HHS lays foundation for health IT network

'I don't want to say that the product we're purchasing is collaboration. But that's the vehicle.'

' David Brailer

Rick Steele

The Health and Human Services Department has given the move toward a national health information network the push many people in government and industry have been waiting for.

HHS secretary Mike Leavitt and National Health IT Coordinator David Brailer recently announced plans to create an organization that will decide on national health IT standards. HHS also released four requests for proposals to develop the foundation for a national network, designed to reduce medical mistakes, improve the quality of care and cut costs.

'It's going to grow organically, first by having clear guidance as to what we should have nationally,' said Marc Overhage, CEO of the Indiana Health Information Exchange in Indianapolis, one of the first health information exchanges in the nation. 'The secretary and coordinator are attempting to provide a stake in the ground, an overarching framework that all these initiatives can move toward.'

HHS has stepped in on this issue because industry has been unable to align medical and technical standards, experts said. About 80 local and regional health in- formation networks exist, but they cannot exchange data with each other.

Industry groups haven't agreed on a set of standards with which to move forward, said Janet Marchibroda, CEO of the eHealth Initiative, a nonprofit organization that in- cludes providers, standards groups and software companies, among others. 'Now this is hardwiring it, getting it to go,' she said.

Leavitt earlier this month announced the formation of the American Health Information Community, which will bring together federal and private physicians, hospitals, payers, community clinics and software vendors to agree on national standards that will enable health care providers to exchange and access patient data.

HHS also released four requests for proposals designed to create development processes for data standards, product certification and the architecture for an online health information exchange, as well as assess state privacy and security policies. HHS expects to award contracts by Sept. 30.

Leavitt's announcements were critical and timely, Marchibroda said. 'We're going to see an acceleration in the use of IT as a result of the standards recommendations.'

HHS officials foresee hospitals and doctors treating patients within local and regional provider networks that can communicate and exchange health information with other networks across the country. The key, many experts said, is having standards for sharing data. And there is a sense of urgency.

'We're watching the clock, because every day people die,' Brailer said at the annual conference for the department's Agency for Healthcare Research and Quality recently in Washington.

Addressing errors, costs

The Institute of Medicine reported in 1999 that up to 100,000 people die annually as a result of medical mistakes, such as misreading illegible prescriptions or treating a patient for the wrong condition because of incomplete medical records. At the same time, the cost of health care is skyrocketing, absorbing 16 percent of the economy, Leavitt said. And government pays for one- third of U.S. health care costs.

Medical and technical standards already exist, but they come in a variety of flavors. Industry organizations have done a lot of work informally to try to set standards but cannot agree, said Dan Garrett, vice president and managing partner of Computer Sciences Corp.'s Global Health Solutions Consulting Group of Berwyn, Pa.

'Leavitt is making the process more formal, as it needs to be, and a lot of organizations are cooperating with the federal government on the initiative,' he said. AHIC will review the standards work of many disparate organizations and decide which to implement, Garrett said.

Leavitt will lead AHIC and name its 17 members from nominations. They will consider national standards project by project instead of one long-term, big bang project.

'We want to see some near-term deliverables that could have the most success,' Leavitt said at another recent conference, sponsored by the National Alliance for Health IT in Washington.

AHIC will likely meet for the first time in September and consider its initial projects, such as modernizing adverse event drug reporting, and prioritize them based on how quickly standards can be set and how transformational and feasible the project would be, Brailer said.

Other early projects could be related to prescription drugs, lab reports or bioterrorism prevention data, projects for which different groups have already made progress on determining data standards, Leavitt said.

Where possible, the group will take advantage of existing standards but harmonize them among users and fill in gaps where needed, he said.

AHIC won't have the authority to make binding decisions, though. 'It will rely upon voluntary self interest,' Brailer said.

NIST standards

While the standards are voluntary for industry, the federal government will adopt them through the National Institute of Standards and Technology's Federal Information Processing Standards. Eventually, the standards will become mandatory for agencies.

Despite the lack of national standards, hospitals and large physician practices have invested in health IT processes, such as electronic prescriptions, computerized physician order entry and patient electronic health records.

The RFPs are aimed at pressuring groups to collaborate and make decisions.

'I don't want to say that the product we're purchasing is collaboration. But that's the vehicle,' Brailer said.

'Our job is to get out ahead of the movement and provide a market of national tools for connectivity that regional projects can subscribe to or pick from a series of accredited or certified national architecture providers,' Brailer said.

HHS and one of the winning vendors will certify a variety of products, such as electronic health records or a computer physician order entry system, to be interoperable with all health network systems, similar to how wireless phones can work within any provider's system. Certification also will lower the financial risk for physicians investing in IT systems, he added.

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