November 16, 2009

By DAVID C. KIBBE and BRIAN KLEPPER

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.

Suppose a RHIO is in your area. Your health data from hospitals, outpatient clinics, and other settings associated with Health System A, are collected and combined with health data stored in similar settings in Health System B. Possibly Health Systems C, D, and E have also collaborated with A and B in this RHIO. Most RHIOs have cost or will cost many millions of dollars to build and operate. They were greatly encouraged by the Office of the National Coordinator under the Bush Administration, and have received additional support and funding under the ARRA/HITECH provisions that establish Health Information Exchanges (HIEs). They generally create large database management systems housed in large data centers. They typically run on proprietary software, creating closed networks that may or may not permit access onto and off the Internet.

As an individual, you probably don’t have direct access to the RHIO data; only doctors and nurses are authorized to access your information. In most RHIOs, if you request access to your health information you must make the request the same way you would to your physician’s medical practice, and often you will receive the results on paper. Transfer of these medical records to another institution or to a new provider outside the RHIO is not possible in most cases, although some RHIOs and HIEs now permit patient accounts and viewing of selected data.

By contrast, the Health Internet is a more current model, centered on the patient/consumer. As the name implies, the Health Internet leverages the Web’s physical network and its open protocols and standards for health data exchange controlled by patients (and/or patient agents, like doctors, through authorized web services). The idea is to develop mechanisms that allow health information to pass easily across institutional and business boundaries, to anywhere it’s needed. The Health Internet builds on the same Internet infrastructure and conventions that under-gird the transactions of major industry sectors like banking, e-commerce, retail sales, home mortgage business, and media and entertainment. Because this infrastructure is largely already in place, although little-used by health care entities now, the Health Internet could grow and scale rapidly at very little cost.

You can already see how the Health Internet is developing. You go to a CVS MinuteClinic, or to a handful of doctors, hospitals, labs, or pharmacies that offer you a personal health record account that lets you transfer your data in machine-readable format at will. You also create a Google Health account (or Microsoft HealthVault, Keas, or any number of personal health record platform websites) which allows you to upload your machine-readable, structured health data to them.

Next, you give your Google Health account permission to transfer your summary health data: to a doctor in anticipation of a visit; to a family member who is helping look after you; to a service that offers decision-support based on your information to help you solve some of your health/wellness problems; or to a service that will organize your health data into folders categorized by date, or provider, or episode of illness. The important thing here is that you, the individual, are deciding when, why, and where your health information is going.

The Health Internet example we’ve described above is performing the foundational transactions required of a national health information exchange network, and is doing so today. There are many examples, and they are growing organically, without government support, without new and complex standards, and at very low cost.

Even so, the Health Internet’s growth is constrained mainly by the limited data available to patients and consumers from their doctors and hospitals, who continue to resist the idea that individuals ought to control their own data. They are also inhibited by patients’ reluctance to challenge their doctors and hospitals on this point.

These and other barriers also make the Health Internet an imperfect solution to the goals of secure and efficient interoperable health data transfer. For example, current coding and classification systems remain a complex stumbling block to any model of health data exchange. Various coding systems are in use. Some are proprietary and require pay-for-use, and others need to be extended and gain industry consensus to be truly useful.

But it is no coincidence that the British government is investigating using both Google Health and Microsoft HealthVault for personal health data exchange, moving away from its own National Health Service program, after the latter spent billions on a national information network that doesn’t appear to work. The NHIN "network of networks" model in this country is beginning to flounder, too, and may never achieve its future potential as a national system. The reasons are partly political, economic, and technological. An NHIN system’s triple burdens – smoothing over competitive markets, enormous cost, and proprietary complexity – created so that large systems like the VA and the DOD, Kaiser and Geisinger, can exchange data without having to reach the Internet, will likely sink this ship even before the British program runs aground.

The Health Internet, on the other hand, has the obvious advantage of not "re-inventing the wheel."  As former Intel CEO Craig Barrett famously said, "We already have a network for health data, it’s called the Internet."  Proponents of the Health Internet argue that, while health data and privacy and security are very important, the data themselves are inherently no different from financial data or the kinds of personal information routinely — and very securely — transported over the Internet using fair market encryption and other security technologies to protect it from intrusion, capture, or breach.  So why go backwards to create the equivalent of Prodigy or AOL in every state?  It could take forever.

We want to give credit to David Blumenthal, the Obama health team members and the folks at HHS who are taking a hard look at how best to create a secure and efficient method for health data transfer in this country.

David C. Kibbe MD MBA and Brian Klepper PhD write together on health care market dynamics, technology, policy and innovation.

November 16, 2009 in Brian Klepper, David Kibbe, HITECH, NHIN, RHIOs, Web/Tech | Permalink

Tue Oct 27, 2009 9:02am EDT

New Mexico Health Information Collaborative (NMHIC) Appointed as State's
Official Health Information Exchange (HIE)
MedPlus(R) Provides Technology Solution to Enable Meaningful Data Sharing for
Improved Health Outcomes

ALBUQUERQUE, N.M., Oct. 27 /PRNewswire-FirstCall/ -- Maggie Gunter, PhD,
president of the New Mexico Health Information Collaborative (NMHIC),
announced today that the organization has been appointed as the state's
official health information exchange (HIE) by New Mexico Governor Bill
Richardson.

NMHIC will create the health information exchange infrastructure to connect
New Mexico's health care providers through a contract with its technology
partner, MedPlus, the healthcare information technology subsidiary of Quest
Diagnostics Incorporated (NYSE: DGX). MedPlus will connect New Mexico's health
care providers to a centralized network containing critical electronic patient
information, using its Centergy(TM) suite of integrated technology solutions. 

State-wide HIEs are critical for building a Nationwide Health Information
Network (NHIN). To ensure this continuity of care, NMHIC will enable health
care information to be linked electronically across organizations, both
regionally and nationally, and to move clinical information among disparate
health care information systems, including physician offices. MedPlus has
connected some of the nation's largest HIEs, including one third of the
original NHIN demonstration projects, one of which is NMHIC.

"New Mexico is a leader in the use of health information technology, and HIE
is key to our success," said Governor Bill Richardson. "The New Mexico Health
Information Collaborative has already built a solid foundation during the last
several years, thus making it an ideal choice to help move us closer to the
goal of quality health care for all at affordable prices."

 NMHIC partner health care providers will have access to a centralized network
of important information such as lab results, patient record summaries,
radiology images, discharge summaries, medication history and claims data.
Several leading New Mexico health care providers are already participating in
NMHIC, including: Presbyterian Healthcare Services, TriCore Reference
Laboratory, Holy Cross Hospital and Albuquerque Ambulance.

"It is an honor that NMHIC has been selected to serve as the state's HIE and
to help drive critical data exchange," said Maggie Gunter, PhD, president of
NMHIC. "Our goal is to enable New Mexico health care organizations to deliver
more efficient and timely patient care by providing streamlined access to
vital information related to different aspects of the care process.  MedPlus
has been instrumental in facilitating the seamless flow of data through all
points and has provided a comprehensive Web-based portal that is the core of
the HIE." 

The MedPlus Centergy integrated solution features a combination of a Clinical
Portal, robust Data Exchange Services and a modular ambulatory EMR, Care360
EHR. The Clinical Portal aggregates patient-specific data from various
clinical systems and, in compliance with HIPAA, presents information in a
single Web-based view at multiple inpatient and remote points of care. The
Data Exchange Services form the foundation for the collection, integration,
aggregation and distribution of clinical data, while preserving it behind the
sponsoring organization's firewall. This real-time data is available to
physicians and provides them with the information needed to make more informed
decisions, ensuring high quality care for their patients.   

"HIEs are an important component of driving better outcomes for patients and
more efficient health care," said Richard Mahoney, president of MedPlus and
vice president of Healthcare Information Solutions at Quest Diagnostics.
"Organizations such as NMHIC are the foundation of building a better health
care system and we are honored to be playing such an important role in helping
them to achieve their goals."

About The New Mexico Health Information Collaborative

The New Mexico Health Information Collaborative (NMHIC) is the name of New
Mexico's rapidly growing health information exchange (HIE) network, as well as
the community collaborative that has supported its development with time and
funding. The collaborative includes important New Mexico stakeholders
representing the largest health care providers, payers, employers, state
agencies and consumers. NMHIC was created in 2004, and continues to be fully
staffed and operated by the Lovelace Clinic Foundation. LCF is a non-profit
applied health research organization founded in 1990.

About MedPlus

MedPlus, based in Cincinnati, Ohio, is the healthcare information technology
subsidiary of Quest Diagnostics Incorporated. MedPlus is a leading developer
and integrator of clinical connectivity and health care information exchange
solutions designed to foster better patient care and improve business
performance for health care institutions, physicians and patients. The
company's Centergy(TM) and ChartMaxx® solutions efficiently and securely
collect, store, manage and integrate clinical information within an
organization, enterprise, practice or community. Centergy enables clinicians
to access patient data in a centralized view aggregated from multiple care
sites. ChartMaxx, the company's award-winning DMI and electronic patient
record system, has been implemented in more than 100 hospitals and integrated
health care delivery networks and has more than 300,000 users. For more
information, visit www.MedPlus.com.

About Quest Diagnostics

Quest Diagnostics is the world's leading provider of diagnostic testing,
information and services that patients and doctors need to make better health
care decisions. The company offers the broadest access to diagnostic testing
services through its network of laboratories and patient service centers, and
provides interpretive consultation through its extensive medical and
scientific staff. Quest Diagnostics is a pioneer in developing innovative
diagnostic tests and advanced health care information technology solutions
that help improve patient care. Additional company information is available at
www.QuestDiagnostics.com.

    Contacts:
    Dave Perry (NMHIC Media): 505-938-9910
    Barb Short (Quest Diagnostics Media): 973-520-2800
    Kathleen Valentine (Quest Diagnostics Investors): 973-520-2900

SOURCE  Quest Diagnostics Incorporated

Dave Perry (NMHIC Media): +1-505-938-9910, Barb Short (Quest Diagnostics
Media): +1-973-520-2800, Kathleen Valentine (Quest Diagnostics Investors):
+1-973-520-2900