Nonprofits accept the e-health records challenge

An example of a nationwide electronic health records exchange could be working before the year's end, the result of a public/private effort led by two prominent foundations. At a cost of $1.9 million, a model e-health records exchange will be set up among clinics in rural Mendocino County, Calif., and medical facilities in Boston and Indianapolis.

The Markle and Robert Wood Johnson foundations will help finance the exchange, Zoe Baird, president of Markle, announced last week at the FCW Events' Web-Enabled Government conference. Connecting for Health (CFH), a Markle-funded group with more than 100 participating organizations, has been working for more than a year on developing policies and technical specifications for electronically sharing medical information while protecting privacy, Baird said.

Markle's approach reflects the Bush administration's interest in promoting public/private partnerships to modernize the nation's health care infrastructure.

"We applaud the innovation and resolve that is shown by private-sector efforts to advance health IT," said David Brailer, leader of the Office of the National Coordinator for Health Information Technology at the Department of Health and Human Services. "These efforts are critical to making interoperability real and usable in everyday clinical settings."

In April 2004, President Bush called for nationwide e-health records within 10 years.

To the delight of privacy advocates, e-records in the proposed exchange will remain in local clinical databases and will not be kept in a central database.

Emily Stewart, a policy analyst at the Health Privacy Project, which participated in the CFH group, said she supports Markle's model for the proposed exchange because it relies on patient-informed consent and control. Patients and doctors can decide to keep records, choose what goes into records and who can access them, she said.

David Kibbe, director of the American Academy of Family Physicians' Center for Health IT, said the Markle project complements the academy's efforts. In cooperation with the American Medical Association and others, the academy has developed the Continuity of Care Record (CCR), a standard electronic snapshot of patient care that can be exchanged among disparate computer systems. The CCR is a 2K Extensible Markup Language file that can be displayed in PDF, Microsoft Word document or HTML format.

"It would seem that the CCR would be a perfect match for a system that is trying to exchange relevant information across the country," Kibbe said.

Baird said she hopes that the consensus among health care stakeholders that CFH has achieved will mitigate potential problems in building a nationwide capability for exchanging e-health records. Federal officials must learn from past information-sharing errors before taking on health data exchanges, she said.

Information sharing should be part of policy conversations at the beginning, Baird said. "It is critical, as we approach information sharing in health care, that we not make the same mistakes the government made with national security projects."