A success for health info exchange

Nonprofits accept the e-health records challenge

Connecting for Health announced Wednesday that its prototype health records exchange has succeeded in exchanging thousands of records among three independently developed regional records systems.

The announcement came about 13 months after the project began. Officials said the prototype involved real records of prescriptions and laboratory test results, but the identifying information was changed to protect patients' privacy. The exchanged records were not used for medical purposes, they said.

Nonetheless, Dr. David Brailer, the national health information technology coordinator, said the results were encouraging in an interview with Government Health IT. "This shows that we're ready to go," he said.

The prototype involves health information organizations in Boston, Indianapolis and Mendocino County, Calif. The first two are well-funded national leaders in the development of regional health information systems, but the Mendocino-based organization is a more grassroots-driven effort in a rural area.

The three organizations developed their regional health records exchanges independently of one another, and they do not have a common architecture. Nonetheless, they were able to apply the common framework developed by Connecting for Health to perform the exchanges.

Connecting for Health is a nonprofit organization sponsored by the Markle Foundation and the Robert Wood Johnson Foundation.

The next step in the program is to test the exchanges using live clinical data, the officials said. They aim to complete this phase by the end of this summer.

This spring, Connecting for Health will release a set of documents describing how they resolved legal, technical and policy issues in establishing the prototype. The information will be free to other organizations that are tackling the same issues, Markle Foundation spokesman Stuart Schear said.

Transmitting the data via the Internet was often no problem for the prototype participants. “Operationally, the transactions were fairly trivial,” said Clay Shirky, who teaches at New York University and is directing the technical aspects of the prototype.

However, issues such as how to consistently indicate a patient’s gender throughout the system were among the most difficult kinds of problems, said Dr. John Halamka, chief information officer of Harvard Medical School.

In addition, the participants had to contend with conflicting state laws and rules. For example, Massachusetts does not allow medical institutions to use Social Security numbers to identify patients, they said.

Rather than using a common index or a unique identifier for each record, the three organizations used record locator services at each site to find the requested records.

Last November, Computer Sciences Corp. won one of four contracts to develop National Health Information Network prototypes from the U.S. Department of Health and Human Services. That project involves the same three regional organizations and Connecting for Health.

"We're going to more or less continue that [Connecting for Health] work" in the NHIN project and take it further, Brailer said. He said the design of the Connecting for Health project influenced the NHIN project's design in his office.

Schear said Connecting for Health will continue to develop its prototype architecture and test it more vigorously this year.