National health network needs incentives too

The politics of health care, business of medicine, concerns about privacy, and sheer technological complexity — all those factors have made it difficult to have effective discussions about the requirements for a common health information network in the United States.

Exchanging patient records and population health data securely is central to the meaningful outcomes ascribed to electronic health records: improving the quality of care, sharing complete patient records among different health care organizations, supporting public health disease monitoring, and reducing medical errors.

Health information exchange, in turn, will not thrive until the many different organizations, subnetworks and medical record systems can come together in a network in which they share common policies and network services. In a common network, they can best use capabilities, share an approach to trusting one another's information, and achieve explosive network effects, such as those that made the Internet what it is today.

There are a lot of good elements in the extension centers and health information exchange grants recently announced by the Office of the National Coordinator for Health Information Technology in the Health and Human Services Department. That stimulus funding will undoubtedly help advance health IT. Many people now want to see how the different pieces will be brought together to produce the desired meaningful outcomes.

The Nationwide Health Information Network initiative has produced a technical and policy architecture that is intended to bring the pieces together and create a common, secure network for exchanging health data.

As things stand, though, without any specific stimulus funding for NHIN, we run the risk of having more than 50 separate jurisdictional networks, a separate quality reporting network, many separate lab results networks, a separate e-prescribing network, many separate public health networks, separate claims networks and others.

The NHIN architecture efforts began in 2005 and have brought agreement on the initial network services and policies needed to bring together many of these otherwise independent systems and networks. A group of more than 30 organizations established the initial NHIN standards-based technical and policy specifications that are the basis for the NHIN architecture.

The NHIN architecture keeps patient information in a distributed form to address concerns about large central databases. It also enables appropriate data exchange to address patient, provider and population needs. It can support a variety of philosophical approaches to electronic health records.

Whether patients, providers or both eventually manage electronic health records, any approach needs to look up and retrieve information, deliver information to the right place, support patient preferences about how information can be used, and ensure that anonymous population data can be delivered to organizations that need it.

Those common needs helped define NHIN network services. And the services support a common secure health network just as Domain Name System services support the Internet.

Trial implementations have demonstrated NHIN’s viability and utility. Yet strikingly, as of now, none of the more than $36 billion for health IT in the American Recovery and Reinvestment Act is dedicated to advancing any common health information network or ensuring that common network services are available.

As with the Internet, a clear commitment to common network services is necessary to open opportunities for the next steps in health information exchange that can attract health care providers into the technology rather than pushing it on them.