ONC began to develop the NHIN in 2004. The first phase included development of prototype architectures, and the second phase developed specifications and services, and developed working constructs.

Phase 1: Prototype Architectures 

Phase 2: Trial Implementations

The Nationwide Health Information Network (NHIN) has been built upon a core set of capabilities to enable nationwide information exchange encompassing a diverse set of organizations, technologies and approaches. These core capabilities include:

• Ability to find and retrieve healthcare information within and between health information exchanges and other organizations
• Ability to deliver a summarized patient record to support patient care and to support the patient's health.
• Ability to support consumer preferences regarding the exchange of his or her information, including the ability to choose not to participate in the NHIN
• Support secure information exchange
• Support of a common trust agreement that establishes the obligations and assurances to which all NHIN participants agree
• Ability to match patients to their data without a national patient identifier
• Support of harmonized standards, which have been developed by voluntary consensus standards bodies for exchange of health information among all such entities and networks.

The current core capabilities of the NHIN establish an interoperable infrastructure among distinct networks and systems that allows for different approaches and implementations, while ensuring secure information exchange as needed for patient care and population health.

The core capabilities of the NHIN were designed in the Trial Implementations phase to support a set of use cases as recommended by the American Health Information Community (AHIC) in order to address key priority areas in health information exchange. These include:

• Emergency Responder-Electronic Health Record
• Electronic Health Record – Lab Results
• Medication Management
• Consumer Empowerment-Consumer Access to Clinical Information
• Consumer Empowerment- Registration and Medication History
• Quality
• Biosurveillance