Feds Complete Transfer Of National Data Exchange OperationsFeds Complete Transfer Of National Data Exchange Operations

8 Health Information Exchanges Lead The Way

The Office of the National Coordinator of Health IT (ONC) has largely completed its transfer of operational responsibilities for the Nationwide Health Information Network (NwHIN) Exchange to Healtheway Inc., a new public-private, not-for-profit organization, said Doug Fridsma, ONC's chief science officer, in an interview with information Healthcare. Healtheway is now the business arm of the NwHIN Exchange, which has been renamed the eHealth Exchange (EHE).

Fridsma noted that ONC always planned to transfer the NwHIN exchange, which it formed in 2007 and became operational in 2009, to the private sector. "We've never envisioned that ONC in perpetuity would manage and operationalize a single nationwide HIE. We always knew that at some point the work we did early on as an incubator would eventually go out into the private sector."

Responding to criticism of ONC's recent request for information on governance of the NwHIN Exchange, Fridsma said, "It's important that we don't get in the way of people who are trying to succeed at exchanging information. The feedback we got from the RFI was that many people thought it was too early for us to insert ourselves into this developing ecosystem. We want to encourage the operations and software development that the private sector can do better than government."

The eHealth Exchange will continue to be governed by the Exchange Coordinating Committee (ECC), a body that ONC founded but on which it is not a voting member. With members representing all exchange participants, including federal agencies, the ECC will have the final say on how the eHealth Exchange is run, Fridsma said.

[ Read Health Information Exchanges Struggle To Prove ROI. ]

Healtheway itself will be governed by a board of directors elected by its membership, which will encompass not only eHealth Exchange participants, but also other stakeholders, Mariann Yeager, interim executive director of Healtheway and a board member, told information Healthcare. "Healtheway membership is open to anyone in the industry," including health IT companies, she said. Federal agencies will have input by providing nonvoting "liaisons" to the Healtheway board, she added.

Healtheway will not receive government grants. But EHE production participants--including federal agencies--pay annual fees that will help support Healtheway, and the corporation's members will pay yearly membership fees, said Michael Matthews, CEO of MedVirginia and a board member and president of Healtheway. In August, the ECC appointed Matthews and executives of two other regional HIEs to the board of Healtheway. Healtheway members will elect up to nine more board directors this fall, according to HIMSS News.

The major operational tasks of Healtheway, according to Yeager, include testing and certifying new participants in the eHealth Exchange; helping organizations that want to join the exchange go through the required steps; supporting the exchange's infrastructure, which includes digital certificates and provider directories to share information securely; and developing legal agreements and operating policies and procedures for the exchange.

Healtheway will delegate the testing and certification function to an outside body that will be announced shortly. In coordination with the EHR-HIE Interoperability Workgroup, a consortium of 14 states that are building statewide HIEs, Healtheway has issued an RFP for an entity that will do testing for both the eHealth Exchange and the states' consortium, Yeager said. Among the companies that received the RFPs were ONC- and ANSI-accredited certification bodies, she added.

As of early 2012, what is now called the eHealth Exchange included 34 participants that represented about 500 hospitals and 3,000 providers, Yeager said. With the "dramatic growth" that the eHealth Exchange has seen recently, she noted, the number of providers exchanging information or about to go into production is much higher than that.

Among the exchange's "production participants"--entities that are already exchanging data--are four federal agencies; four states; eight Beacon communities; and about 20 healthcare systems, integrated delivery networks, and health information exchanges (HIEs), Yeager said. The federal government entities involved in the national exchange include the Centers for Medicare and Medicaid Services (CMS), the Department of Defense (DoD), the Department of Veterans Affairs (VA), and the Social Security Administration (SSA).

Until recently, most of the hospitals participating in the eHealth Exchange were involved in one of two federal programs. The VA and DoD Virtual Lifetime Electronic Record (VLER) program uses the network to exchange information between VA and military providers and private-sector providers that care for veterans and active-duty military personnel. Second, the eHealth Exchange has enabled some healthcare organizations to exchange data with the SSA to expedite the determination of eligibility for disability benefits.

Nevertheless, Healtheway forecasts a big increase in private-sector use of the eHealth Exchange in the next two years. Matthews offered these reasons:

-- The continuing expansion of the VLER program. Forty percent of veterans receive care outside the VA system, and 60% of active military personnel receive care outside DoD facilities. Private-sector physicians can greatly benefit from getting information from those facilities.

-- The ability to improve quality and lower costs by exchanging information between SSA and private providers.

-- The spread of EHR adoption and the increasing ability of physicians to retrieve data from HIEs.

-- The interoperability criteria of Meaningful Use stage 2, which will require providers to exchange more information with each other.

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