T1

Conclusion

We began the technical work for Markle Connecting for Health in early 2004, and are very pleased to have arrived, in a little over two years, at a proof-of-concept system that demonstrates the core goal of the technical work to date:

It is possible to link disparate entities and regions together in a way that improves information sharing while protecting privacy, and to do so using mainly existing standards, across many hardware and software platforms, and at relatively low cost.

With three different regions involved in deploying the actual hardware and software required, we've seen that standards-based communications can provide secure links between different health care entities and networks, and that the deployment will not require massive hardware or software upgrades; will not require uniformity of hardware, software, or implementation strategies; and can be undertaken by different groups of programmers all working to an agreed set of standards.

As important as this test has been, however, we want to emphasize the modesty of the achievement relative to the enormity of the task. The actual deployment in the three regions is still early and there is insufficient usage to gauge its success. While lowering the cost of implementation and working to integrate existing IT investments where possible is necessary, it is not sufficient. If we want nationwide adoption of interoperable health IT, there is considerable additional work to be done both on extending the technical work documented here and on problems outside the technical domain, such as improving incentives for interoperability, and raising data quality at the point of collection.

We are optimistic that by taking on the issues of packing and transporting data securely among diverse sets of participants, we can create an environment where it will be easier to understand the non-technical problems, and easier to imagine solutions for them. To reach this goal, however, we need feedback on our efforts to date. In 2006, Markle Connecting for Health will continue to host public forums for discussing the issues relevant to improving health care, and we welcome any feedback you might have on this document, on the technical architecture this document covers, and on the related policies documented in the accompanying The Markle Connecting for Health Common Framework: Resources for Implementing Private and Secure Health Information Exchange.