CHIME: Slow NwHIN Governance Train

The march toward issuing a notice of proposed rulemaking about the planned nationwide health information network should be slowed to allow for additional investigation of best practices and streamlining of objectives, according to a comment letter filed by CHIME in response to a government-issued request for information on the subject.

In its comments, CHIME focused on four main themes:

• The organization voiced concern that rulemaking relating to NwHIN governance is being unduly rushed. CHIME urged ONC to consult more thoroughly with the HIT Policy and Standards Committees on the subject, as well as hold dialogues in “Town Hall” style meetings, for example. “In the absence of more extensive consultation and dialogue, we believe it would be a serious mistake to issue a notice of proposed rulemaking regarding NwHIN governance in the near term.”

• Prior to proposing NwHIN governance specifics, CHIME says ONC should devote more time and resources to identifying and publicizing best practices among existing HIEs. Though the RFI appears to assume that trust is the principal barrier to information exchange at this time, CHIME states, it believes that interoperability, patient data-matching, the lack of consistent patient consent practices at the national level (with respect to the exchange and disclosure of protected health information), and a sustainable business model for health information exchange are actually greater challenges. ” … we believe there is a serious risk that new rules on NwHIN governance could compromise HIE viability and performance, since the need to comply with these rules could end up being ‘the straw’ that breaks the HIE ‘camel’s back.’

• CHIME is “very uncomfortable” with the notion that the NwHIN governance mechanism and the related conditions for trusted exchange (CTEs) could become a means for imposing requirements that go beyond the HIPAA Privacy and Security rules. The organization urges that any perceived deficiencies in the HIPAA Privacy and Security rules be addressed directly, through changes in those rules following the usual opportunity for public input. “We see great danger in attempting to use the NwHIN governance mechanism as a ‘work-around’ to the normal rulemaking process, and we would not support this.”

• The RFI, according to CHIME, appears to envision that NwHIN-validated entities (NVEs) could include a wide range of organizations, rather than just those involved in national-level information exchange. “It would be quite burdensome if the validation requirements were imposed on private, enterprise HIEs. There are too many business needs unique to any given enterprise and any unnecessary friction or government intrusiveness risks failure.”