National health records network to expand

By Bob Brewin

March 27, 2008

The federal office in charge of creating a national network that intends to allow clinicians to exchange electronic health care information plans to expand the system this year to include electronic health records maintained by federal agencies as well as personal health records developed by "entrepreneurial organizations," a top official with the Health and Human Services Department said.

The Office of the National Coordinator for Health Information Technology plans this year to expand its Nationwide Health Information Network to exchange electronic health information with the departments of Defense and Veterans Affairs and the Indian Health Service, which operate electronic health record systems covering millions of Americans and integrated health care systems that span numerous communities, said Charles Friedman, chief operating officer for the national coordinator office. Friedman spoke March 26 at the Defense Health Care Information Technology Conference at Georgetown University in Washington.

The NHIN is a key component of a project that President Bush kicked off in 2004 to create a system that eventually will provide electronic health records for every American. Bush set 2014 as the deadline to have the majority of the public's electronic health records available to any doctor's office, hospital or clinic hooked up to the network. NHIN is conducting trials with nine organizations in broad geographic areas under contracts awarded last October.

Friedman provided few details on how the office would include in the NHIN information from personal health records developed by what he called "entrepreneurial organizations" such as Google. Last month, Google launched a pilot project with the Cleveland Clinic to provide patients the results of their doctor visits, prescriptions, tests and procedures through Google's secure Web authentication proxy service. A spokeswoman for the national coordinator's office said there is no agreement to include Google personal health records in the NHIN. In October, Microsoft launched a personal health record initiative called HealthVault.

By the end of this year, HHS will have demonstrated the exchange of health information with multiple organizations connected to the network, Friedman said. He did not say how his office will incorporate multicommunity integrated health care delivery systems, but plans to tie these systems into the NHIN indicate that the office wants to expand the network from the state to the local level, with the network hooking up cities and towns within a state, according to an executive of a health IT vendor at the conference who declined to be identified.

Federal interfaces to the health network will be through an entity called NHIN Connect, Friedman said. NHIN Connect will be based on the National Health Information Exchange Gateway, which Harris Corp will develop under a contract HHS awarded last week, said Lt. Col. Hon Pak, director of the advanced information technology group of the Army's Telemedicine and Advanced Technology Research Center at Fort Detrick, Md.

Pak, who serves as the Defense representative on NHIN Connect, said the network will use software developed by Defense and VA for the Bidirectional Health Information Exchange, which clinicians in both departments use to share electronic patient information, and software developed by the National Cancer Institute for its Cancer Biomedical Informatics Grid. The NHIN connect gateway integrates health care IT information from several federal agencies into the NHIN. This includes VA, Defense and the Indian Health Service as well as the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services, Pak said. NHIN Connect is in an early development stage; the first multiagency planning meeting was held yesterday, he added.

The NHIN gateway will save the government significant money by correlating simple demographic information with federal programs, such as determining who is alive and who has died, said Dr. Stanley Saiki Jr., director of the Pacific Telehealth and Technology Group, a joint Defense and VA research organization funded by the Army's Telemedicine and Advanced Technology Research Center.

States and the federal government "really can't even keep close track of who dies so that their Social Security and other benefits can be terminated," Saiki said. "This savings alone could go a long way to finance important data systems. Magnify this by the potential increased efficiency in the delivery of health care and magnify this again with universal coverage and [the gateway and NHIN Connect] is a big deal."


By Bob Brewin

March 27, 2008

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