National E-Health Care Records: Working Out the Details

Loraine Lawson

Dr. Doug Fridsma is the acting director of the Office of Interoperability and Standards in the Office of the National Coordinator for Health Information Technology. He recently explained to Loraine Lawson the role of the NHIN and a new project called NHIN Direct in addressing the integration and interoperability challenges of electronic medical records. In a coming second installment, he discusses what he sees as the main integration obstacles to and the next steps required for national electronic health care records.

Lawson: Can you explain the NHIN?
Fridsma: The Nationwide Health Information Network is a project that actually predates the HITECH Act and it's really a description of the standards - the services and the policy frameworks that are necessary to use the Internet to securely transport information related to health care for patients and doctors and the like.


With the passage of the HITECH Act in February 2009, there were standards that had to be adopted that would define the criteria for certifying electronic health records and then there would be outcomes and metrics that would be identified that would be indicative of using the electronic health record in a meaningful way.


"The NHIN working group came to the conclusion that interoperability is something that isn't one size fits all. We need a variety of different ways of exchanging information."

Dr. Doug Fridsma
Office of the National Coordinator for Health Information Technology


The HITECH Act gave the Office of the National Coordinator responsibility to identify standards that would allow for the exchange of information and those standards needed to be adopted by the secretary by December 2009. They also said that we needed to be able to provide a mechanism for incentivizing providers to exchange that information.


So, with an association with the advisory committee, they created this concept called "Meaningful Use," and the goal there was we wanted physicians and providers and health care organizations to use information technology to support patient care. What we didn't want to have happen is for a bunch of people to buy technology and simply install it and not use it. So Congress set up about $38 billion of incentive money that said, "If you can show us that one, you're using electronic health care records that are certified and, two, that you're using those electronic health records in a meaningful way, you'll be eligible for this $38 billion of incentive payments."


We then identified the functionality required to support that, and then we identified the standards that would be necessary to be able to create that functionality in a standardized way. So in January we published an interim final rule that articulated all of the standards needed for electronic health records to be certified. Then, in March, we described the certification process for how an electronic health record would get certified against those standards.


With the Nationwide Health Information Network, we realize that there's going to be lots of kinds of information people are going to want to exchange. We want a cohesive set of services standards and policies that allows people to have that directed exchange, say with a laboratory or with a pharmacy as well as more comprehensive things in which you have data that needs to go from one hospital to another because there's a patient who is unconscious in the emergency room and you need to get some additional information about them. That's kind of a different complexity of information exchange than just writing a prescription and sending it electronically to a pharmacy.


The NHIN working group took a look at some of the work with the definitions of meaningful use, the ways in which the information was being exchanged, and came to the conclusion that interoperability is something that isn't one size fits all. We need to support the kinds of interchanges that we have across the nation both to support meaningful use and to improve the safety and the care of patients. We need a variety of different ways of exchanging information.


That led to the formation of this project called NHIN Direct, which is really trying to look at are there methods we can use to allow directed communication between a provider and a provider, or a provider and a laboratory, or between a laboratory and a hospital that would allow the secure exchange of information? So the NHIN Direct project was started essentially to examine the services standards and policies related to that kind of exchange in the setting of meaningful use and the HITECH Act.

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May 19, 2010 11:58 AM Jeremy Engdahl-Johnson Jeremy Engdahl-Johnson  says:

Federal funding may be encouraging a move toward EHR, but there's more to it than just installing systems. How can healthcare data pooling lead to a better system? More at


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