Building blocks

Contractors enlist to help build a national health network ? one piece at a time

Officials responsible for constructing the
Nationwide Health Information Network
are relying on numerous information technology
contractors for assistance as they
embark this month on an initiative to connect
regional health information exchanges.

Contractor support is expected to expand
further in the next several years as federal
and state officials strive to link the nine
regional information exchanges, federal and
industry officials said. The initiative eventually
will involve all 50 states.

"The Nationwide Health Information
Network will be a secure network: a network
of networks," said John Loonsk, director of
interoperability and standards at the Health
and Human Services Department's Office of
the National Coordinator of Health
Information Technology, which is overseeing
development of the network. He said
that federal officials hope to show how the
regional networks can link to one another by
September 2008.

The national network has been in the
planning and demonstration phase for at
least three years and is expected to provide a
foundation for electronic medical records by
2014. Some basic hurdles remain to be overcome.

For example, it is not yet clear
whether patients and physicians will accept
electronic records as sufficiently private and
accurate. More than 80 percent of medical
records are on paper.

Officials also need to standardize formats
and terminology for the exchanges. And
some technology issues are still being debated,
such as which information should reside
in a secure network and which should be
stored on a computer chip or card carried by
the patient.

Burst of activity

But a flurry of activity and contracts in
recent months suggests that the national
network idea is gaining traction. HHS
Secretary Mike Leavitt announced contracts
Oct. 5 totaling $22.5 million to nine
health information exchanges in California,
Delaware, Indiana, New Mexico, New York,
North Carolina, Tennessee, Virginia and
West Virginia. Those exchanges will
begin operating and linking with one
another in a nationwide network.
The major IT contractors supporting
those efforts include:
  • CGI of Fairfax, Va.,announced Oct.
    24 that it has been selected as the
    lead systems integrator for connecting
    CareSpark's regional
    health information network in
    Tennessee and Virginia with the
    national network.

  • Computer Sciences Corp. announced Oct. 15 it is supporting
    the New York eHealth
    Collaborative for the implementation
    of the national network.
    CSC estimates the value of the
    contract, which has a one-year base
    and two one-year options, to be
    $3.5 million if all options are exercised.

  • IBM Corp. said earlier this year that it had developed a standards-based
    system based on
    a service-oriented
    architecture to connect
    information
    exchanges for the
    national network.
    IBM has installed and
    operated the solution at
    the Duke University
    Health System and six
    other hospitals as part of
    the North Carolina
    Healthcare Information and
    Communications Alliance.

    IBM said it had used
    open-source software from
    openEMR.org and products
    from subcontractors Allscripts
    LLC, of Chicago; BioImaging
    Technologies Inc., of Newtown,
    Pa.; GE Healthcare, of the United
    Kingdom; Healthvision Inc., of
    Irving, Texas; Initiate Systems Inc.,
    of Chicago; McKesson Corp., of San
    Francisco; MediTech Inc., of Westwood,
    Mass.; and SureScript Systems Inc., of
    Alexandria, Va.

  • Medicity Inc.
  • of Salt Lake City and Perot
    Systems Corp.
    teamed on a contract to create
    the Delaware Health Information
    Network as part of the national network.
    The first phase of the project involves
    three hospitals, several physician offices
    and a clinical laboratory network. The
    companies also are working together,
    along with Hewlett-Packard Co., to create
    a health information exchange in San
    Francisco that is not yet part of the
    national network.

Multiple challenges remain

The national network is working on a
menu of seven core services, including the
electronic exchange of patient lab results,
medication histories and basic patient registry
information that physicians typically
request. "The idea is not to have to fill out
the dreaded clipboard so many times,"
Loonsk said.

The goal is to make the information more
portable so that a patient from, for example,
California who gets injured in New York does
not have to rely on numerous calls to his or
her primary-care doctor at home to get basic
medical information. If the patient is brought
to a New York hospital unconscious from an
accident, the need for prescription drug
information and medical history is urgent.

Even so, the challenges are daunting as
most patients, physicians and medical institutions
want to maintain strict control of the
information. "In my view, we cannot begin to
build and operate the technology without an
underlying foundation of how to protect the
information," said Holt Anderson, executive
director at the North Carolina Healthcare
Information and Communications Alliance,
which operates one of the nine regional
exchanges.

In North Carolina, officials are starting
modestly with an initial focus on electronic
exchanges of recent drug prescriptions and
recent lab results for specific patients rather
than a full medical history. It will enable
caregivers in Charlotte, for example, to
receive background information on recent
drugs taken by a patient visiting from
Asheville. "Eventually, we will want a complete
picture, but right now, 85 percent of
that information is resident in physicians'
offices," Anderson said.

In other states, officials are also working on
sharing additional types of clinical information,
providing situational awareness for public
health, and reconciling information on
such items as medication.

So far, the hospital and health care systems
seem willing to pay part of the tab. For example,
the California Regional Health
Information Organization in San Francisco
announced in May its intention to build the
country's largest statewide health information
exchange utility. It did not receive an
HHS contract in the latest round of funding
for the national network but intends to join
the national network eventually.

The organization is touting a goal of
reducing an estimated 50,000 instances of
medical errors and suboptimal care occurring
per day in the state because of missing
information. It wants to offer communities
an alternative to building and financing their
own infrastructures.

However, the federal approach is to
expect that regional health systems will gain
benefits from the electronic exchanges and
will be willing to provide the primary funding
for the networks, Loonsk said. "We are
sticking to making the nationwide network
self-sustaining."

Staff writer Alice Lipowicz can be reached at
alipowicz@1105govinfo.com.

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