Editor’s note: Craig Chapman is vice president of network consulting for Telumenous, a Raleigh-based consulting firm and a former longtime telecommunication sales executive with BellSouth.
_______________________________________________________________________________________For those healthcare providers who gritted their teeth while working to comply with the Healthcare Insurance Portability and Accountability Act (HIPAA) regulations, fresh initiatives by the federal government to make healthcare information systems not only confidential and secure but also “interoperable” seem as welcome as new production quotas in a Gulag work camp.

Yet, the recent Request For Information (RFI) for a National Health Information Network (NHIN) issued by the Department of Health and Human Services reveals a straightforward strategy to improve the country’s healthcare processes through the sharing of timely and relevant patient information.

With HIPAA rules in place to protect the privacy and security of patient data, the government wants to create a NHIN that enables physicians and hospitals to see a more complete picture of a patient’s health by accessing records of other providers who have come in contact with the patient. Better information at the point of care holds the promise of improving health, reducing medical errors, enabling research, and limiting unnecessary testing.

The North Carolina Healthcare Information and Communications Alliance (NCHICA) responded to the RFI by compiling input from over a dozen member organizations to generate a collective vision of what a NHIN should look like. The 112 page report can be accessed on NCHICA’s web site: www.nchica.org/FinalDraftNHINresponse.doc

One Format for Records

Although the initial input into the process managed by NCHICA came up with as many opinions on the form and function of a NHIN as there were contributors, a general consensus did emerge from the collaborative discussion that took place over a two-day workshop:

  • The government should bring together stakeholders to define a standard format for a generic electronic health record (EHR).

  • Software vendors of hospital information and practice management systems must step up to write middleware that allows their proprietary systems to translate to and from the generic EHR.

  • NHIN rules and protocols should restrict access to a patient’s EHR based on factors such as the requesting provider’s role, the sensitivity of the data and the patient’s wishes.

  • The exchange of patient data will flow securely over providers’ Internet connections instead of a separate healthcare network, making the NHIN more of a virtual than physical network.

  • Regional and local healthcare organizations should emerge to help physicians locate EHRs for the same patient, wherever they may exist, through the creation of a patient records index.

  • Market incentives should drive software vendors and healthcare providers to adopt the NHIN standards, as long as the entry-level costs remain modest.
  • No Government-Funded Infrastructure

    NCHICA’s response is noteworthy for what it avoids as much as for what it embraces.

    The respondents, almost universally, ruled out the creation of a government-funded network infrastructure devoted to healthcare. Most felt that the industry did not need an expensive, proprietary network, and the government bureaucracy to run it, while software tools and utilities could allow patient information to move safely across a virtual healthcare network overlaying the Internet.

    The strategy expressed in NCHICA’s response can be summed up as 1) adopt national standards, 2) keep the investment to a minimum, and 3) rely on market forces to push widespread adoption of NHIN standards as it becomes economically feasible for the vendors and providers to make the investment.

    The Department of Health and Human Services will spend the next several months digesting the input from the RFI. Its timetable beyond that is unclear. “We don’t envision procuring a solution from the market at this point. We do envision having further dialog.”

    Stay tuned.

    Craig Chapman can be reached at (919 345 6464) or cchapman@telumenous.com