Building blocks

The national network is working on amenu of seven core services, including theelectronic exchange of patient lab results,medication histories and basic patient registryinformation that physicians typicallyrequest. "The idea is not to have to fill outthe dreaded clipboard so many times,"Loonsk said.The goal is to make the information moreportable so that a patient from, for example,California who gets injured in New York doesnot have to rely on numerous calls to his orher primary-care doctor at home to get basicmedical information. If the patient is broughtto a New York hospital unconscious from anaccident, the need for prescription druginformation and medical history is urgent.Even so, the challenges are daunting asmost patients, physicians and medical institutionswant to maintain strict control of theinformation. "In my view, we cannot begin tobuild and operate the technology without anunderlying foundation of how to protect theinformation," said Holt Anderson, executivedirector at the North Carolina HealthcareInformation and Communications Alliance,which operates one of the nine regionalexchanges.In North Carolina, officials are startingmodestly with an initial focus on electronicexchanges of recent drug prescriptions andrecent lab results for specific patients ratherthan a full medical history. It will enablecaregivers in Charlotte, for example, toreceive background information on recentdrugs taken by a patient visiting fromAsheville. "Eventually, we will want a completepicture, but right now, 85 percent ofthat information is resident in physicians'offices," Anderson said.In other states, officials are also working onsharing additional types of clinical information,providing situational awareness for publichealth, and reconciling information onsuch items as medication.So far, the hospital and health care systemsseem willing to pay part of the tab. For example,the California Regional HealthInformation Organization in San Franciscoannounced in May its intention to build thecountry's largest statewide health informationexchange utility. It did not receive anHHS contract in the latest round of fundingfor the national network but intends to jointhe national network eventually.The organization is touting a goal ofreducing an estimated 50,000 instances ofmedical errors and suboptimal care occurringper day in the state because of missinginformation. It wants to offer communitiesan alternative to building and financing theirown infrastructures.However, the federal approach is toexpect that regional health systems will gainbenefits from the electronic exchanges andwill be willing to provide the primary fundingfor the networks, Loonsk said. "We aresticking to making the nationwide networkself-sustaining."

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
    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 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

Staff writer Alice Lipowicz can be reached at