There is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network.

Continue reading “The Health Internet vs. the NHIN — A Matter of Control, Cost, and Timing”

There is growing tension within the Obama administration’s health team over who will control health data exchange: everyone (including consumers and their doctors), or just large provider organizations. The public debate will be framed in terms of privacy, security, and the adequacy of current exchange standards. But what really matters is who gets to make decisions about where health data resides, how it can be accessed, how much exchange will cost, and how long it will take for exchange to become routine.

Now is a good time to re-visit the plans for a National Health Information Network (NHIN), since we can finally observe and compare different health data sharing and exchange models in the marketplace. NHINs represent an older model that tries to use regional health information organizations (RHIOs) to establish secure networks, privately owned and operated by large provider organizations, mostly hospitals and health systems. The idea was that, over time, each private regional network would develop a gateway to other networks, creating a “network of networks” that would allow Stanford to talk to Partners Health, or Kaiser to Mayo. This communications model was enterprise/provider-centric. Patients/consumers were relegated to depending upon each RHIO’s policies for access to their health information. It was also a massively expensive and time consuming – think decades – way to build a health data network. Continue reading “The Health Internet vs. the NHIN”

By Matthew Holt

Last Thursday I gave a talk to a very high powered group, the National Committee on Vital and Health Statistics. My old colleague Matt Quinn is now working for the soon to be very rich Agency for Health Research and Quality (another HHS agency), and he lined up a series of talks for the committee on non-traditional data sources. Non-traditional, by the way, means about anything that isn’t from one of the huge Federal government household surveys (like MEPS) that’s used by HHS to analyze health care spending and consumption. John Halamka, CIO of BIDMC and Chair of HITSP, gave an excellent summary talk about data sources that are being collated and integrated in Massachusetts. It’s available on his blog here. Bear in mind that a LOT of work has already gone into putting various patient data sets together in that part of the country. The most encouraging thing was how relatively easy it was for BIDMC to interface with Google Health and Microsoft HealthVault, and how problem free those interfaces have been.

My talk was about Health 2.0, and given that it was less familiar to the committee I both introduced the concept of social networking and consumer tools, and discussed how it might be integrated into a national data capture strategy to improve quality reporting and hopefully spur improvements in medical care processes. Both talks are available here. You need to go to 4.48.00 or so to catch where I start. John’s talk is after the discussion

Continue reading “Health 2.0 more interesting than porn!”

By RICK PETERS, MD

As we debate whether or not the Obama Administration and the 111th Congress should work towards directly funding EHRs, one of the key questions seems to be whether or not EHRs and interoperability standards are mature enough.

My colleague, John Halamka, Chair of the Healthcare Information Technology Standards Panel (HITSP), made an rational and impassioned plea last week that we have reached a state of interoperability that is at least good enough not to delay allocating Federal funds for investments in EHRs. Dr. Halamka had earlier in December advocated direct grants from the Federal government of $50,000 per U.S. clinician to states to fund the purchase of CCHIT compliant commercial EHR products.

In the ideal world, I agree with John’s position, but have spent perhaps too much time in the real EHR world and in health care standards to truly believe we are where we think we are.  We have been here before and our best intentions were subverted.

Continue reading “Confusing ‘Standards’ With ‘Interoperability’–Lessons For The 111th Congress From HIPAA”

Health Affairs just published a study by a team of Harvard
researchers that has cast a pall on the
sustainability of Regional
Health Information Organizations (also referred to as Health
Information Exchanges). The report, The State Of Regional Health Information Organizations: Current Activities And Financing,
by Julia Adler-Milstein, Andrew P. McAfee, David W. Bates, and Ashish
K. Jha, seems to imply that the maladies suffered by RHIO efforts
around the country might be fatal, at least if you read the many news stories and blogs
that are talking about it.  I say "seems to" because our analysis
suggests that the industry echosphere is still missing quite a bit of
the big picture.  Let’s take this step by step, starting with the
Harvard study and moving into the invisible economy and the nature of
the RHIO challenge.

First, the "scary facts" presented by the researchers:

• 25% of previously-listed RHIOs seem to be "defunct"
• Only 20% of the remainder reported exchanging significant volumes of clinical data
• Most of the data they were exchanging falls into the categories of lab results, inpatient data and medication history
• A majority reported receiving in-kind donations, about half
  reported grants or financial contributions and slightly less than half
  reported no financial contributions

Read the rest at the Health 2.0 Blog