EHNAC Responds Critically to ONC RFI

As featured on EHR Intelligence

By Patrick Oullette

The Electronic Healthcare Network Accreditation Commission (EHNAC) thinks the government needs to get more aggressive in advancing health information exchange (HIE) progress.

EHNAC issued its response to the Office of the National Coordinator for Health Information Technology’s (ONC) Request for Information (RFI) on governance of the Nationwide Health Information Network (NwHIN) from May 15. Above all else, it maintains that the government needs to step up its endeavors in accelerating the availability and use of HIE. EHNAC is a non-profit standards development organization and, according to, says that HIE “must achieve a correct balance between guidance and flexibility, constraints and enablement – regulation may not be the appropriate framework to achieve such governance.”

EHNAC offered these conditions and foundational activities that, in its opinion, must take place simultaneously:
Standard integration with certified EHR technologies – As the number of physicians and hospitals who have adopted and are now using certified EHR technology grows, the tendency is for these users to want all of the functionality for care management to occur within the “interface” of their chosen EHR.  Therefore, the integration of clinical messaging via standard protocols and specifications becomes increasingly important.
The establishment and maintenance of a security and trust framework – Secure exchanges require that providers, medical practices, and patients must rely on several key “trust agents” in order to maintain security and trust on their behalf.
Predictability in the market – If there is to be orderly and sustainable growth of secure network exchange in the US, the market which is composed of entities who are essential service providers, e.g. HISPs, CAs, EHRs, EHN’s, PHRs and other stakeholders must be presented with clear and consistent information regarding the commitment of the federal agencies involved to the promotion of health data and information exchange standards.
Furthermore, EHNAC recommends that ONC takes these actions:
  • Makes explicit which electronic exchange methodology and framework within the nationwide health information network is under consideration as being the subject of any “condition of trusted exchange,” and specifies that an objective third party national certification/accreditation organization(s) be designated to provide this level of review.
  • Assists with industry development of specifications, procedures, and the security and privacy framework necessary to assure that the exchange networks meet the standards and provide for interoperability between entities.
  • Recognizes two classes of recognition and oversight, namely certification and accreditation including auditing and makes clear the roles, functions, and responsibilities for which kinds of products, organizations, and other entities require either certification or accreditation.
The biggest takeaways from this response to ONC’s RFI are that EHNAC clearly thinks that proper standards haven’t been put in place and security continues to be an issue. HIE has been in the news a lot lately, both in state developments and new ONC guidelines, but the points raised above prove that there is still a lot of HIE work to be done.