Nationwide Health Information Network and Exchange


The nationwide health information network known as NwHIN is a set of standards, services and policies that enable secure health information exchange over the Internet. It is not a group of stakeholders or group of computers. It is merely the foundation for how health information will be exchanged and follow a patient in our country. Enacted in February 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act requires the National Coordinator for Health Information Technology to establish a governance mechanism for the nationwide health information network (section 3001(c)(8) of the Public Health Service Act (PHSA)).

On the other hand, the Nationwide Health Information Network Exchange, which was formerly known as the NHIN Cooperative, is a group of stakeholders and integrated delivery networks that are collaborating to securely exchange health information electronically. The group includes federal agencies, local, regional and state-level Health Information Exchange Organizations (HIOs) and private organizations. And today the organizations are demonstrating actual health information exchange using the standards and policies adopted by the NwHIN.

Recently events have happened that impact both the network and the exchange. In May the ONC issued a Request for Information (RFI) on conditions of trusted exchange for the NwHIN. Comments received strongly objected to the direction and time frame the ONC was proposing for governance of the NwHIN. After review of the comments we were expecting the ONC to begin creation and release of a Notice of Proposed Rulemaking (NPRM). Instead last week, ONC Mostashari issued a statement on the future NPRM. “Based on what we heard and our analysis of alternatives, we’ve decided not to continue with the formal rulemaking process at this time, and instead implement an approach that provides a means for defining and implementing nationwide trusted exchange with higher agility, and lower likelihood of regret.”

Since 2007 the ONC has been operating the Nationwide Health Information Network Exchange under a department program. The program is now being transitioned to a public-private partnership to foster continued growth and create a sustainable business model. The goal is to have the transition completed by October and the new name is HealtheWay.

From HealtheWay’s transition presentation these are the current and future structures:


  • ONC initiative and program – NwHIN Exchange
  • Coordinating Committee (CC)
  • Data Use and Reciprocal Support Agreement (DURSA)
  • Onboarding & testing facilitated by ONC
  • Operations supported / funded by ONC
  • Services provided to participants for free

Transition To

  • Public-private initiative – eHealth Exchange
  • Coordinating Committee (CC)
  • Testing facilitated by testing body designated by CC
  • Operations supported/ funded by Healtheway
  • Participants begin paying for services in future