helps ensure low costs and expandability.

NHIN was originally focused on the secure exchange of patient information between groups of clinics, hospitals, and the Federal Government. However, there are growing number of services being defined so that both medical information AND healthcare billing information can be exchanged across NHIN. For example Medicare/CMS has announced an effort early next year to pilot billing-related information using NHIN.

One problem many clinics and hospitals have is finding a patient’s medical information at another clinic or hospital. So one of the “core” services in NHIN is the ability to ask the question “Do you have any information on this patient (lets use John Fraser as an example) in your system?”. If the answer is yes, then the next question defined by NHIN is: “Can you give me a list of information available for patient John Fraser?” and so on. NHIN is focused on solving practical, day-to-day problems common in most clinics and hospitals across the United States.

Have you ever had to fill out a three page health questionnaire at a new doctors office? Have you ever been to an urgent care center or emergency room and wondered if they had all your medical records on hand? These are critically important business processes that have long ago been automated by the credit card and financial services industries. NHIN can solve these problems, along with many more, and NHIN’s collaborative approach to development and testing involving many different organizations is the right approach.

NHIN is winning due to a variety of reasons: NHIN is based on a modern Internet and standards-based system, the Federal Government is working with the community to solve the simplest problems first (that are common across health care), and, having personal experience with the NHIN infrastructure, I can attest to the high quality and level of sophistication of the NHIN security and communications architecture. Numerous Federal Agencies are in test mode or moving to production with the NHIN infrastructure each day. Given the federal commitment and Internet-based approach, any other system would be challenged to emerge any time soon to displace the quickly emerging NHIN network.

Imagine…
- a secure medical network that stretches from coast to coast using the infrastructure of the Internet.
-this network sending and receiving medical images and medical summaries between hospitals and clinics hundreds of miles apart for emergencies.
-ambulances looking up medical information even before they reach the accident scene or patient.
-hospitals reporting de-identified disease notifications in real-time to state and federal agencies to accurately track outbreaks like the H1N1 virus, and that these notifications are then sent to vaccine manufacturers in near-real time (so that critical vaccines can be positioned and shipped directly to the providers who need them most).

Imagine no more; these and similar projects are underway or in final stages of testing right now utilizing the NHIN infrastructure – the future is not far away!