The Nationwide Health Information Network is not a new concept. The phrase itself goes back to the heady days of Dr. David Brailer's 2004-06 tenure as national coordinator for health information technology. Dr. William Yasnoff, who predated Brailer at HHS, was a senior advisor to the health agency for what was then called the National Health Information Infrastructure. (After leaving government service, Yasnoff, for a while, ran a consulting firm called NHII Advisors.)

Back in the middle part of this decade, Brailer described the proposed NHIN as a "network of networks" or a "medical Internet" of sorts. Some pieces of an NHIN have been built, in the form of state and regional health information exchanges, but for the most part, an interoperable system of electronic health records for all Americans remains a pipe dream. It's nice to build some connections now, but it would be nice to, you know, have some electronic data to transfer across that series of tubes.

A couple of leading health IT thinkers have urged us to take a step or two back and perhaps speak in less-lofty terms. Uber-CIO Dr. John Halamka of Boston's CareGroup Health System and co-chairman of the Health IT Standards Committee, recently described the NHIN as a long-distance carrier of sorts. Yeah, we all remember when it cost extra to call long distance--like way back in 2003. Such a system would work if there were a number of local exchanges that all followed common data standards and vocabularies, Halamka says. And patient privacy must be respected.

Halamka's musings apparently came from an event last week that featured federal Chief Technology Officer Aneesh Chopra and HHS CTO Todd Park. There, Chopra and Park suggested a modular approach to building a health Internet, rather than a one-size-fits-all model. That concept seems to have resonated with at least one NHIN critic--John Moore of Chilmark Research. Moore blogged about the idea, calling it worthy because it brings consumers back into the equation. "We chided the HIT Policy workgroup for HIEs for their complete lack of acknowledging the consumer's role and ownership of [protected health information]. We came back from DC recently disillusioned at the nearly myopic focus of ONC on clinicians," Moore writes.

That's because Moore and Chilmark liken the NHIN to building the Interstate highway system before people traded in their horses and buggies for motorized vehicles. Yeah, HIT still is primitive like that.

Meanwhile, yours truly will be hosting a FierceEMR webinar on Oct. 14 at 2 p.m. EDT, exploring how EMRs and other technology are changing medical transcription, hopefully for the better. It's free to register and participate. - Neil