Members of the federally chartered Health Information Technology Standards Committee wrangled Thursday with two new additions to the alphabet soup of health information technology.

The new abbreviations are NVEs, for nationwide health information network validated entities, and CTEs, for conditions for trusted exchange.

When the American Recovery and Reinvestment Act of 2009 created the standards committee, it also gave HHS, through the Office of the National Coordinator for Health Information Technology, a mandate to "establish a governance mechanism" for the proposed nationwide health information network that would enable the ready exchange of patient information among network participants.

But who should be allowed to participate in the network? Under what rules? And who decides whether an applicant to join the NwHIN is worthy? These and other questions—there were 66 specific questions in all—were posed to the standards committee, other federal health IT advisory panels and the public on May 15, when the ONC published a formal request for information on the NwHIN conditions for trusted exchange. The RFI addresses creating a program through which groups that "facilitate electronic health information exchange" would demonstrate that they meet ONC conditions for trusted exchange.

ONC head Dr. Farzad Mostashari, in charging the committee Tuesday, said what the government wants is what providers will want: to choose an NVE —a connection services provider to the NwHIN—simply "because it works."

However, Mostashari noted, "a fair degree of specificity" is needed in the technical standards for the program to work. "Where does that specificity come from?" he asked? "Is it at the top level through rulemaking and test specification? Does it come in at the validating entity level? I want you to help with that."