Each organization will decide how to support NwHIN Exchange transport specifications independently. Some may choose to implement the Open Source Connect gateway. Others will implement their own solutions. For example, Kaiser has a self-developed gateway in production.
Initially, content will include problem lists, medication lists, and allergy lists. The next phase will include laboratories, vitals, immunizations, and other content. Of course, if organization sends more than the minimum required content, the others will be capable of receiving it. They plan to use the same Clinical Document Architecture (CDA) implementation specifications as the VA/DOD Virtual Lifetime Electronic Record (VLER) project.
In addition to supporting healthcare information exchange for clinical care, they will implement a patient-chosen portable ID, similar to the HealthURL concept I've discussed.
They will also adopt a common Data Use and Reciprocal Support Agreement.
The five organizations share very few patients in common, so the real benefit is that they are implementing efficient, standard health information exchange methods that are extensible to organizations which do share significant numbers of patients.
If they work out standards-based, secure methods for sharing information among themselves, those methods would then be attractive to and implementable by other organizations with fewer resources for development and become usable, useful, de facto standards for information sharing.
I look forward to their progress. When five major institutions across the country implement common policy and technology for healthcare information exchange, we'll achieve a tipping point and others will rapidly follow.