In 2004, the Office of the National Coordinator (ONC) under the Department of Health and Human Services (HHS) began to develop the Nationwide Health Information Network (NwHIN) Exchange for the purpose of allowing organizations and agencies to securely exchange health information with one another. This virtual network leverages gateway technologies to securely transport messages between organizations based on standards and specifications developed by Standards Development Organizations (SDOs). These SDOs include Health Level Seven (HL7) and the Organization for the Advancement of Structured Information Standards (OASIS) among others.

Leveraging these standards, The Integrating the Health Enterprise (IHE) creates profiles, such as ITI-55, which describes the IT Infrastructure Technical Framework necessary to securely exchange health and health information. The NwHIN utilized IHE profiles to accelerate organizations' adoption of health information exchange by ensuring interoperability, or the secure and accurate exchange of health information from one organization to another, using many of the industry standards already in practice.

Organizations who wished to securely exchange patient information over the NwHIN were required to go through an onboarding process. Within this process, compliance testing, or testing to ensure the organization's gateway conformed to the developed NwHIN specifications (conformance testing) as well as could send and receive secure messages over the NwHIN (bi-directional interoperability testing).

While the National Institute of Standards and Technology (NIST) serves a critical role in the development of testing tools related to Health IT the ONC required an interoperability test platform be developed to support early adopters onto the NwHIN Exchange. In response to this need, the Interoperability Test Lab was introduced, providing a self-service, bi-directional, multi-participant test platform which allowed prospective exchange participants to simulate health information exchange with reference implementation (RI) gateways.

The Interoperability Test Lab would serve the role of an automated test lab, validator and provide participants immediate feedback on tests which were executed. The Interoperability Test Lab contained many progressive features and functionality including a Service Oriented Architecture (SOA), self-directed and automated test cases, and the ability for a user to quickly execute tests and analyze test results.

On a regular basis the Interoperability Test Lab development worked one-on-one with NwHIN onboarding candidates to solve interoperability challenges between multiple organizations. Occasionally the challenges were routine, resulting in a minor configuration to an organization's gateway to successfully exchange health information. Other times, interoperability issues found were complex, resulting in additional re-work and development by the onboarding candidate to successfully demonstrate compliance.

Through these exercises, the development team observed that participants would benefit by earlier access to the automated lab while in the development and early testing phases of their gateway technology. Although the Interoperability Test lab was focused on certification and compliance testing within the onboarding process, early access to the lab was not encouraged nor supported.

In response to the Federal Health Architecture (FHA) Federal Partners requests to provide for faster onboarding, the development team conceived an approach to provide access for onboarding candidates to an automated test lab earlier in the onboarding process, when it was most necessary to ensure compliance testing. To avoid confusion on the two labs, the development team coined this new lab the Developers Integration Lab (DIL), with the focus being to share with a health organization's development teams the tools necessary to ensure health interoperability.