Summer of HIT: NHIN Is Closer Than Ever

The summer sun wasn't the only thing sizzling this past summer! Health information technology (HIT) and the national health information network (NHIN) were hot, hot, hot.

"I can't recall a summer that had more high-impact changes going on all at the same time," says Jill Callahan Dennis, JD, RHIA, president-elect of AHIMA. She is principal of Health Risk Advantage in Parker, CO. "Our forward momentum toward a national health information network really seems to be gaining speed and gathering support."

Congress and federal agencies made aggressive moves to set up a framework for creating the NHIN. Since state and local entities will carry out the actual work of building the NHIN, activity at the local level will really heat up in the coming months. Don't just watch the wave go by: catch it and "Hang 10"!

Here's a brief summary of some key happenings.

HIT a Hit with Federal Agencies

The federal government issued several high profile reports and initiatives. AHIMA staff and volunteers made sure our voice was heard.

The Office of the National Coordinator for Health Information Technology (ONCHIT) made a splash at the beginning of June with its report "Summary of Nationwide Health Information Network Request for Information Responses." It was a high-level summary of 500 public comments on how to build the NHIN. The report included many of the recommendations AHIMA made as part of an industry collaborative through the Markle Foundation.

Days later HHS Secretary Mike Leavitt announced the creation of a new public-private collaboration, American Health Information Community (AHIC), that will provide input and recommendations to HHS on how to best share health information while assuring privacy and security of patients' records. The association nominated AHIMA CEO Linda Kloss, MA, RHIA, CAE, to be a member of AHIC. Although there are only a few seats and many nominees, she is an industry leader who could add an important perspective to AHIC's efforts. AHIC will announce the members this fall.

HHS also issued four requests for proposals (RFPs) to build different components of the NHIN and to address complex issues like privacy and security. AHIMA has been actively responding to the RFPs. Contracts will be awarded by October 1.

One RFP called for a process to harmonize HIT standards. Another called for prototypes for the NHIN architecture. A third RFP came though HHS's Agency for Healthcare Research and Quality (AHRQ) and asked for plans on how to identify and address the business practices and state and federal laws relating to privacy and security that may be barriers to exchanging health information.

The fourth RFP requested plans for an EHR certification process. The Certification Commission for Healthcare Information Technology (CCHIT) has already been addressing this issue. AHIMA served as the lead partner in assembling a response.

In late July, the Centers for Medicare & Medicaid Services (CMS) held a personal health record (PHR) open door forum to discuss the role that CMS might play in supporting the development and adoption of PHR technologies. The agency also released a request for information (RFI) seeking input on its role as contributors to PHR data, as well as in advancing PHR adoption. AHIMA issued a response, highlighting how HIM professionals can help define the PHR, identify the differences between the PHR and the EHR, and educate consumers on how to manage their own health records.

Congress Jumps In

Capitol Hill saw a lot of activity, too. Legislators paid attention to what HHS and ONCHIT were doing, crossed party lines to work together and solicited input from the healthcare industry. In fact, AHIMA staff worked with legislators to help them understand issues ranging from AHIC to the work force shortage and even wrote language for bills.

In the Senate, many bills relating to adoption of HIT were introduced in June. Influential senators from both parties collaborated to sponsor various pieces of legislation. In mid-July, they finalized Senate Bill 1418-the "Wired for Healthcare Quality Act." This bill contains provisions to reduce healthcare costs and improve efficiency by setting up a framework to create the NHIN.

At the end of July AHIMA staff testified at a hearing on HIT, urging the adoption of the ICD-10 coding system and arguing that the data that goes into the EHR is just as important as the technology. Meanwhile, the House of Representatives developed several pieces of legislation on HIT. Some key committees, such as the Energy and Commerce committee and the House Ways and Means Health subcommittee, are expected to create important bills in the coming weeks.

It is likely that HIT legislation will be passed before the end of the year. President Bush has been an outspoken advocate for the creation of the NHIN and many Congressional leaders want to use the EHR to reduce the costs of healthcare and enhance patient safety.

Join the Party!

With all the action in DC, it's time to join in. AHIMA members need to volunteer expertise, participate in new developments like RHIOs or demonstration projects, and move the profession toward e-HIM. For more information on how you can be a volunteer, visit [web page no longer available].

"What HIM professionals bring to the table specifically is expertise in how to implement these initiatives. Our training prepares us to have a broad understanding of the healthcare industry. And our volunteer efforts and professional networking give us even further breadth," says AHIMA board member Jennifer Garvin, PhD, RHIA, CPHQ, CCS, CTR, FAHIMA, medical informatics postdoctoral fellow at the Center for Health Equity Research and Promotion at the Veterans Administration in Philadelphia, PA.

"I think that overall in the area of privacy, security and data integrity, HIM professionals have skills and can add value," says Karen G. Grant, RHIA, CHP, corporate director for Health Information Services and privacy officer for Partners Healthcare System in Boston, MA. We have a unique understanding of healthcare encounter data, release of information, data content standards, legal medical records and other expertise -all of which are vital to the success of the NHIN.

Even if the network organizers don't know it, they need to have HIM professionals in their projects. Some HIM professionals have lobbied state officials, networked and basically invited themselves on to these projects. Here are some other ways you can get involved.

  • Influence HIT legislation-Write to your senators and representatives asking them to support HIT legislation. Visit AHIMA's Advocacy Assistant at for sample letters that make it easy to contact your elected officials.
  • Support the Health Level 7 (HL7) EHR Standard Initiative-The goal of this initiative is to create a gold standard for the EHR. A number of stakeholder groups have provided expert comments on the draft EHR system functional model, including pediatricians, long-term care experts and emergency room physicians, to ensure that the model reaches from birth to death and reflects inpatient, acute, urgent care, and ambulatory perspectives. Attorneys and HIM professionals have added their perspectives as to what would make the EHR a legal record. And a group is examining how the PHR links to the EHR. The HL7 EHR technical committee is soliciting public comments and will incorporate some enhancements into the functional model later this year. It's expected that the standard will be put up for a vote to become an ANSI standard by spring 2006. HIM professionals are encouraged to get involved by contributing input or joining a work group.
  • Contribute documents to the RHIO directory-This fall, watch for the announcement of new RHIO-related services that will help AHIMA members be more effective in their RHIO efforts. Consider sharing letters, grant proposals, policies and other resources in a new RHIO directory of resources. While AHIMA staff may contribute some best practices and other materials, most of the resources will come from fellow AHIMA members. "The more we share information, the more efficiently and accurately we can work ... and it will make for a bigger and better product in the end," says Linda Vernon, RHIA, president of the Virginia component state association (CSA) and active member and volunteer in VHIMA for more than 15 years. She contributed a letter her CSA sent to their governor asking him to include HIM professionals on an EHR task force and subcommittees.
  • Attend the 2005 AHIMA Annual Convention-David Brailer, MD, PhD, director of ONCHIT, and others will be speaking about the NHIN, e-HIM® and other topics. "The more information we can give our members about topics like e-HIM, the HL7 standards, and the push toward the NHIN by the federal government and individual states," says Heidi Shaffer, RHIA, chair of the program committee for the 2005 Annual Convention and health services project coordinator for mental health services for San Diego County in San Diego, CA, "the more of an impact HIM professionals will have on the state of healthcare."

Surf the Web for NHIN

Here are some Web sites that can help you get up to speed on the NHIN.

AHIMA's Communities of Practice: Log on at Potential CoPs include e-HIM; HL7 EHR functional model; HIPAA: computer-based patient record; and your geographic state forum.

Source: AHIMA Advantage 9:6 (September 2005)