Health net gets a checkup

SAN DIEGO - Amid privacy, security and technology concerns, healthcare IT professionals got a progress report on the status of the Nationwide Health Information Network, a project that seeks to improve patient care and reduce medical errors in implementing electronic health record systems.

At the Health Information Management and Systems Society (HIMSS) show in San Diego last week, 25,100 IT managers and CIOs listened as a number of speakers, 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 being made.

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

Last December, Brailer's office awarded $18.6 million in contracts to four consortia led by Accenture, Computer Science Corporation (CSC), IBM and Northrop Grumman to develop prototype architectures for the NHIN. Each consortium consists of technology developers, hospitals, laboratories, pharmacies and physicians who must prove that EHRs can be exchanged seamlessly among entities. The consortia are using existing collectives of hospitals and other healthcare providers called regional health information organizations (RHIO) 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 healthcare delivery," Brailer said in a statement.

Brailer envisions the architecture of the NHIN to be such that existing RHIOs can connect to it, and organizations and physician offices that are not part of an RHIO also will be able to connect.

"I did not start out by believing the national solution will be a network of regional networks," Brailer said 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 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 these networks is how physicians will be reimbursed for adopting information technology. There also are technological issues about adopting EHRs and a nationwide health network that need addressing, such as a lack of recognized standards, the security and privacy of patient health information and the trusted access and authentication of clinicians to EHR information.

Dr. John Halamka, CIO for Harvard Medical School and chair of the Health Information Technology Standards Panel (HITSP), is charged with dealing with one of these concerns by coordinating the standards for medical vocabulary and electronic data exchange.