Health IT Network Showcases Information Sharing

SPECIAL REPORT: Information Sharing & Analysis

By Barbara DePompa, 1105 Government Information Group Custom Media

Perhaps one of the best examples of federal information sharing today involves the work currently under way to connect federal health information systems to the Nationwide Health Information Network (NHIN).

Agencies Advised to Get Started Now

As a very early adopter of the Nationwide Health Information Network (NHIN) the Social Security Administration sees a strong requirement for other federal organizations to get involved now, rather than waiting for the maturation of NHIN to learn how to share information among federal and private sector healthcare providers. “I would strongly recommend to any federal agencies involved in healthcare provision or other related services that it's wise to participate now,” said Debbie Somers, senior advisor to the deputy commissioner for systems at SSA, rather than waiting for everything to be completed and fully matured in five years.

Involvement in this project requires participants to understand that not everything will work perfectly, and there are undoubtedly calculated risks involved. This is why she also recommends that agencies take it slowly, testing the network thoroughly and learning how the processes work. “Obviously, federal agencies can't risk jeopardizing the security of medical records, and much additional work in both functionality and governance is still to be finalized,” she explained.

Barry Rhodes, PhD., acting director for the division of emergency preparedness and response within the Centers for Disease Control, recommends that federal agencies or departments must realize that involvement in this evolving NHIN project requires a strong commitment, and backing from the highest levels of an organization. “Agency personnel must gain buy-in from leadership, and be will to participate in conference calls and technical meetings,” he explained.

But the sooner federal agencies participate, the more they will learn, and the more they will be able to influence the evolution of this nationwide healthcare information sharing network, Somers added. And Vish Sankaran, program director for the Federal Health Architecture maintains “the stars have aligned” to make NHIN possible as a viable network for healthcare information sharing. “We luckily have a president who wants this to happen. Congress also wants this. And citizens, too, are demanding at the point of care, to have access to their electronic health records.”

Working with 20 federal agencies has been no simple task, but Sankaran said because the agencies involved have a real need, not just a federal regulatory mandate, they have been able to come together to resolve challenges and successfully build out such an ambitious network. 

As an eGov initiative, the Federal Health Architecture (FHA) coordinates federal efforts to work with more than 20 federal agencies, along with private hospitals and doctors’ offices to build and use the NHIN to share information and support patient care, including benefits claims, public health information and numerous other health-related goals. “FHA's efforts are driven by an overwhelming need to improve information sharing,” said Vish Sankaran, program director for the FHA.


Of the $2.1 trillion spent annually on healthcare in the U.S., Sankaran reports, the federal government accounts for 40% of that total. “We needed to come together to build a common solution that will help the government reduce overall costs,” he explained.


Once in operation, government organizations at all levels, along with private sector healthcare providers will connect to the NHIN to exchange information on the network. Through FHA's efforts, 20 federal agencies have already combined forces to create the open source gateway, now called CONNECT, which provides each agency with a way to tie into the NHIN. Version 1.0 of CONNECT was released last year, and six agencies have already demonstrated its viability.  In late March, Version 2.0 was rolled out to federal agencies and the public to encourage software development, according to Sankaran.


CONNECT enables secure and interoperable electronic health information exchanges with other NHIN participating organizations, including federal agencies, state, tribal and local-level health organizations, and healthcare participants in the private sector. The NHIN will eventually be a vast network of public and private-sector organizations sharing information under clearly defined specifications, agreements and policies.


When CONNECT is ready for full release later this year, agencies will receive a deployable package that includes the CONNECT Gateway, along with enterprise service components and an adapter software development kit (SDK). In the meantime, a growing number of federal agencies will participate in trial implementations that deploy an initial set of services for the secure exchange of interoperable health information.


Government agencies such as the Department of Defense, the Department of Veterans Affairs, the Social Security Administration participated in development and have demonstrated how CONNECT works. For the Social Security Administration (SSA) which processes disability claims for over 2.6 million people every year, the NHIN will provide a way to more quickly evaluate healthcare records and provide benefits to those citizens with disabilities, said Debbie Somers, senior advisor to the deputy commissioner for systems at SSA. If the provider is on the NHIN network, the medical evidence process that once took 90 days or more can be completed in minutes, which dramatically improves speed of treatment, helping the patient concentrate on getting better, rather than gaining social security benefits, she said.


“The NHIN provides us with much needed bi-directional communication,” said Barry Rhodes, PhD., acting director for the division of emergency preparedness and response within the Centers for Disease Control.


The flow of information will help practitioners as it won't be just about hospitals reporting conditions. Instead, the CDC will be able to report back to hospitals and providers about outbreaks or other important information, Rhodes explained in an interview with the 1105 Government Information Group.


Each agency has unique reasons for connecting to the NHIN, and will use CONNECT to tap into this nationwide network. Among the benefits of linking to NHIN include:

* Enabling warfighters to receive coordinated care across the public and private sector. Providers will have access to medical records throughout the continuum of care, including when a soldier transitions from active duty to veteran status;

*Ensuring U.S. citizens receive health-related federal benefits to which they are entitled, in a timely manner;

*Enhancing federal, state and local agency response to public health emergencies, including disasters and pandemic diseases;

*Speeding the dissemination of clinical and scientific research results to government, industry and the scientific community;

*Improving regulation of pharmaceutical products and medical devices through faster, more comprehensive and more accurate detection of adverse drug events.


SSA is looking forward to partnering with more health and insurance industry partners on the NHIN in 2009. Providers with electronic health records and health information exchanges can be brought on quickly, said Somers, which “will help further demonstrate the benefits, especially the speed of processing eligibility requests for patients and providers,” she said.


Rhodes said the CDC is looking forward to sharing information at least at a summary level with hospitals and practitioners across the nation. For example, he explained, “it would be helpful to be able to provide information on how many cases of the flu are showing up in specific geographic regions at any given time.”