With a poor track record to date getting Regional Health Information Organizations off the ground, the Office of the Coordinator of Health Information Technology within HHS is now looking to expand the National Health Information Network (NHIN) to exchange data with both Google Health and Microsoft’s HealthVault.

But first the Feds look to be scaling back their broad ambitions from a massive NHIN that incorporated (and funded) public and private entities with state and local RHIOs in a federated-type network. This is not working RHIOs seem to be collapsing about as fast as new ones are created as most do not have a sustainable business model. Now the Feds are focusing on what they can control forming a multi-agency initiative (includes such entities as the VA, Dept of Defense, Indian Health Services, CMS, CDC, etc.) to develop NHIN-Connect. The objective of NHIN-Connect is to create an information exchange gateway that these federal agengies can use to exchange electronic medical records. Couple of weeks ago, long-time Government contractor, Harris, won their first healthcare contract for $6.1M for the first phase NHIN-Connect. Please, don’t even get me started on why these contractors are allowed to keep feeding from the federal trough, even when show little experience – talk about a good ol’boy network.

Getting back to Google and Microsoft, this admission by the Feds to open and connect to these two consumer platforms clearly points the way as to how the future of NHIN will develop. It will not be in the control of the federal government, but consumers and those that serve them. But this does bring up a couple of questions as well. For example:

• What about Dossia, will they be seen in the same light as Google and Microsoft by those leading NHIN initiatives?
• When we start looking at privacy and security, how will Google and Microsoft address as the proxy for consumers in the broader context of population health studies that the CDC and NIH may want to do against aggregate data in the NHIN?

There are few easy answers and the questions are many. Ultimately, it may be Google and Microsoft (and Dossia) who end up calling the shots as they will be closest to the end consumer and those in Washington DC promoting NHIN will simply follow in their footsteps.