Farzad Mostashari, MD, the national health IT coordinator, urged the Health IT Standards Committee to push forward with standards that are “good enough” to get started on health information exchange rather than waiting until they gain maturity and wide adoption.

The lack of transport standards is one of the biggest barriers to providers sharing information on a national scale, he said, at a meeting of the federal panel on Sept. 28. It is holding back recognition of the progress made in Stage 1 of meaningful use, he added. Currently, exchange occurs mainly through proprietary exchange technology formats and Health Level 7 standards. 

Yet Stage 2 meaningful use requirements will call for more complex health information exchange. Providers need a portfolio of standards, tools and services to meet exchange goals, Mostashari said.

“My request to you is to push. There is a sense in which not moving on anything is a greater risk than moving forward on something that may be imperfect,” Mostashari said. “We can’t afford to wait another five years before we have exchange in this country.” 

The committee wrestled with how to scale nationally the specifications for the nationwide health information network (NwHIN Exchange) and aspects of how data moves. NwHIN is the set of standards and services that enable typically large organizations and federal agencies to share information securely through the Internet. ONC wants to expand NwHIN Exchange participation.

The NwHIN team explored “if we were to adopt today's standards for nationwide use, what seems directionally good enough for that particular purpose and what needs more work,” said John Halamka, MD, committee co-chair and CIO of Beth Israel Deaconess Medical Center. 

The group provided its observations and evaluation of what is available.

Standards, services and policies for NwHIN Exchange must be deployable within an architectural framework capable of supporting secure information exchange at a national scale. “The building blocks have to fit and operate within an architectural framework,” said Dixie Baker, NwHIN team lead and SAIC senior vice president and chief technology officer for health solutions.

NwHIN standards, services and policies need to address transport, security and the content using standards for clinical documents and controlled vocabulary. Structured clinical documents and controlled vocabulary should be equally valuable regardless of what transport is used, whether it’s Direct or Exchange transport or some other transport down the line, she said. 

“That is really, really important for interoperability,” Baker said. Direct Project is the streamlined version of NwHIN for point-to-point sharing. However, neither NwHIN Exchange nor Direct Project is deployed widely.