Notable news late last week included ONC Coordinator Dr. Fazad Mostashari publishing a blog post stating that ONC has decided NOT to pursue promulgating regulations to govern the NwHIN. The decision was made in part after his Office considered comments to the RFI it released in the early summer seeking public input on a potential regulatory approach for the NwHIN and its participants, including the possibility of requiring accreditation and certification to validate organizations seeking to participate in the NwHIN. Mostashari explains in his post that many RFI responders expressed concern that issuing new regulations to set governance standards for the NwHIN could actually slow the development of trusted exchange. In light of this, Mostashari indicates that his Office has decided to allow the HIE and HIT markets to continue evolving organically, at least for now.
The NwHIN website currently posts a list of 27 organizations that are already approved NwHIN Participants. Other organizations seeking to become a NwHIN Participant have to "on board" to the Exchange by following the (painfully detailed) process on the NwHIN website, which you can review here.
But buyer beware...
While current NwHIN Participants may have "on boarded" and be using the NwHIN for free, it looks like subscription and/or use fees for the NwHIN are coming soon .....
On August 20th, the HealtheWay Exchange Transition Update was published, which summarizes some of the "transitions" to expect with regard to the NwHIN. To start, it's helpful to know that HealtheWay is the nonprofit organization now chartered to support the NwHIN Exchange. The entity's Articles of Amendment and Restatement of the Articles of Incorporation were recently filed in the Commonwealth of Virginia and made effective July 30, 2012. Bylaws for HealtheWay are posted there as well. The Update notes a list of changes to how the NwHIN will be operating, including:
- Currently, NwHIN Exchange is an ONC initiative, but as of October 2012 it will transition to the public-private initiative called the eHealth Exchange;
- Currently, NwHIN operations are supported and funded by ONC, but going forward, operations will be supported and funded by HealtheWay;
- Currently, all services are provided to NwHIN Participants for free, but very soon Participants are going to be asked to pay for the NwHIN's services being supported through HealtheWay.
It is probably not a huge surprise that, going forward, Participants will be charged fees to connect through the NwHIN Exchange because "free" is not a viable model for financial sustainability. However, it will be interesting to see how organizations respond and whether paying fees to utilize the NwHIN was something that such organizations, and States for that matter, have factored in to their HIE models.
In light of all this, it is important for organizations, providers and even State governments looking to join the NwHIN to have a solid understanding of how the DURSA works, especially with regard to how "material terms" can be changed (i.e., like imposing new fees), and how a Participant can terminate its participation with the NwHIN if it cannot meet (or does not agree with) a material change.
If NwHIN Participants are going to be charged fees to use the NwHIN Exchange, then organizations should be considering this as part of their evaluation of whether the NwHIN Exchange is the best solution to meet its organization's primary needs. Organizations will also want to evaluate whether the NwHIN delivers sufficient value in exchange for the fee that they will be charging (an amount which we don't yet know). In addition, the integration and on-boarding process is extremely time-consuming and resource intensive, and so organizations will not necessarily want to "go through" this process with two different HIE vendor solutions. Finally, for those that were expecting to connect to the NwHIN for "free", they should update their plan (and budgets) to reflect the transition of the NwHIN Exchange to a "for fee" model.
To review the provisions of the DURSA that pertain to "changes" to material terms, click "Continue Reading".