In launching NHIN Direct, a set of tools designed to make it easier for small providers to share electronic health information securely, health IT policymakers are forcing states to rethink their plans for rolling out health information services in their communities.

NHIN Direct, the brainchild of the Health IT Policy Committee’s NHIN workgroup, would enable small healthcare organizations to ramp up health information exchange quickly by offering them basic network transport services for sharing records securely over the Internet.

Time is of the essence, since providers must be able to show by late 2011 that they can participate in health information exchange in order to qualify for federal health IT incentives.

But offering shortcuts for these providers might throw a wrench into state plans to bundle such services into the menu of HIE offerings they plan to market to providers in their states, workgroup members acknowledged at a meeting today.

It would certainly call into question the plans of those state HIEs which had planned to offer secure networking transport exclusively.

“Certain groups that were planning secure routing absent value added services may have been in jeopardy regardless of what we do or don’t do with NHIN Direct,” said Dr. Farzad Mostashari, senior advisor at the Office of the National Coordinator for Health IT and its representative on the workgroup.

Some states had planned to offer secure routing along with more advanced HIE services such as patient locator, translation services, document discovery, aggregation and quality measurement. But NHIN Direct may bite into revenues – at least from transport services – expected by some HIEs.

“To the extent that they were hoping to use some of those revenues to subsidize some higher level services, that’s a challenge for the business models,” he said Micky Tripathi, chief executive officer of the Massachusetts eHealth Collaborative and a member of the workgroup.

States may also have to revise their plans to build services on top of transport.

Without transport services, states will instead be forced to focus on higher level services. Tripathi said his organization will add NHIN Direct to its exchange services offerings, which currently include services for quality data collection and submission.

The Massachusetts organization uses a health information exchange that includes a proprietary option for providers that use a particular vendor, as well as a comprehensive NHIN gateway. “The value that we provide is working on the model that the participant wants and defining the documentation requirements,” Tripathi said.

Yet despite altered business models, states will continue to have role in enabling other aspects of secure HIE, such as identity management assurance and authentication services, according to a workgroup planning  document.

They can also generate revenue from high-level service offerings such as directory services of providers, health plans and pharmacies as well as offering policy services in the areas of privacy and security requirements.