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NHIN Governance Questions Raised

June 25, 2010
by David Raths
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ONC must establish rules by next year

As the Nationwide Health Information Network (NHIN) begins to move from concept to reality, how will it be governed? Is there a role for federal and/or state oversight? Is there a need for a federal mechanism of oversight over information exchange organizations?

These are the kinds of questions raised at the HIT Policy Committee meeting on June 25. Mary Jo Deering, who works in the ONC (Office of the National Coordinator for Health Information Technology) Office of Policy and Planning, laid out the issues surrounding governance of NHIN.

The HITECH Act directs the National Coordinator to establish a governance mechanism for the NHIN. A final rule is expected by next summer, Deering said.
She led the committee through a series of key questions ONC is seeking input on regarding oversight, enforcement and accountability.

According to Deering’s presentation, ONC must decide some of the same policy and legal issues that state health information exchanges are currently working through.

When should patient consent be required and for what? Should intermediaries, such as organizations running HIEs, be certified or accredited and if so, who should do the certifying? How should the NHIN specify appropriate purposes for using, exchanging, and reusing data and minimize data required for transactions?

ONC Director David Blumenthal, M.D., framed the issue this way: As the country moves toward a national interoperable network, there is a sense that there is a continuing need for a referee, an organizing force. That leads to a series of questions about the role of the government and the private sector, he said.
Organizations now trying to use NHIN to share data need this policy guidance, he said.

“Our general counsel has ruled they can’t do much without guidance from us,” he said. “NHIN governance may sound abstract or like a political science exercise, but actually these are very real issues we have to deal with in the short-term,” said Blumenthal. “Of all the pants-on-fire, short-term issues we have to deal with, this is one of them.”