Markle Connecting for Health Prototype Successfully Moved Electronic Health Information Among Medical Record Systems in Three States on Three Independent Networks
Publication Date:February 8, 2006
NEW YORK, NY—Markle Connecting for Health announced today that its three-state prototype has achieved an important first milestone toward the secure, authorized, and private exchange of health information, based on a series of tests conducted throughout 2005. The prototype, initiated in January of 2005 and announced last June, involves very different, independent local networks serving diverse communities in Boston, Indianapolis, and Mendocino County, CA. This prototype effort is managed by the Markle Foundation and funded by Markle and the Robert Wood Johnson Foundation.
Members of Markle Connecting for Health will discuss this successful prototype at a meeting of the Healthcare Information and Management Systems Society (HIMSS) in San Diego on Monday, February 13. They will explain how the prototype linked information using a specially developed Record Locator Service (RLS) rather than a single patient identifier, and how it exchanged anonymized electronic health information during its first tests. The RLS does not store any clinical data centrally; it simply identifies the location of records wherever they are stored.
"The prototype demonstrates that completely different regional, local, and other health information networks can communicate with one another and exchange information, even if they operate on different technological platforms, use different registration systems, and organize patient data differently," said Clay Shirky, who directs the technical work for Markle Connecting for Health and teaches at New York University. "We have demonstrated that the Connecting for Health Record Locator Service, the one novel piece of infrastructure in this prototype, is a viable means of supporting a federated and decentralized approach to identifying and exchanging health information in a secure and private manner. Even so, we recognize that there are many challenges remaining in making nationwide health information exchange a reality."
In keeping with the goals of the prototype and based on achieving this first milestone, Connecting for Health will release in spring 2006 a set of technical, policy, and legal documents to any organization wishing to create a decentralized and federated health information network that exchanges information using the Internet. The Connecting for Health prototype materials will include the actual code, technical specifications, testing interfaces, as well as the privacy and security policies and model contracts that have been developed to securely exchange health information while protecting privacy. By sharing these materials, Connecting for Health hopes this first set of materials will help to reduce the many existing financial, legal, and technical barriers to achieving secure health information exchange and that it will encourage new entrants into the field. Another key benefit of the approach is based on the ability of the Connecting for Health Common Framework to make it possible for any multi-regional or non-geographic network, such as a group of specialty providers that share a network over a widely disbursed area, to have a single common way of communicating with any local network.
The prototype was designed to test the principles of the Connecting for Health Common Framework summarized in the collaborative's Roadmap, released in June of 2004. The detailed technical specifications and the policies that dictate the use, access, privacy, and security of information have been developed together through a consensus process over the last year with the Connecting for Health Collaborative's many participants. The work is based on common open, non-proprietary standards and strong model policies to protect privacy and information security. The tests showed that local networks and other organizations could communicate with one another using a decentralized model that adheres to the Connecting for Health Common Framework, avoiding the need to create a "one-size-fits-all" network or a national database.
"Mendocino County is a rural community three hours north of San Francisco. Our participation in the Connecting for Health prototype is an important part of enhancing the medical care that individuals in our area can receive," said Will Ross, project manager with Mendocino Health Records Exchange in Ukiah, CA. "We demonstrated that large systems with tremendous information technology resources and rural networks like ours, made up of safety net clinics and small practices capable of only modest technology investments, can affordably exchange health information over the Internet using tools which conform to the Connecting for Health Common Framework."
During this first phase of the prototype, each site developed a RLS that linked anonymized patient records across the three networks without using a common patient identifier, and the regions were then able to exchange information about prescription records and laboratory test results. The teams at each site are now preparing to test the secure exchange in live clinical settings. Connecting for Health expects to accomplish this exchange by the end of summer 2006.
"This effort builds on the existing work done to connect Indianapolis-area hospitals by the Indiana Health Information Exchange and Regenstrief Institute. Connecting with these two other communities demonstrates the tremendous possibilities that can be created by being able to use health information to improve the quality of care," said J. Marc Overhage, MD, PhD, president and CEO of the Indiana Health Information Exchange. "Given the current burden of chronic illness and the aging population, our patients need us to have access to comprehensive, well-integrated clinical data, and health information exchange is the only way to provide it."
"We demonstrated that it is possible to link our network with two very different community networks in other parts of the United States," said John Halamka, CEO of MA-SHARE and an emergency physician at Beth Israel Deaconess Medical Center in Boston. "As an emergency physician, I am confident that a connected electronic health care system will save thousands of lives each year by enabling authorized clinicians to retrieve the complete medical histories of critically ill patients in a matter of seconds and thus avoid major medical errors."
Working together, the prototype team used approximately 20 million anonymized clinically accurate medical records associated with 500,000 patients. The records were stored at each of the three sites in diverse local information systems. Requests for information among the locations resulted in responses that were entirely consistent across sites, despite the fact that the data were formatted in different architectures, systems, and platforms at each location, and that each site used different hardware and software to house, locate, and retrieve their electronic records.
"The technology marketplace is extremely interested in the results of this prototype," said Zoë Baird, president of the Markle Foundation. "Private-sector innovators are eager to develop products that help track and share information in a secure manner because they know that this is the future of the health care industry and will ultimately enable physicians to deliver safer and more cost-effective patient care."
"As a physician currently engaged in building a regional health information organization in Tennessee, I believe that Markle Connecting for Health's prototype provides valuable, practical guidance for how we can build a health information network, while meeting stringent requirements for security and privacy," said Mark Frisse, MD, co-chair of the prototype's Policy Subcommittee, director of regional informatics programs through the Vanderbilt Center for Better Health, and professor in the Vanderbilt Department of Biomedical Informatics.
"The successful test of this prototype is instrumental in advancing information exchange that can improve health and health care for all Americans," said John Lumpkin, MD, MPH, senior vice president of the Robert Wood Johnson Foundation and vice chair of Markle Connecting for Health. "The accurate and secure exchange of medical records across disparate networks represents a critical breakthrough that will help patients get the efficient, high-quality care they need."
On November 10, 2005, U.S. Department of Health and Human Services Secretary Mike Leavitt announced the award of contracts totaling $18.6 million to develop prototypes for Nationwide Health Information Network (NHIN) architecture. The Connecting for Health prototype architecture will be shared with all involved in the NHIN effort and the broader field, and Markle Connecting for Health will develop it further and "stress test" it in the coming year.
"This model underscores that our goal to enable health care providers and communities to improve patient care through private and secure health information sharing is close at hand," said Carol Diamond, MD, MPH, managing director of the Markle Foundation and chair of Markle Connecting for Health. "We know there are still significant challenges ahead, but we hope that this effort will make it easier for others and reduce the risks associated with health information exchange, which continues to lack a clear and sustainable business model."
Markle Connecting for Health is a public-private collaborative with representatives from more than one hundred organizations across the spectrum of health care and information technology specialists. Its purpose is to catalyze the widespread changes necessary to realize the full benefits of health information technology while protecting patient privacy and the security of personal health information. Markle Connecting for Health tackles the key challenges to creating a networked health information environment that enables secure and private information sharing when and where it is needed to improve health and health care. Learn more about Markle Connecting for Health at www.markle.org/health.