title: Shifts in the architecture of the Nationwide Health Information Network.
abstract: In the midst of a US $30 billion USD investment in the Nationwide Health Information Network (NwHIN) and electronic health records systems, a significant change in the architecture of the NwHIN is taking place. Prior to 2010, the focus of information exchange in the NwHIN was the Regional Health Information Organization (RHIO). Since 2010, the Office of the National Coordinator (ONC) has been sponsoring policies that promote an internet-like architecture that encourages point to-point information exchange and private health information exchange networks. The net effect of these activities is to undercut the limited business model for RHIOs, decreasing the likelihood of their success, while making the NwHIN dependent on nascent technologies for community level functions such as record locator services. These changes may impact the health of patients and communities. Independent, scientifically focused debate is needed on the wisdom of ONC's proposed changes in its strategy for the NwHIN.
authors.affiliation: Department of Medicine, University of Utah, Salt Lake City, Utah 84132, USA. leslie.lenert@gmail.com
authors.forename: Leslie
authors.initials: L
authors.lastname: Lenert
authors.forename: David
authors.initials: D
authors.lastname: Sundwall
authors.forename: Michael Edward
authors.initials: ME
authors.lastname: Lenert
mesh_terms: D019058:Community Networks / Q000458:organization & administration*; D017598:Efficiency, Organizational; D063005:Health Information Systems / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D016247:Information Storage and Retrieval; D017146:Models, Organizational; D009313:National Health Programs / Q000458:organization & administration*; D017149:Private Sector; D018511:Systems Integration; D014481:United States