The Bush Administration's greatest triumph in health IT was the National Health Information Network (NHIN).
(Art by Roland Heath of Decatur, GA. Reprinted with permission.)
NHIN-Connect was created under a contract with Harris Corp. The man behind the plan, Jim Traficant, turned out to be an inspiring personal story. A survivor of two liver transplants and septic shock, he built a secure method for transferring health records to keep what happened to him from happening to you.
But a government-owned private network is expensive. So while the military may still use NHIN-Connect to fulfill its pledge of a single health record system from induction through a veteran's heroic burial, the Administration is doing a work-around for the private sector.
It's called NHIN Direct. The idea is to turn the NHIN into a set of standards, and a policy framework, enabling hospitals and other service providers to fulfill the promise of the technology on their own.
It's not a Health Internet. But it's not a private network, either. It's a way to use the existing Internet to transmit sensitive patient data securely.
As the Department of Health and Human Services' Web page on NHIN explains, it's government laying down the rules and private innovators being given permission to build around them.
Much as in the creation of the Internet you're now using, Tim O'Reilly writes, the government will set the rules and police them, while the private market will implement the rules and innovate on top of them.
Common protocols and file formats are desperately needed in this area. Some states already have a number of Health Information Exchanges (HIEs), operating on different standards, which make them incompatible. If your hospital is in HIE A but your doctor is in HIE C, in other words, they can't pass records because they don't speak the same technical language.
NHIN-Direct won't solve those problems overnight, but it will provide a framework under which private companies can solve them over time.
This is not without controversy. Some states, and vendors working with those states, will find the NHIN standards make their private networks less profitable, and may argue the NHIN-Direct standards don't provide the breadth of services they were planning.
The answer is for them to innovate on top of the standards, as on the real Internet. Today's Web has little in common with what the government was running 20 years ago, but it is based on the same standards.
The Health Internet, like the real Internet, will be in private hands, but will be regulated by the government through standards.