J Am Med Inform Assoc doi:10.1136/amiajnl-2011-000442
  • Perspective

Shifts in the architecture of the Nationwide Health Information Network

Open Access
  1. Michael Edward Lenert3
  1. 1Department of Medicine, University of Utah, Salt Lake City, Utah, USA
  2. 2Department of Family and Community Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
  3. 3Department of Communications, University of San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Leslie Lenert, Department of Medicine, University of Utah, 30 North 1900 East, Room 4C104, Salt Lake City, UT 84132, USA; leslie.lenert{at}
  1. Contributors LL conceived of and authored the initial versions of this manuscript and contributed to subsequent revisions. DS contributed to the conceptual development of initial versions of the manuscript and helped refine subsequent drafts. MEL contributed to the conceptual development of the manuscript.

  • Received 24 June 2011
  • Accepted 23 December 2011
  • Published Online First 21 January 2012


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.


  • Competing interests Dr Lenert is a consultant to IBM Federal Systems and United Biosource Corporation. Dr Sundwall is a consultant to Abbott Laboratories.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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