Adoption of the National Information Exchange Model in order to facilitate data sharing among incompatible health information technology systems is not a CIA plot, said David Blumenthal, the national coordinator for health information technology.

Blumenthal spoke during a nearly five hour Health and Human Services Department health information technology standards committee meeting on March 24. In a recording of the meeting--at the 03:13 mark and after a discussion of the best ways to achieve interoperable data--Blumenthal said he wanted to "clarify" something.

Rumors in the blogosphere, he said, have been circulating that NIEM and the health community's adoption of it "is some kind of Trojan Horse for government control over health information."

"That is, because it is a government-developed mechanism for generating standards and implementation specifications, might it make it easier for health information to be transmitted, or might it make it inevitable that it is transmittable to the Department of Justice, Department of Homeland Security, the CIA, the NSA, I don't know where else," he said, to some audible giggling.

"Um, yes," he added, "and the answer to that question is absolutely ‘No'. I just want to say that for the record: Absolutely no."

The HHS already uses NIEM to support child and family services, said Doug Fridsma, acting head of the Office of Standards and Interoperability at the Office of the National Coordinator, earlier in the meeting.

NIEM is itself not a health information technology data standard, Fridsma explained. Rather, it is an effort to harmonize existing and different standards, he said.

NIEM started as a Justice Department effort but is now managed by DHS. It uses XML schemas to standardize core data components for exchange and allows other communities of interest to create mutually-intelligible data components specific to their communities.

Some meeting participants criticized NIEM. "NIEM is many things, few would accuse it of being a model, despite the name," said one attendee. "The semantic specification is under-specified, but I think that's fixable. But [what] seems less clear is how we address the cross use-case harmonization, and I don't think merely articulating that there is a harmonization process is sufficient," he said.

NIEM has long been criticized even as 48 out of 50 states have adopted it and its use has grown in unexpected ways.

"XML is a favorite but is attacked continuously in relation to weak data modeling support, weak encoding of binary objects, performance issues, and many more. Remember, the roar of legacy systems has a long tail," wrote NIEM founder Michael Daconta, in 2008.

For more:
- listen to an audio recording of the March 24 meeting of the HHS HIT standard committee. The NIEM discussion begins at about 02:29; Blumenthal makes his remarks starting at 03:13.
- see the agenda and presentation associated with the meeting
- read the opinions gathered by Nextgov on whether NIEM is a plot, including one from one Twila Brase, who says it could be.

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