Agencies move toward goal of sharing health records
By [email=ecastelli@federaltimes.com?subject=Question from FederalTimes.com reader]ELISE CASTELLI[/email]
March 11, 2009
An Obama administration priority is to launch a system that allows health care providers to share records electronically. Work is already under way to begin with records federal agencies use.
Since 2004, 26 agencies with roles in citizen health care have collaborated on standards, known as the Federal Health Architecture (FHA). The goal is to allow health care providers to exchange records with the government and among themselves. The system would work somewhat like the Internet, which is built on a common set of standards, so it can be used by many.
Later this month, those agencies will release common codes that will guide creation of the network’s software. The network is called the National Health Information Network (NHIN), said Vish Sankaran, the director of the program, which is run out of the Health and Human Services Department.
“The goal is to build a network of networks,” Sankaran said.
To get the network started, these 26 agencies agreed on common mission-specific needs, Sankaran said.
“Everyone has a different mission and understanding of what needs to be done,” he said. By bringing agencies together, the FHA was able to create a comprehensive, interoperable system that still addresses unique needs, Sankaran said. This means when agencies use the network, they’ll be able to obtain the information they need, he said.
Testing the system
One agency is already using the NHIN. The Social Security Administration began sharing information with a local health system, MedVirginia, on Feb. 28.
Although SSA doesn’t provide health care, it does review more than 3 million disability cases each year. In each case, medical files are required to confirm a disability, said Debbie Somers, senior adviser to SSA’s deputy commissioner for systems.
With the current, paper-based system, it could take several months to receive files. Case workers then must thumb through them looking for the appropriate diagnoses to confirm the disability, Somers said.
Electronic health records can reduce this time from months to minutes, and case workers can electronically search the documents for the pertinent information, Somers said. That was the experience in a pilot program with a Boston hospital, Beth Israel Deaconess Medical Center. But that pilot did not use the NHIN like the MedVirginia test, she said.
SSA hopes to expand the use of the NHIN to exchange information for disability cases. It is in discussions with Kaiser Permanente and the North Carolina Health Care Information and Communications Alliance to do so, she said.
The experiences exchanging information through this pilot will help other agencies launch their own connections to the network later this year.
The Veterans Affairs Department is one of the departments hoping to learn from SSA’s experience, saidLinda Fischetti, VA’s chief health informatics officer.
About 40 percent of veterans receiving care through VA also use private-sector health care providers. It can be an onerous process to obtain paper medical records from those providers, she said. VA is identifying areas where levels of joint care are highest to test the electronic system starting in the fall, she said.
VA already has its own electronic records systems for more than 90 percent of medical actions, but private-sector adoption of electronic health records remains below 30 percent, making it a challenge to fully use of the network in this early stage, she said.
“We almost exist in a future state,” Fischetti said. “We’re reliant on adoption rates getting higher for the health information exchange to be transformative.”
By accelerating the exchange of medical information and automating some activities, such as flagging drug interactions, health IT can help save lives by avoiding medical errors.
The FHA is part of a larger office, the Office of the National Coordinator for Health Information Technology, which is working toward a 2014 goal of having electronic health records for all Americans. While Sankaran can’t say if that goal will be reached, “every day being wasted by not making the data available at the point of care means someone is suffering.”
Tim Young, a former deputy Office of Management and Budget administrator for IT, said agencies are leading by example.
“FHA’s collaborative interagency governance structure is enabling a more unified approach to investment alignment, data interoperability and information sharing,” said Young, now a senior manager with Deloitte LLP. “FHA is implementing the program with the partner agencies, not to them.”
Challenges ahead
The low adoption rate in the private sector is just one of the challenges facing the FHA and the broader health IT initiative. Security is another.
The biggest challenge, Sankaran said, is reconciling the differences in privacy and security protocols under two competing laws: the Health Insurance Portability and Accountability Act (HIPAA) and the Federal Information Security Management Act (FISMA).
For example, health data the federal government produces is governedunder FISMA privacy standards. If that information is transferred to a private-sector provider covered by HIPAA, must those private providers follow FISMA?
Answering this question is made easier because agencies have agreed to develop a single protocol to dictate which law applies, instead of each agency negotiating the point with private-sector providers, Sankaran said. By avoiding competing instructions to the private sector, government can ensure data is properly secured, he said.
Already, agencies decided that the records will not reside in a central portal and users of the network won’t be able to be call up information as they might on Google. Instead, users will follow current protocols for the release of health information: getting authorization from the patient and sending out a data call to individual service providers for the files, he said. |
发表于 2009-3-18 08:53:35