Health collaborative backs standards-based records

A nationwide collaborative of hospitals, federal health care agencies and health care industry IT vendors that’s backed by the New York-based Markle Foundation Thursday released the results of their efforts to use information systems to improve patient care, lower costs and protect privacy.

Connecting for Health (CFH) working groups developed broad guidelines for both patient information protection and development of an electronic personal health record. The privacy working group, chaired by Dr. Thomas Murray, president of the Hastings Center in Garrison, N.Y., an independent bioethics research organization, called for development of secure, personal patient Web pages, the screening of e-mail for personal health information (PHI), controlled access to PHI and authentication of users, according to material distributed at a news conference on CFH in Washington.

The CFH Personal Health Group, chaired by David Lansky, president of the Foundation for Accountability in Portland, Ore., called for development of a clearly defined, standards-based personal health record that every individual can access electronically.

CFH also launched the Healthcare Collaborative Network (HCN), backed by the Washington-based ehealth Initiative Inc. The HCN will serve as a yearlong testbed of many of the standards and policies developed by CFH working groups, including the development of a secure Web-based nationwide network pilot program that uses health care data standards backed by the U.S. government and CFH.

Organizations participating in HCN include the federal Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services (CMS) and the U.S. Food and Drug Administration. Participating hospitals include New York-Presbyterian Hospital, Wishard Memorial Hospital in Indianapolis and Vanderbilt Medical Center in Nashville.

IBM Corp. will provide the infrastructure for the HCN, based on its line of WebSphere middleware, according to Dr. Russell Ricci, general manager of IBM’s global health care division. During its pilot phase, HCN will be used to electronically exchange lab and pharmacy data. If the network is a success, it can be expanded to serve as an automated surveillance system that provides early warnings of epidemics such as the SARS virus or a bioterrorist attack.

Bruno Nardone, a managing consultant in IBM’s business consulting service, said each of the participants in HCN is equipped with a WebSphere gateway housed on an Intel PC with at least 2 GHz of processing power that manages the exchange of information over the network. HCN also includes a portal housing the network’s “business rules,” including how information is exchanged.

CMS plans to use the network to electronically check “quality of care” measurements, according to spokesman Peter Ashkenazi. This means, for example, that if CMS receives a record that a heart-attack patient has been discharged, it can quickly determine whether that patient was prescribed a beta blocker. If not, Nardone said, CMS could automatically alert the hospital that the patient needed the drug.

David Liss, vice president for government relations and strategic initiatives at New York-Presbyterian, said that from his perspective, the HCN’s emphasis on standards could eliminate the need to develop interfaces between the 400 or so health care IT systems the hospital uses. Adopting something like the XML-based Health Level 7 messaging standard would eventually help New York-Presbyterian cut the number of interfaces it must develop. Doing so, Liss said, now eats up 30 percent of the hospital’s IT budget.

Dr. Marc Overhage, who works on clinical information systems at Wishard Memorial, said the HCN has also been developed to protect patient privacy. The network automatically scans search fields for confidential information and “strips it out” before transmission.

Overhage called the cost of Wishar’s participation in the HCN “modest,” requiring the hospital to spend about $10,000 to buy a dedicated server and allocate two days of staff time to set it and the gateway up. For that amount, Overhage said, hospitals can enter a new world of medical IT, where the exchange of information is easier and treatment provided to patients is better.

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