Panel: Gov't could save time, money with open-source NHIN
The federal government’s current shift to sharing health information using open-source technology could potentially reduce costs and time for patients and the government, according to a panel discussion of health IT experts who gathered Oct. 30 in Washington, D.C.

The panel, sponsored by communications technology company Harris Communications, sought to frame the progress of the Nationwide Health Information Network (NHIN) and how the federally-developed CONNECT system promotes the adoption and use of standards-based health IT systems while streamlining information, ideas and reducing costs.

CONNECT is an open-source implementation of the NHIN specifications that enables federal agencies and healthcare providers to exchange patient information.

Vish Sankaran, director of the Federal Health Architecture in the Office of the National Coordinator for Health IT (ONC) in the Department of Health and Human Services (HHS) began the panel by discussing interoperability in the healthcare setting and the importance of maintaining the perspective that  “[w]e are really talking about people’s lives.”

Sankaran said that the three goals of the initiative were to reduce healthcare costs and increase quality and access to care. “The idea is not to create a large database,” Sankaran said. "It is to create a connected, secure technology."

Brian Behlendorf, CONNECT Community Collaboration advisor, stated that the open-source approach of CONNECT will help alleviate the aggressive goals of health information exchange (HIE) reform. “The point,” Behlendorf said, “is to try and replicate other successful technologies on the Internet--for example, email.” Communities that were initially seen as hobby communities such as Mozilla and Linux incorporate this type of bottom-up technological approach," Behlendorf stated.

“It’s a tool to create a technology that is non-discriminatory,” said Behlendorf. “The processes of development are public. As the community develops additional features, they can bring and vet them in and accelerate the progress. So far, we’ve seen large companies as well as start-ups incorporate themselves into the community.”

The community will eventually be driven by different groups of stakeholders with common goals, Behlendorf stated. “We see ourselves as instigators.” Behlendorf cited Apple’s iPhone and the proliferation of its applications as an example of crafting technologies from the bottom-up. iPhone was the base, he said, and the cornucopia of various applications to follow were explosive afterthoughts.

Jim Borland, special advisor for health IT to the commissioner of Social Security, deemed CONNECT a success for the Social Security Administration (SSA), the largest long-term disability insurer in the United States. The SSA was the first of about 20 federal agencies attempting to implement NHIN CONNECT.

SSA “makes about three million medical determinations concerning long-term disablity claims a year,” said Borland. “That’s 15 million requests to the nation’s 500,000 clinicians for medical reports to support medical claims. We have a system in Baltimore that has collected over 400 million digital paper medical records over the last five years. Obviously, it’s a storage and workload challenge,” Borland stated.

Borland noted that health IT provides SSA with the ability to disseminate and receive medical request information much faster on a network level. The SSA has two pilot programs, one located at MedVirginia, a regional health information organization in Richmond, Va., and one in Massachusetts. In Virginia, SSA requests information electronically on MedVirginia's patients and they respond to those requests in less than a minute instead of four to eight weeks, Borland said.

"There are benefits to getting the structured data,” Borland said. “It can be analyzed.” Borland added that SSA has 250 medical disability listings that health IT can use to interpret incoming medical information, match to and alert examiners so that they can process the claims immediately, in everyday terms.

In Richmond, Borland said, “the average, traditional paper disability claim takes 90 days to process. That same disability determination, where even one piece of medical evidence is electronically gathered, takes about 47 days. That’s almost cut the time in half.

"That's a huge benefit for the government. That's a huge benefit to the taxpayer," Borland concluded.

The panel announced that the version 2.3 of CONNECT will be available in January 2010, which should include final meaningful use definitions and EHR criteria.