Friday, April 30, 2010

What is the NHIN

John Moore of Chillmark Research asked for this one:

What is the NHIN, NHIN Connect and NHIN Direct, and the differences between them?

NHIN stands for the National Health Information Network.  But NHIN is not really a network, rather, it is a concept describing the infrastructure needed to connect healthcare providers from Maine to California to Alaska to Hawaii to Alabama to ...

A better name for NHIN would be the National Health Information Infrastructure, or NHII.  At least that's what we called it in 2004.  Some of this is covered in a post I did on the history behind ARRA.

The NHIN has been described as the backbone for exchange, much like the Interstate Highway infrastructure.  We really already have the necessary infrastructure needed: that is the Internet.  What NHIN really did was specify the rules of the road for traveling on the healthcare interstate.

In 2006, the newly create Office of the National Coordinator issued an RFP to test (pilot) technologies that would be used to connect heatlhcare providers across the states of this country.  I'm not sure why, but they used the name NHIN for this program, rather that show continuity with the NHII work that had gone on before.  Four organizations were awarded contracts for this NHIN Pilot project.

Subsequently in 2007-2008, a new RFP was issued and awarded by ONC across 11 different healthcare organizations to support NHIN Implementations.  The Federal Health architects across the federal agencies realized that they needed a platform to help agencies and organizations to connect to these NHIN implementations.  This project was an Open Source software project that became NHIN Connect.  NHIN Connect provides the software you need to get on the highway and follow the rules of the road.  It's been called the onramp to the NHIN.

Finally, we have NHIN Direct.  To get from my home to my doctor's office, I never go near the highway.  To get from my doctor's office to one of my specialists,  I still need to travel from the office parking lot, to the interstate.  I drive differently on these back streets and local highways than I do on the Interstate.  The rules are different there.  The same is true for the small practice.  In order to connect to their collegues and to their paitients, they need a different infrastructure.  That infrastructure needs to be sommething that they can purchase from Best Buy, or sign up for over the web, using the stuff they already have, to allow them to connect up to the NHIN.  NHIN Direct is the way that providers can connect to others without having to be aware of the gravel, concrete and steel that they are driving over.  They just want to get into their car and go.


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  2. NHIN is a HIE where the trust of many nodes is centrally managed/certified by a 3rd party (the NHIN Coordinating Committee). The NHINCC is the on/off ramp for that highway.

    On the other hand, NHIN Direct is a HIE where trust managed locally between the participating nodes.

    1. Almost four years later, the ability to manage trust locally is still part of DIRECT; however, I now understand the value of multiple DIRECT implementations being able to re-use the same directory.

      Implementing DIRECT with a common provider directory (owned by an ACO or HIO for example) better automates what is an otherwise cumbersome process.

      This point was demonstrated in the 2011 HIMSS when there was a last minute challenge placed by the ONC for vendors to integrate their direct implementations in under 60 minutes. The demonstrations using a provider directory work fluidly. The demonstrations without the Provider Directory required Tier-2 support representatives to exchange certificates on each eHR.

  3. Actually, it's the "NationWIDE Health Information Network." National implies that the federal government runs it.

  4. I think of it as
    CONNECT: HIE, pub/pull, complex
    Direct: No HIE required, known endpoints, push, simple

  5. Thanks for the analogy. But my question is where can I find the rules of the road (i.e. NHIN standards). Have they already published the standards for health information exchange, or are they employing already-established standards. I ask this for research purposes. Thanks.

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