Developing a national healthcare network will take backbone

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Progress towards a national healthcare network is slow in coming because more effort is needed to improve regional cooperation, as well as information sharing, said John Loonsk, MD, director of interoperability and standards for the Office of the National Coordinator for Health Information Technology (ONCHIT), at last week’s IHE 2007 Connectathon in Chicago. The successes that have been seen have been built on trust and common business goals, while the hindrances often have come from duplicative and incompatible systems and projects. If cooperation continues to lag then the challenge will only get worse, he said.

A national common architecture is needed to move forward as sort of a “backbone” that would act as a healthcare “network of networks” to connect all providers, consumers, and networks oriented to specific functions, said Loonsk. Unfortunately, a vision of this backbone has not been a big priority in this country, he added.

Certain recent happenings have provided a boost to these efforts towards a national healthcare network, such as an Executive Order regarding privacy requirements, as well as changes to Stark/Anti-kickback regulations, he said. However, complicated issues exist that must be addressed, such as:

  • How do they manage data persistence to support clinical decision-making;
  • Propagation of consumer access preferences;
  • Auditing needs of inter-organizational exchange;
  • Coordinating directories of providers to support authentic, access and audit activities;
  • Authenticating providers who do not have EHRs; and
  • Matching patient data without a national identifier.

Some of these issues already have planned solutions, but a number of others don’t, he said. The existing solutions that ONCHIT have in mind include: directly engaging state and regional health exchange efforts; further developing health information network service providers and service partnerships; focusing on connections between networks; and others.

Moreover, Loonsk indicated that there is a need for a “national test harness” which could include IHE-like efforts to provide virtual environments and simulations to further advancement of interoperable networks.

For ONCHIT one of the essential ingredients for success is working with organization such as IHE to develop interoperability standards.

Another crucial ingredient is the ONCHIT developed and sponsored American Health Information Community of which there are now seven working groups. The existing groups within AHIC have looked at consumer empowerment, chronic care, EHR, and biosurveillance. Other more recently formed groups within the community have been established to address issues such as confidentiality, privacy, security, quality, and personalized medicine, said Loonsk.

These groups develop user cases — areas in which there is a dire need for interoperability standards — which are then tested and evaluated by HITSP (HIT Standards Panel).

Developing user cases within the workgroups is difficult because they are trying to “walk the line” between detailed specificity as well as neutrality so that the results are highly useful but also broad enough to be applicable for the greatest number of people. He explained that AHIC, as we as the rest of ONCHIT, has the task of constantly viewing their work in terms of national goals using what he calls “strategic specificity.”

Four new use cases are coming from AHIC after a January meeting that will address problem areas related to health IT for disaster preparedness, such as situational awareness, response management, and emergency communications.