NHIN Exchange and the limitations of governance

A June 25 posting by Mary Mosquera of Government HealthIT is representative of the challenges facing ONC as they implement HITECH. Despite remarkable execution, one gets the feeling that the complexity of the legislation and the governing process often reduce sincere intentions and intense effort into a Beltway version of "whack-a-mole."

According to Mosquera (and consistent with my experience), "participation in the NHIN Exchange is currently limited to federal health agencies and healthcare organizations that contract with them or are federal grantees." By the HHS General Counsel imply that the current collaboration between Kaiser, SSA, the VA, and a few others cannot be extended because the parties "have no framework for doing that now, and they have no legal authority or mechanism [to extend the NHIN Exchange)," according to David Blumenthal. This is particularly crippling to State HIEs who under Section 3013 of HITECH are supposed to connect to the NHIN. (The entire role of States and 3013 is a far larger matter for discussion).

So, what is going to happen? Does this limitation in some way preclude Kaiser Permanente from connecting to the rest of the world using exactly the same standards? I would think not. Does this limitation somehow prohibit the rest of the Health IT community from connecting with one another following sensible standards? I would think not. (For an understanding of the NHIN standards, nothing is better than Wes Rishels' blog.)

There is a sense among some in ONC (quoted in Mary Mosquera's piece) that governance "won't happen by itself" and that a significant degree of national governance is required to maintain trust. This is no doubt true at some level, but what kind of governance is required and how soon?

Despite significant disagreements between various groups of vendors, real progress has been made. Although there are many points of view, the degree of convergence is fairly impressive. Given that the Federal rule making process does not allow a proposed rule until early 2011 and a final rule in the second or third quarter of 2011, the degree of governance required will be tested in reality. This writer believes people will go a long way toward figuring things out during the rule-making process.

The past year has witnessed an extraordinary degree of critical thinking and collaboration. These Herculean efforts should help realize rapid progress while the rule-making process proceeds. This writer has a belief that if its a good goal, people will find a path and most will follow along similar tracks.

Additional note: Whack-a-Mole may be a trade mark. Apologies for that. This term is not used by ONC, but according to Mosquera, one colloquialism is "pants-on-fire short term issues that we have to deal with." Well said.