NwHIN Direct & NwHIN Exchange

Everyone is asking, “What is NwHIN Direct we keep hearing about, and how does it differ from the original NwHIN Exchange?” NCHICA follows the development of the NwHIN closely; the article below provides an updated description of these initiatives, and how they will impact providers and healthcare organizations.

Before we dive into NwHIN Direct, we need to review the "NwHIN Limited Production Exchange" (ONC's formal name for it.) In this article we’ll refer to it as "NwHIN Exchange." The NwHIN Exchange is a collection of standards, protocols, legal agreements, specifications and services that enables the secure exchange of health information over the internet. The NwHIN Exchange has methods to perform universal patient lookup, document discovery and retrieval, and exchange between organizations and federal agencies (VA, DOD, CDC, SSA, plus 22 others). The organizations entering into an exchange with those federal agencies are typically sizable HIOs, HIEs or large IDNs. Participation in the NwHIN Exchange is currently limited to federal health agencies and healthcare organizations under ONC contract and other recipients of federal grants. There are technical teams devoted to the on-boarding process (validation and conformance testing), security, authentication, and adherence to the specifications/standards, including producing/accepting structured data in defined formats.

However, most individual providers/small practices (with no affiliation to an HIO or HIE) have limited technical resources. Those providers certainly don’t want to spend their precious free time figuring out how to create a CCD C32 record and writing interfaces into EMR systems! Since many providers will not be able to participate in the NwHIN Exchange, they still need a model to help them reach Stage 1 Meaningful Use (MU) requirements. Much of the NwHIN Exchange development was geared toward large HIOs/IDNs before the HITECH Act/Meaningful Use criteria existed. In order to provide a simpler option to help providers meet basic MU requirements, earlier this year the ONC began development of an exchange geared toward a larger set of participants.

Enter the NwHIN Direct
The ONC defines NwHIN Direct as “the set of standards, policies and services that enable simple, secure transport of health information between authorized care providers. NwHIN Direct enables standards-based health information exchange in support of core Stage 1 MU measures, including communication of summary care records, referrals, discharge summaries and other clinical documents in support of continuity of care and medication reconciliation, and communication of laboratory results to providers.”

The NwHIN Direct use cases (aka user stories) are different and simpler than the NwHIN Exchange use cases. NwHIN Direct is not a replacement of the NwHIN Exchange. NwHIN Direct exclusively supports cases of “pushed communication” between providers, hospitals and laboratories. Authentication, certificates, vocabulary messaging standards and security are all part of both the NwHIN Exchange and NwHIN Direct.

One fundamental difference between the NwHIN Direct and NwHIN Exchange is messaging: the NwHIN Direct specifications will support unstructured messages (i.e., simple text or PDF), semi-structured text, and highly structured messages like CCD C32 (like its big brother the NwHIN Exchange). NwHIN Direct specifications are scheduled for release in late summer 2010. It is important to note that in our opinion, NwHIN Direct is not currently capable of supporting MU exchange requirements beyond elemental Stage 1 requirements. With the recent release of the final rules for MU, it remains to be seen if NwHIN Direct will mature beyond support for only “pushed communication” exchange.