Guidelines target health records exchanges

Connecting for Health issues guidelines for resolving technical, legal and organizational issues that are likely to be encountered.

A nonprofit organization on Thursday released guidelines for establishing health information exchanges. The guidelines are the most detailed cookbook developed so far.

The 'Common Framework' from Connecting for Health provides technical and policy guidelines, including a model legal contract for participants in the exchanges, which can support sharing health records among providers locally, regionally or nationwide.

Zoe Baird, president of the sponsoring Markle Foundation, said the work leading up to the Common Framework shows that health information exchanges are feasible. 'Up to now,' she said, 'people have said, 'Can it be done?' Now we know it can be done.'

However, widespread adoption of e-health records and health information exchanges (HIEs, also known as regional health information organizations or RHIOs) still will require leadership, Baird warned.

The Common Framework allows for HIE participants to use different software and internal technical architectures, as long as they adhere to data and messaging standards.

Privacy and security policies can be set locally and in accordance with differing state laws. For example, one hospital could choose to send its patient records to doctors upon request, while another could withhold them when the doctor did not practice at that hospital.

In addition, the framework calls for patients to specifically authorize release of their own records. 'Privacy is foundational to everything we do,' said Dr. John Halamka, chief information officer of Harvard Medical School and a Connecting for Health participant.

The guidelines recommend keeping health records where they are created, rather than in a central repository, and relying on common, open technical standards. Those participating in exchanges should be able to use whatever software and hardware are already in place.

The framework captures knowledge developed during creation and testing of the prototype for a national health information network. The prototype links health networks in Boston, Indianapolis and Mendocino County, Calif.

Another element of the framework is use of a record locator service rather than a single index or unique patient identification number. Halamka said 20 million records belonging to 500,000 patients were exchanged in a test that used real records without patients' real identifying information. 'There were no mismatches on any of the individuals' when the record locator service was put to the test, he said.

Dr. Mark Frisse, a Vanderbilt University professor, physician and organizer of an HIE for the Memphis, Tenn., area, said following the Connecting for Health framework could shave six months to a year off the time it takes to establish an exchange.

Connecting for Health is sponsored primarily by the Markle Foundation and the Robert Wood Johnson Foundation. More than 100 organizations take part in its programs.

About the Author

Nancy Ferris is senior editor of Government Health IT.

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