HIE, NHIN, DURSA and you
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| Mary Stevens, Editor |
Below are some of them, as answered by the panel: Steve Gravely, JD, Troutman Sanders LLP; Melissa Hargiss, JD, ONC Office of Policy and Planning; Molly Smith, ONC State Health Information Exchange Cooperative Agreement Program; Lynn Dierker, RN, State-Level HIE Project, AHIMA Foundation; Liesa Jenkins, State HIE Technical Assistance Project, Deloitte; and Aaron Seib, Interim CEO, National eHealth Collaborative.
Q: How do you explain the value proposition of NHIN Exchange to physicians?
A: The thing that resonates most with providers is that it’ll help them improve the quality of care. We can talk a lot about how it will help them become more efficient, more engaged with their patients, be able to communicate with their patients better, but at the end of the day, practicing physicians want to know how will this help me increase the quality of care that I deliver?
Reducing administrative burden, getting better aligned with CMS from a quality reporting perspective, are nice decorations. But the thing that is really going to bring this to the provider and to the patient community as well is that this is the standard of care and practicing medicine any other way is impeding you from practicing the best medicine you can.
Q: Will providers be able to connect directly with NHIN Exchange?
A: Right now, at least, to participate in the exchange, there needs to be a contractual relationship with ONC or one has to be a federal agency. That is an interim requirement that will hopefully resolve itself in the near term. There are reasons why this has to be in place. But down the road, there will be plenty of opportunities for physicians to plug in to different exchange mechanisms, and hopefully those organizations will be NHIN exchange participants, so you really get to the same place.
Q: At the community or regional level, what’s the incremental value of participating in NHIN?
A: It is the ability to exchange information with federal agencies, the VA and DoD in particular, for a physician who has patients in common with folks who are served by those agencies. They have a very difficult time now coordinating care, and that has been a huge benefit for the clinicians.
The decision by federal agencies to embrace NHIN exchange is very important and will be a big driver of participation by HIEs across the country.
Q: If physicians must commit to NHIN through an HIE, are there any mechanisms in place to reconcile conflicting requirements?
A: We attempted to anticipate that when the DURSA was developed. This is why we have the list of flow-downs. To the extent that an HIE had a contradictory provision to what’s in the DURSA, they would need to modify that to become a participant. In the process of drafting the DURSA, we learned that in some HIEs there’s a rule that only physicians have the authority to request a data result. In others, nurse and other clinicians have that authority. So the DURSA says participants are free to administer their policies and procedures that they have created.
Q: How do the current NHIN Direct activities related to DURSA?
A: We are still evaluating that. If you think about NHIN Direct as a creative way to develop a set of specifications around a different exchange framework, there’s a recognition that whatever model or models may emerge, it still fits into the trust framework and does transcend architecture and models. But that evaluation will take time: there’s nothing we can rush through here.
NHIN is growing and evolving, and that last sentence nicely sums up the entire discussion.
Mary Stevens, Editor
mstevens@trimedmedia.com