The Nationwide Health Information Network (NHIN) is still being defined by the Office of the National Coordinator’s Office for Health IT – more specifically the Health IT Policy Committee. The goal appears to be to build a new infrastructure using “a collection of protocols, legal agreements, specifications, and services that enables the secure exchange of health information over the internet.”
My prediction is that it is not going to be broadly adopted for healthcare information exchange. Here are some reasons:
(1) Look at what happened to Internet II (also known as I-2 – not to be confused with Web 2.0), a Federally funded program to build a high speed, second generation internet with “gigapop” connections for everyone. Having served on its various committees, the goal was to have this become the next generation internet. So what happened? The test beds were academic research centers and that is where it has ended. So, if you are lucky enough to be at a hospital associated with a Medical School, you will have Internet II access. But not for most other hospital networks – the dream of a very fast, next generation internet never went beyond the 140 or so colleges and universities that have access. And I bet you can name the institutions where it was first implemented (think Ivy League, Stanford, UMich).
(2) We already have the same elements in place that can meet the same objective (cloud computing, health banks), but all will fail if the consumer/patient is not engaged. The driver for the NHIN was supposed to be secure health information exchange for patients and providers. Unless the Personal Health Record or an equivalent consumer-driven application becomes ubiquitous on PCs, mobile phones and devices, or as a paper-based form for those without internet access, then the consumer/patient is removed from the healthcare exchange.
(3) The Regional Heath Information Organizations (RHIOs) and Health Information Exchanges (HIEs) are not exchanging health data because there is no compelling need. Instead, they can work on a regional level or within their own infrastructure without any impetus to connect with other similar organizations. Less than 10% of RHIOs are actually exchanging data as of early 2010.
So, I believe the NHIN will go the way of Internet II. Prestigious and well-connected researchers (pun intended) at the “best places” will get funded first, and they will use it for healthcare information exchange within their own communities. The rest of us will have to wait, or better yet, take advantage of, and build on, the applications (e.g., Microsoft’s HealthVault®, Google Health®) and reservoirs of unused computing capacity like Amazon’s Elastic Compute Cloud, that already exist today.