A recent article in the Journal of the American Medical Informatics Association explores changes in development of the Nationwide Health Information Network.

The authors question whether a shift away from regional health information organizations to the use of point-to-point information exchange (such as the Direct Project) and private HIEs is wise. “We write this article to prompt a pause for reflection on the wisdom of this approach. We describe the history of RHIOs, the value of RHIOs to patients and communities, the changes in the policies of the Office of the National Coordinator, and likely the consequences of these changes. Based on this analysis we call for an open debate and the development of scientific consensus before irrevocable commitment to one model or another for the NwHIN is made.”

The de-emphasis on RHIOs is opening the door to private networks, such as those of delivery systems, networking firms like SureScripts and VisionShare, and electronic health records vendors, the authors contend. These networks have an advantage over RHIOs as they are not obligated to provide services necessary for a community health system or universal coverage for a region. “They can recruit participants based on favorable economics, reaping profits without having to meet the requirements for undertaking the truly difficult tasks in health information exchange. Further, health information exchange with business partners on private networks will likely meet proposed Stage 2 criteria for meaningful use incentives.”

Authors of the article are Leslie Lenert and David Sundwall of the University of Utah, a region served by the long-established Utah Health Information Network; and Michael Edward Lenert of the University of San Francisco. The article, “Shifts in the Architecture of the Nationwide Health Information Network,” is free here, but registration is required.

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