CONNECT & NHIN Direct: What Are They?

There has been a lot of talk in recent months of two federal initiatives to ease connectivity in the health care industry-CONNECT and NHIN Direct. One of them is real software and the other is an emerging recipe for connectivity. Here's a primer.

CONNECT is real, downloadable software with three components:

* Gateway, which implements nationwide health information network specifications for secure data exchange over the Internet;

* Enterprise Service Platform, which enables an organization to plug practice management and electronic health records systems into a framework to communicate with the Gateway; and

* Universal Client Framework, a platform to develop end-user applications that support meaningful use if a physician doesn't have an EHR.

CONNECT includes one or more open source applications for each of the components, plus some private vendor tools such as IBM/Initiate Systems' master patient index software.

The Department of Health and Human Services in March 2008 awarded a contract to Melbourne, Fla.-based Harris Corp. as the prime contractor to develop CONNECT, with Chantilly, Va.-based Agilex Technologies and Richardson, Texas-based Scenpro Inc. as subcontractors.

The Federal Health Architecture initiative, a collaboration of multiple federal departments and agencies, in April 2009 released CONNECT's source code as open source and began developing the open source community. Releases are announced on a quarterly basis, says David Riley, CONNECT initiative lead contractor and owner of Enaptics Consulting LLC, Marshall, Mo.

Organizations using CONNECT, some in full production and others in testing stages, include HealthBridge in Cincinnati, Thayer County Health Services in Nebraska, Indianapolis-based Regenstrief Institute, Departments of Defense and Veterans Affairs, Kaiser Permanente, and Orange County and Redwood MedNet in California.

NHIN Direct isn't developing connectivity software, but the tools to guide development. These include descriptions of standards, services and policies to enable secure health data transmission over the Internet.

While CONNECT was done to meet certain needs of government agencies and large organizations, NHIN Direct is focused on more modest goals by smaller entities, such as physician-to-physician or physician-to-laboratory connectivity. It builds off CONNECT to offer an additional set of standards and specifications to support point-to-point interactions for meaningful use of health information technology, says Doug Fridsma, M.D., acting director of the office of standards and interoperability in the Office of the National Coordinator for Health Information Technology.

"Knowing where to send information will require directions to make sure it goes to the right place," he explains. "Part of the project is to determine what is the right way to do it."

NHIN Direct was formally announced in early 2010 and the initial goal is to test specifications during this summer. Working groups are tackling such issues as directories, security, and how to do particular types of exchanges.

The initiative won't create software but set the groundwork for development of a less-complex version of CONNECT that is suitable to the data exchange needs of smaller organizations, Fridsma says. The goal, he adds, is to get a simple but robust set of specifications, and then build innovations on top of them. "We hope having a clear, concise and well-vetted set of specifications around NHIN Direct will enable many people to develop solutions. If we've done a good job, one would hope this would provide innovation fodder to create applications for various types of provider organizations."

Eventually, the plan is to give communities three clear options for connectivity, either via CONNECT, NHIN Direct or health information exchanges, which themselves may use the other two options.

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--Joseph Goedert


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