With that work nearing completion, the people behind it are asking themselves how big such a group should be. Should it be broad and deep, covering all stakeholders, or narrow and focused so it can move quickly?
It's an important question, because while the original NHIN Direct group contained mainly health IT specialists, big vendors like AT&T are now going to crowd into the market and seek to define its future direction.
An overview of the project, published last month, describes it as "a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet."
Follow the standards, in other words, and you can become a health ISP. Let 1,000 Health Information Exchanges bloom.
Each side of any data transmission will have its own Health ISP. The Health ISP will be responsible for assuring that privacy and security are maintained, that the recipient of the data is authorized to get it, that everything is encrypted and safe.
Essentially, Health ISPs will maintain what amounts to both a virtual private network and a file translation service, which clinics and hospitals will join through contracts.
AT&T, which is already a major backbone provider and Internet Service Provider (ISP), would seem to be perfectly positioned to become a large Health ISP.
AT&T does not want to stop there. It sees itself delivering mobile and cloud services based on the health care applications of various companies it partners with. It said $4 billion in revenue came through last year from health companies.
But what NHIN Direct seems to need most are health ISPs that will stick to their knitting, acting as honest brokers of data between any applications, rather than favoring their own partners.
It remains to be seen whether AT&T will play that way.