A program involving more than 20 agencies establishes standards and creates the software necessary for federal organizations to exchange records.
But a standards-based, open-source approach orchestrated by the Health and Human Services Department's Office of the National Coordinator for Health IT promises to do just that via the Connect program.
The Connect program supplies free software that government agencies and private-sector health care providers can use to exchange patient information.
Federal agencies that provide health-related services often face conflicting requirements. They must provide the best possible medical care for people, and they must make sure that patients' medical records remain private and secure. Moreover, they need to share health information using Nationwide Health Information Network (NHIN) standards. In addition, each federal agency has its own regulations about medical information.
From left, Ivy Eckerman, Eric Larson, Vanessa Manchester, Bart Harman of Harris Corp., David Riley, Jim Traficant of Harris and Shannon Leigh.
For example, the Defense Department provides health care for its military personnel, but more than 60 percent of those personnel and their families also use outside providers through the Tricare benefits program. DOD and Tricare don’t share information.
Similarly, the Veterans Affairs Department offers quality health care to veterans, but more than 40 percent of veterans also use non-VA providers. Again, neither VA nor the non-VA organizations can access all the necessary information. Such gaps in medical information often lead to less than ideal care and force patients to become the custodians of their own information, carrying boxes of files from agency to agency.
To overcome the obstacles to sharing medical information, the Federal Health Architecture at the Office of the National Coordinator for Health IT began developing the Connect program in 2007.
“The goal of Connect was not simply to define standards for exchanging medical information but to create the actual software necessary for federal agencies to start sharing that information securely and efficiently,” said Dr. Douglas Fridsma. Fridsma is director of ONC's Office of Interoperability and Standards and interim director of FHA and Connect.
The Connect program is an unprecedented collaboration that combines the efforts of more than 20 federal agencies to create a single platform for exchanging health information. The aim is save each federal agency the time, cost and resources needed to create a compliant system by fielding a single system that all agencies could immediately implement. Using a single system also eliminates the necessity of integrating different systems and testing them separately.
Early in the program's planning stages, Connect managers and stakeholders decided to use open-source technology. Using open-source tools lowers the cost of development and allows different organizations to deploy the solution without complicated licensing arrangements.
The Connect program used a variety of open-source components and tools during the development process. For example, officials chose GlassFish, an open-source application server for the Java Enterprise Edition platform that has a free software license. They also selected the NetBeans integrated development environment for writing code.
The Connect program, with Harris Corp. as prime contractor, delivered its system in 2008, allowing health organizations to securely exchange health-related information that follow NHIN standards via the Internet.
It consists of three primary components.
- The Core Services Gateway enables health care organizations to locate their patients within other organizations. They can then requestand securely receive pertinent documents for those patients.
- The Enterprise Service Component includes default implementations of many essential components necessary for exchanging electronic health information.
- The Universal Client Framework consists of a set of applications that organizations can adapt to create an edge system. Those applications can also serve as a reference system for testing or demonstration.
In addition to the technological aspects, the Connect team needed to resolve legal and political issues. “Data use and support agreements require legal review,” said David Riley, contractor at HHS and Connect program lead. Meetings with private-sector organizations resulted inmutually acceptable language that defines the proper use of data, required behaviors and remedies for problem situations. Organizations must subscribe to that agreement before they can join the system.
“Building trust and relationships is essential with a project with such a large number of partners,” Riley said.
The collaborating federal agencies decided to release Connect as an open-source system to the entire health care industry. That means any health care organization can use Connect without paying for a software license. The hope is that this framework, originally intergovernmental, will literally connect federal agencies, health care providers, state governments, public health organizations, pharmacies, insurers and others. As a result, health care records for patients will become available anywhere in the United States, giving health care providers the complete information necessary for quality care.
By providing a single system for federal agencies to implement, the economies of scale of the Connect program have saved the government an estimated $200 million that would have been necessary to develop separate solutions. In addition, the Connect solution is helping to resolve some of the long-recognized gaps in medical information and care.
For example, DOD's system and the Tricare benefits program have the ability to connect using NHIN-based exchanges, and they can securely share patient health records. As a result, DOD and Tricare can obtain a full, all-inclusive and current picture of a patient’s health.
Similarly, Connect provides a comprehensive view of a veteran’shealth for VA and non-VA health care providers. “The Kaiser Permanente managed health care organization is performing pilot programs with the VA using Connect,” Fridsma said. Additionally, VA has a backlog of about 200 organizations that would like to exchange health care information.
“It would cost a lot of money to set up these connections one by one,” Riley said.
The benefits of the Connect system extend beyond providing health care. For example, the Social Security Administration underwrites long-term disability benefits. To verify disability claims,SSA must request more than 20 million paper-based records annually from about 900,000 private health care providers at a cost of nearly $500 million.
Examining paper records manually requires time, personnel and resources, which delays the process of approving valid claims. Using Connect with NHIN-based health information exchanges, SSA officials and private providers can quickly and securely exchange information to speed the determination process. Because the data is highly structured, SSA can add it to systems that automatically make benefit recommendations for certain well-defined types of impairment. The result is a reduction in the time needed to conduct initial determination process from months to minutes.
MedVirginia, a health information exchange that serves central Virginia, is partnering with SSA to share health care information. “In a recent pilot program, the time for determination was cut from 84 days to 25 days,” Fridsma said. More than 20 federal agencies and private-sector organizations are using Connect in production, and 20 more are running pilot programs.
Furthermore, because the Connect system uses open-source technology, organizations can create new applications for a variety of needs in all areas of health care delivery, administration and tracking.
The Connect program has created the Connect Community, an open forum in which government and private-sector health stakeholders can discuss and collaborate on improvements and new features for the software. Any health IT organization is welcome to participate infuture development.
Connect is poised to support more missions, including improved tracking of childhood vaccinations and faster and more accurate data about outbreaks for the Centers for Disease Control and Prevention.