What is the NHIN or NwHIN

The NHIN or sometime abbreviated NwHIN, now rebranded as eHealth Exchange was developed under the control of the ONC (Office of the National Coordinator) to efficiently and securely exchange health information between constituents to facilitate clinical decision making and public health by making consumer health data more readily available. Securely getting the right health information where it needs to be, when it needs to be there and in a format that is usable to all, for faster, more efficient and higher quality decision making was the ultimate goal of this effort.

The NHIN was designed as a set of standards, rules, technical specifications, and a trust model to exchange data over the internet. This was predicted to be one of the largest SOA implementations in the country.

Technical Challenges

The NHIN posed a number of architectural technical challenges:

• Scalability - The number of entities was very difficult to estimate but as with all Federal project we had to think big. Federal agencies (DoD, SSA, VA, etc.) states, territories, all providers of medical services, payers, and individuals are all candidates to be members of the exchange

• Security - healthcare data is inherently highly sensitive and we needed rock solid security to be put into place. We also had to make sure our constituents believed in the security of the system or they would not use it so communications and marketing were critical to the NHIN’s success

• Open Source - Not exclusively but for the most part we relied on open source tools. In the bureaucracy of the Federal Government it was easier not to make specific vendor choices when building a new product, making open source an easier alternative. Open source also facilitated the goal of developing a package for free distribution to NHIN members and it supported the federal agencies decision to interconnect their health systems using the NHIN as opposed to each agency developing their own system.

I presented some of the foundational work we did for the NHIN at HIMSS where I defined the web services system architecture, the managed PKI security infrastructure, the data use and reciprocal support agreement (DURSA), web services discover (we developed UDDI service registry), and the test environment that was being provided as part of the service to assist on-boarding of new members. This was an exciting time as we were bringing members on, dealing with the inevitable project technical issues and working through healthcare business challenges. I have worked in the healthcare domain for over 20 years but experiencing the technical challenges of this scale and the soft skills necessary to balance the competing business interest was very different than most implementations.

Over the years the NHIN has morphed from an ONC backed initiative and is now supported by a public-private structure where the ONC maintains governance responsibilities. A more scaled down version of the NHIN is also available called The DirectProject as a streamlined solution.