Government updates national health network plans, focuses on implementation concerns

SAN DIEGO - Amid privacy, security and technological concerns, healthcare IT professionals got a progress report on the status of the Nationwide Health Information Network (NHIN) which seeks to improve patient care and reduce medical errors in implementing electronic health records systems.

At the Health Information Management and Systems Society (HIMSS) show in San Diego, as many as 22,700 IT managers and CIOs listened as a number of individuals including Dr. David Brailer, national coordinator for Health Information Technology for the Department of Health and Human Services, described their visions of such a network, the current barriers to adoption and the progress toward the NHIN.

In April 2004, President George Bush charged the IT industry to build a system that would provide every citizen of the United States with an electronic health record (EHR) that could be accessed from any location by 2014. He appointed Dr. Brailer to coordinate this effort and establish the NHIN.

This last December, Brailer's office awarded $18.6 million in contracts to four consortia led by IBM, Computer Science Corporation, Accenture and Northrop Grumman to develop prototype architectures for the NHIN. Each consortium consists of technology developers and hospitals, laboratories, pharmacies and physicians who must prove that EHRs can be exchanged seamlessly among entities. The consortia are using existing collectives of hospitals called regional health information organizations (RHIOs) to build these data interchange networks.

“These prototypes are the key to information portability for American consumers and are a major step in our national effort to modernize health care delivery,” says Dr. Brailer, in a statement.

Brailer envisions the architecture of the NHIN to be such that existing RHIOs can connect to it; other organizations and physician offices that are not part of a RHIO will be able to connect too.

“I did not start out by believing the national solution will be a network of regional networks,” says Brailer in his keynote speech at HIMSS. “Our goal with the national health information network is to allow those who do not want to participate in RHIOs to not have to do it."

Two networks – those proposed by Northrop Grumman and CSC -- consist of distributed peer-to-peer networks, which use a federated identity model that lets different organizations share identity data with trusted network access and authentication. Patient information would be identified by unique metadata tags and be exchanged among organizations using standard protocols.

Foremost in IT professionals' minds in building out these networks is how physicians will be reimbursed for adopting information technology. Outside of that are concerns that adopting an EHR and nationwide health network will focus attention on a number of technological issues. Among those concerns are a lack of recognized standards, the security and privacy of patient health information and the trusted access and authentication of clinicians to EHR information.