Before that contract process starts, ONC awarded this sole-source contract for Nitor to provide ongoing governance and technical support that will move the NHIN “to production readiness and production status,” according to the contract. The contract did not specify an amount funded to the company. An e-mailed response from Nitor directed all questions to ONC, which responded after deadline to an interview request. Nitor's Web site listed the company as a provider of software consulting services but did not provide an address or location.
ONC said it was awarding the contract to ensure that efforts made to develop the NHIN continue while the office prepares to start a competitive award process that will open such network governance and strategic oversight to eligible bidders. That process is expected to begin this year, according to the contract.
Meanwhile, health information exchanges, or HIEs, that have been part of the ongoing NHIN work say their efforts demonstrate the effectiveness of a national network. A project between the Social Security Administration and MedVirginia has reduced claims processing from 84 days to 25 days since it went live in February, said Michael Matthews, CEO of the Richmond, Va.-based exchange. “We have done a lot to demonstrate proof of concept.”
The nine HIEs that were the original participants in the NHIN have worked to develop a document to serve as a policy framework, which established agreements on data sharing and security, Matthews said. Building that level of trust and security among providers and data users is critical to the national network's success.
Still, it seems that exchanges have experienced more success at the local and regional levels than across the nation. While health IT funding through the American Recovery and Reinvestment Act of 2009 is designed to spur growth at various levels, ONC has not specifically designated any money for the NHIN. There is $564 million for states to develop HIEs.
But the NHIN participants have shown “real working” services, according to J. Marc Overhage, a physician who is president and CEO of the Indiana Health Information Exchange. There still needs to be a group to manage and grow the national network over time. Large-scale collaborations are “always slow,” he said. “If you try to force it too fast it will break.”
In addition, progress on local exchange has to happen before the national network can be realized, Overhage added. The Indiana HIE is continuing to build out different services and different business models for its various exchange participants.