David Blumenthal, head of the Office of the National Coordinator for Health Information Technology at HHS, took to
e-mail and the Web last week to get the word out about an alternative way for providers to communicate to meet federal meaningful-use requirements and qualify for billions of dollars in health IT payments.
The American Recovery and Reinvestment Act of 2009, also known as the stimulus law, requires that providers must meaningfully use an electronic health-record system to qualify for up to an estimated $27.3 billion in federal reimbursements.
Last December, the CMS, which will administer the EHR funding under the Medicare and Medicare Advantage programs, issued a proposed rule defining the meaning of meaningful use. Congress, however, mandated three meaningful-use criteria that providers must meet—electronic prescribing, reporting quality measures to HHS and exchanging information electronically to improve patient care.
As proposed, the nationwide health information network will be capable of handling all three mandated transactions. However, as originally contemplated, the NHIN was to be a “network of networks,” reliant on local, regional or statewide exchanges to serve as on-ramps to the NHIN.
With the clock running down on the start of the stimulus law funding program—the first “payment year” for the Medicare portion of the plan begins Oct. 1—and with only a limited number of the exchanges up and running, the government came up with an alternative method of peer-to-peer connection called NHIN Direct so that providers without access to an exchange or the techno-savvy to use it could still meet the meaningful-use criteria and qualify for EHR payments.
“To make meaningful use possible, including the necessary exchange of information, we need to meet providers where they are, and offer approaches that are both feasible for them and support the meaningful-use requirements of the Centers for Medicare & Medicaid Services Electronic Health Record Incentives Programs,” Blumenthal wrote on May 14. “As with the Internet, it is likely that what is today considered ‘highly sophisticated' will become common usage. Moreover, users may engage in simpler exchange for some purposes and more complex exchange for others.”
There are examples of the NHIN's “high level of interoperable health information exchange,” Blumenthal said, specifically touting work in this area by the Defense Department, Social Security Administration, Veterans Affairs Department, Kaiser Permanente and MedVirginia, which “came together to show, on a pilot scale, that this type of highly evolved exchange was possible.
“Having succeeded, they continue to expand the level of exchange among their group and with their own respective partners in a carefully phased way to demonstrate and learn from these widening patterns of exchange,” he said.
Using the standards, services and policies that constitute the NHIN, these pioneers are using the system for what Blumenthal describes as “robust exchange,” including finding and accessing patient information among multiple providers, supporting the exchange of information using common standards; and documenting trust agreements between participants, such as Data Use and Reciprocal Support Agreements.
However, Blumenthal said, not every organization or provider “needs or is ready for this kind of health information exchange today. Nor do the 2011
meaningful-use requirements set forth by CMS in the recent proposed rule require it. Direct, securely routed information exchange may meet the current needs of some providers for their patients and their practices, such as receiving lab results or sending an electronic prescription.”
That's where NHIN Direct comes in.
Still under development by HHS, the
NHIN Direct Project is a set of open-source software and standards aiming “to create a means for direct electronic communication between providers, in support of the 2011 meaningful-use requirements.”
While NHIN Direct remains a work in progress, Blumenthal said, “We are on an aggressive timeline to define these specifications and standards and to test them within real-world settings by the end of 2010. Timing is critical so that we may provide this resource to a broader array of participants in health information exchange as a wave of new, meaningful users prepare to qualify for incentives provided for in the HITECH Act and ultimately defined by CMS.”
“It is meant to enhance, not replace, the capabilities offered by other means of exchange,” Blumenthal said, adding that an example of an NHIN Direct transaction would be sending an electronic referral letter along with a patient-care summary from a primary-care physician to a specialist.
Blumenthal also issued a call for help and participation in developing and using the new, peer-to-peer channel.
“The NHIN Direct Project will conduct an open, transparent and collaborative process throughout its development by using a community wiki, blogs and open-source implementation already available on the project's website,” he said. “I encourage you to participate through the website, via public participation at the implementation group meetings, and by deploying and testing the resulting standards and specifications.”
