Officials responsible for constructing the Nationwide Health Information Network are relying on numerous information technology contractors for assistance as they embark this month on an initiative to connect regional health information exchanges.

Contractor support is expected to expand further in the next several years as federal and state officials strive to link the nine regional information exchanges, federal and industry officials said. The initiative eventually will involve all 50 states.

“The Nationwide Health Information Network will be a secure network: a network of networks,” said John Loonsk, director of interoperability and standards at the Health and Human Services Department’s Office of the National Coordinator of Health Information Technology, which is overseeing development of the network. He said that federal officials hope to show how the regional networks can link to one another by September 2008.

The national network has been in the planning and demonstration phase for at least three years and is expected to provide a foundation for electronic medical records by 2014. Some basic hurdles remain to be overcome.

For example, it is not yet clear whether patients and physicians will accept electronic records as sufficiently private and accurate. More than 80 percent of medical records are on paper.

Officials also need to standardize formats and terminology for the exchanges. And some technology issues are still being debated, such as which information should reside in a secure network and which should be stored on a computer chip or card carried by the patient.

Burst of activity
But a flurry of activity and contracts in recent months suggests that the national network idea is gaining traction. HHS Secretary Mike Leavitt announced contracts Oct. 5 totaling $22.5 million to nine health information exchanges in California, Delaware, Indiana, New Mexico, New York, North Carolina, Tennessee, Virginia and West Virginia. Those exchanges will begin operating and linking with one another in a nationwide network. The major IT contractors supporting those efforts include:

• CGI of Fairfax, Va.,announced Oct. 24 that it has been selected as the lead systems integrator for connecting CareSpark’s regional health information network in Tennessee and Virginia with the national network.

• Computer Sciences Corp. announced Oct. 15 it is supporting the New York eHealth Collaborative for the implementation of the national network. CSC estimates the value of the contract, which has a one-year base and two one-year options, to be $3.5 million if all options are exercised.

• IBM Corp. said earlier this year that it had developed a standards-based system based on a service-oriented architecture to connect information exchanges for the national network. IBM has installed and operated the solution at the Duke University Health System and six other hospitals as part of the North Carolina Healthcare Information and Communications Alliance.

  IBM said it had used open-source software from openEMR.org and products from subcontractors Allscripts LLC, of Chicago; BioImaging Technologies Inc., of Newtown, Pa.; GE Healthcare, of the United Kingdom; Healthvision Inc., of Irving, Texas; Initiate Systems Inc., of Chicago; McKesson Corp., of San Francisco; MediTech Inc., of Westwood, Mass.; and SureScript Systems Inc., of Alexandria, Va.

• Medicity Inc.
of Salt Lake City and Perot Systems Corp. teamed on a contract to create the Delaware Health Information Network as part of the national network. The first phase of the project involves three hospitals, several physician offices and a clinical laboratory network. The companies also are working together, along with Hewlett-Packard Co., to create a health information exchange in San Francisco that is not yet part of the national network.

Multiple challenges remain
The national network is working on a menu of seven core services, including the electronic exchange of patient lab results, medication histories and basic patient registry information that physicians typically request. “The idea is not to have to fill out the dreaded clipboard so many times,” Loonsk said.

The goal is to make the information more portable so that a patient from, for example, California who gets injured in New York does not have to rely on numerous calls to his or her primary-care doctor at home to get basic medical information. If the patient is brought to a New York hospital unconscious from an accident, the need for prescription drug information and medical history is urgent.

Even so, the challenges are daunting as most patients, physicians and medical institutions want to maintain strict control of the information. “In my view, we cannot begin to build and operate the technology without an underlying foundation of how to protect the information,” said Holt Anderson, executive director at the North Carolina Healthcare Information and Communications Alliance, which operates one of the nine regional exchanges.

In North Carolina, officials are starting modestly with an initial focus on electronic exchanges of recent drug prescriptions and recent lab results for specific patients rather than a full medical history. It will enable caregivers in Charlotte, for example, to receive background information on recent drugs taken by a patient visiting from Asheville. “Eventually, we will want a complete picture, but right now, 85 percent of that information is resident in physicians’ offices,” Anderson said.

In other states, officials are also working on sharing additional types of clinical information, providing situational awareness for public health, and reconciling information on such items as medication.

So far, the hospital and health care systems seem willing to pay part of the tab. For example, the California Regional Health Information Organization in San Francisco announced in May its intention to build the country’s largest statewide health information exchange utility. It did not receive an HHS contract in the latest round of funding for the national network but intends to join the national network eventually.

The organization is touting a goal of reducing an estimated 50,000 instances of medical errors and suboptimal care occurring per day in the state because of missing information. It wants to offer communities an alternative to building and financing their own infrastructures.

However, the federal approach is to expect that regional health systems will gain benefits from the electronic exchanges and will be willing to provide the primary funding for the networks, Loonsk said. “We are sticking to making the nationwide network self-sustaining.”

Staff writer Alice Lipowicz can be reached at alipowicz@1105govinfo.com.