If you’re still trying to understand exactly what the Nationwide Health Information Network (NwHIN) is, take comfort. You’re not alone. But the canvas – often impressionistic if not downright abstract – is on the verge of manifesting a certain focus on enabling public-private healthcare interoperability and partnerships.

Indeed, what started as a conceptual network of networks, was then refined by ONC into the array of “standards, services, and policies that enable information to be securely exchanged over the Internet,” and later launched into pilot testing is, today, ready for prime time. The title of this portrait: NwHIN-Exchange.

“What we realized is that 6 months ago, 500 hospitals were already connected, 30,000 clinical users, 3,000 providers, and a patient population coverage area of 65 million people, and 1 million shared records. It became pretty clear this wasn’t a pilot anymore – and it’s time for it to stand on its own,” says Mariann Yeager interim executive director, NwHIN-Exchange. “So there’s been this very collaborative process with ONC and my role is to help this transition from a federal program that has been tremendously successful, although folks aren’t always aware of it, to an actual standable public-private partnership model. And so we will have that pretty much launched and transitioned to stand on its own beginning in October of this year.”

When that day comes the NwHIN Exchange will encompass at least 4 federal agencies – CMS, DoD, SSA, and VA – as well as 21 non-federal entities that can all share patient records for episodes of care.

What standing-up an exchange means

“The NwHIN-Exchange continues to progress, and is now released from some of the previous shackles,” John Moehrke, principal engineer specializing in standards architecture and interoperability at GE, wrote on his Healthcare Security/Privacy blog. “I think that more people need to recognize just how BIG this is.”

In addition to the federal agencies, the roster of participants includes such healthcare heavyweights as Kaiser Permanente, Marshfield Clinic, MedVirginia, North Carolina Healthcare Information and Communication Alliance, Regenstrief Institute and the University of San Diego Beacon Community, to name just half-a-dozen.

And it’s growing. At least two more agencies are currently “coming through the process and will be testing,” Yeager says, as are private healthcare organizations.

“We’re really at a game-changing point in time as the exchange moves into a public-private model with potentially significant expansion, opening up more broadly to the community, engaging the community in development of some solutions going forward,” adds Lauren Thompson, director of the Federal Health Architecture (FHA) within ONC (pictured at left). “Because of the very deliberate approach that’s been taken up to this point we feel very strongly that the exchange is now well-poised to move to this new public-private model and stand from there.”

[Q&A: What the NwHIN folks are learning from the DoD, VA open source efforts.]

Specifically, under that new model the Exchange Coordinating Committee, the group driving this effort, voted on March 1, 2012 to approve a plan that maps out the strategy, sustainability model, and operational transition of NwHIN-Exchange to a non-profit organization.

“This is not a federal exchange,” says Tim Cromwell, director of standards and interoperability at the VA.

Rather, NwHIN-Exchange “will enable the sharing of health information among private organizations as well as between private organizations and governmental agencies,” Yeager says. “Once the legal entity is established, we will begin to transition operational functions from ONC to the new organization, which will then support the Exchange ongoing.”

ONC’s Exchange Coordinating Committee is still working to determine where the physical headquarters for NwHIN-Exchange will reside, but Yeager expects it to be in the Washington, D.C. area.

Technological building blocks
Today, those 25 organizations share information using a common set of specifications, some specific to NwHIN, while others are industry standards, and they do so under the Data Use and Reciprocal Support Agreement, affectionately known as the DURSA.

“Everybody agrees to do the exact same thing – you can imagine that took some time to achieve, but the awesome thing is that it worked,” Yeager says. “I mean, it really does work.”

Rather than debating how to protect information, what to do with it, each entity’s obligations and liabilities, everybody abides by the same set of rules, the same testing process. All participating healthcare providers adhere to the same bundles of specs depending on the use case.

“Now that the group has been in production for three years, there’s really rapid growth and interest in expanding participation,” Yeager adds.