The Office of the National Coordinator for Health Information Technology is calling for public comment on proposals for rules of the road to govern the nationwide health information network (NwHIN).

ONC will use the comments to help it develop a notice of proposed rulemaking (NPRM), according to a May 11 announcement in the Federal Register preview section. Once it is officially published May 15, the public will have 30 days to offer its views.

ONC seeks help on a range of topics, including the creation of a voluntary program under which entities that enable electronic health information exchange could be validated based on meeting ONC-established “conditions for trusted exchange.” ONC also wants to hear views about the scope and requirements included in the initial conditions for trusted exchange and processes used to revise them over time.

ONC is interested in knowing about processes to classify the readiness for nationwide adoption and use of technical standards and implementation specifications to support exchange and interoperability related to those conditions.

The NwHIN Exchange standards, services, policies and implementation specifications enable the secure exchange of information over the Internet with other participants, typically large healthcare organizations and federal agencies. Until recently, NwHIN Exchange members had to be a contractor or vendor of the federal government to assure security and other aspects of agreements.

ONC is developing governance to open up participation. NwHIN Exchange enables complex health queries with many participants at the same time instead of just direct, one-to-one exchange.

At the May 2 advisory Health IT Policy Committee meeting, Dr. Farzad Mostashari, the national health IT coordinator, said, “We really need rules of the road to enable that trust to emerge more broadly and more readily than in point-to-point negotiation. We think it could spur a health information exchange market and lay a foundation for future stages of meaningful use.”

An important component of the governance mechanism would be the establishment of a voluntary framework for organizations that allow electronic sharing to be validated to certain conditions of trust adopted for the exchange services or activities they are capable of supporting, according to the request for comments.

ONC wants to know if such a voluntary validation approach would be sufficient, and, if not, what would best produce a trusted, secure and interoperable exchange. Other questions ask commenters to explore:

• how a national validation method would affect states and their regulation of local and regional health information exchanges
• what should be the extent of ONC’s role
• what approaches operate successfully in other industries
• how an accreditation/validation body would affect the volume and efficiency of electronic health information exchange in local healthcare markets and provider confidence
• the best way to maximize the benefit while minimizing the burden on providers.