title: A Framework for evaluating the costs, effort, and value of nationwide health information exchange.
abstract: OBJECTIVE
  The nationwide health information network (NHIN) has been proposed to securely link community and state health information exchange (HIE) entities to create a national, interoperable network for sharing healthcare data in the USA. This paper describes a framework for evaluating the costs, effort, and value of nationwide data exchange as the NHIN moves toward a production state. The paper further presents the results of an initial assessment of the framework by those engaged in HIE activities.
  
  
  METHODS
  Using a literature review and knowledge gained from active NHIN technology and policy development, the authors constructed a framework for evaluating the costs, effort, and value of data exchange between an HIE entity and the NHIN.
  
  
  METHODS
  An online survey was used to assess the perceived usefulness of the metrics in the framework among HIE professionals and researchers.
  
  
  RESULTS
  The framework is organized into five broad categories: implementation; technology; policy; data; and value. Each category enumerates a variety of measures and measure types. Survey respondents generally indicated the framework contained useful measures for current and future use in HIE and NHIN evaluation. Answers varied slightly based on a respondent's participation in active development of NHIN components.
  
  
  CONCLUSIONS
  The proposed framework supports efforts to measure the costs, effort, and value associated with nationwide data exchange. Collecting longitudinal data along the NHIN's path to production should help with the development of an evidence base that will drive adoption, create value, and stimulate further investment in nationwide data exchange.
authors.affiliation: Regenstrief Institute, Inc and Indiana University School of Informatics, Indianapolis, Indiana 46202, USA. bdixon@regenstrief.org
authors.forename: Brian E
authors.initials: BE
authors.lastname: Dixon
authors.forename: Atif
authors.initials: A
authors.lastname: Zafar
authors.forename: J Marc
authors.initials: JM
authors.lastname: Overhage
mesh_terms: D003365:Costs and Cost Analysis; D057286:Electronic Health Records / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D007255:Information Services / Q000191:economics / Q000458:organization & administration*; D008498:Medical Record Linkage; D008962:Models, Theoretical; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration*; D011050:Policy Making; D013673:Technology Assessment, Biomedical / Q000379:methods* / Q000458:organization & administration; D014481:United States