Next up: Governance
While everyone interviewed for this article agreed that NwHIN Exchange is ready to stand on its own, much work remains.

“A year from now, we anticipate that the number of NwHIN-Exchange members is going to be over 50,” the VA’s Cromwell said. Some optimists say it could reach 10,000, but Cromwell believes the top is somewhere around 100 partners.

“So we’d like to make sure that the infrastructure required to sustain 100 or so members – and these are potentially state HIEs acting on behalf of all the healthcare providers in the state – that the infrastructure sustains us in a way that addressed our needs for identifying the patient, exchanging the information in a rapid way, can change quickly if needed so if new standards come out then we embrace the standards,” Cromwell continues. “It has to be resilient and robust at the same time and there’s an infrastructure there that needs to be supported. And that’s the value of taking it to the public-private partnership we’re envisioning.”

[Related Q&A: On driving common governance between the DoD and VA.]

Those are among reasons why ONC has been working on governance for NwHIN. Speaking this past June at the Government Health IT conference in Washington, D.C., Doug Fridsma, MD, director of ONC’s office of standards and interoperability, said that ONC is working on a draft governance Notice of Proposed Rulemaking (NPRM) document, to be released in late 2011 or early 2012, that would ultimately enable more providers to join the NwHIN effort. Then during an interview at HIMSS12 in February, Fridsma said that ONC is “working on that as quickly as they can,” in terms of writing the document. “They’re trying hard to get things out.”

But as everyone anxiously awaiting the meaningful use Stage 2 NPRM learned, there’s just no hurrying the regulation writers – and the process can be a bit like watching paint dry.

A critical tipping point ahead
While that canvas is still being painted, NwHIN-Exchange participants are looking toward the future and what they hope the organization will provide – beginning with continuing federal support.

“We’re very proud of the accomplishments so far but we also recognize that there’s a long way to go," says Matthews (pictured at left). "Government’s continued support is going to be critical. Now is not the time for any of the stakeholders to back off. We have to stay at this until we really have ubiquitous HIE as the standard, not the exception.”

As Cromwell notes, that will require an architecture both resilient and robust – and one on which more services can be built.

“Everybody is worrying about stage 2 meaningful use, public health reporting, CDC, CMS, I would like to know that all that reporting could be pulled using NwHIN connectivity and standards,” CHIC’s Stephens says. “So let’s pull everybody together in using a singular set or a singular process to determine what those guidelines need to look like.”

In addition to reporting, Stephens and others are hoping for analytical analysis of de-identified data – something of a still-drying portrait, a horizon in its own right.

Matthews adds that, although he advocates improved clinical care as the biggest return on investment, proving a purely-financial ROI on the business side “should take cost concerns off the table, and the rest of the effort can be spend on how to maximize the benefits for stakeholders.”

That kind of ROI manifests not just in instances such as the VA, SSA, and Bon Secours Richmond but, ultimately, across all participants as NwHIN-Exchange enables them to implement and test once, then use that connectivity for multiple permitted purposes.

[Related Q&A: NwHIN as a bridge between private, public health in southeastern Minnesota.]

Thompson said ONC is bringing together federal agencies to discuss the next high priority areas, particular to NwHIN-Exchange as well as other NwHIN facets, such as Connect.

“As far as Exchange, we’re developing a strategic roadmap where we’ll begin to take a look at future uses and business cases that can be supported,” NwHIN-Exchange’s Yeager adds. “We’ll certainly have more on how current and future participants can leverage this connectivity.”

More partners will serve as final brushstrokes that continue bringing the picture into a clearer and clearer focus, which several participants believe will only increase interest in NwHIN-Exchange.

“The tipping point happens when you get state-to-state information exchanges," says Cromwell. "A person in Idaho comes to Salt Lake City for care and the Salt Lake City private hospital is able to query and retrieve patient information from the Boise, Idaho private hospital. Once that value case is seen, I think you reach the tipping point and we’ll get a lot of buy-in there.”