History of the Health Information Exchange (HIE)

In the wake of multiple failed attempts at national healthcare reform in the late '90s and early 2000s; in response to concern raised by the post 9/11 anthrax attacks; and in hopes of improving the nations capability to provide real time surveillance against bioterrorism and being proactive in addressing the United States' ability to detect and combat potentially emerging epidemics such as SARS, West Nile Virus and Avian flu, President George Bush took the largely symbolic, though minimally funded step, of creating the Office of the National Coordinator of Health Information Technology (ONCHIT). Dr. David Brailer, a physician, the co-founder, Chairman, and CEO of CareScience Inc, (a health-care-management firm acquired by Quovadx, Inc., and the overseer of the Santa Barbara County Health Data Exchange (SBCHDE), the nations first peer-to-peer electronic health-information data exchange, was named to be its head. This step formalized the administration and the public's desire to aggressively advance the development and growth of health information technology (HIT) as an important and vital step in the effort to improve the quality and reduce the cost of health care in this country.

Dr. Brailer, who quickly became known as the "Health IT Czar" under the direction of the Secretary of Health and Human Services (initially Tommy Thompson and then Mike Leavitt), initiated a number of programs to accelerate the adoption of health information technology and to begin to develop an effective and efficient National Health Information Network (NHIN).

1. The Healthcare Information Technology Standards Panel (HITSP), sponsored by the American National Standards Institute(ANSI), to develop, prototype, and evaluate a harmonization process for achieving a widely accepted and useful set of health IT standards that will support interoperability among health care software applications, particularly Electronic Health Records (EHRs).
2. The Certification Commission for Health Information Technology (CCHIT) to develop criteria and evaluation processes for certifying EHRs and the infrastructure or network components through which they interoperate.
3. The Health Information Security and Privacy Collaboration (HISPC), sponsored by RTI International, to assess and develop plans to address variations in organization-level business policies and state laws that affect privacy and security practices which may pose challenges to interoperable health information exchanges.

In late 2005, HHS also awarded $18.6 million to four groups of health care and HIT organizations to develop prototypes for the NHIN architecture. The four consortia are led respectively by Accenture, Computer Science Corporation (CSC), International Business Machines (IBM) and Northrop Grumman. Each consortium is a partnership between technology developers and health care providers in three local health care markets, and each group is developing an architecture, and a prototype network for secure information sharing among hospitals, laboratories, pharmacies and physicians in the three participating markets. Additionally, all four consortia will work together to ensure that information can move seamlessly between each of the four networks to be developed, thus establishing a single infrastructure among all the consortia for the sharing of electronic health information. Notable sites selected for implementation of these demo projects include the MA-HealthShare, the Indiana Health Information Exchange (IHIE), and Mendocino Health Records Exchange. These 3 projects were designed and developed using a single standard "Common Framework" which had recently been conceived by the Markle Foundation (with additional funding from the Robert Wood Johnson Foundation). Other notables include the Taconic Health Network and Community (THINC), the West Virginia eHealth Initiative, and the University Hospitals Health System (in Ohio). In contrast to the Markle "Common Framework", these projects were modeled on a separate standard called Integrating the Healthcare Enterprise (IHE) which was developed under the leadership of the Healthcare Information and Management Systems Society (HIMSS) and has been adopted by many HIT vendor communities.

While in their infancy and clearly encumbered with several important unanswered questions regarding such topics as liability, security, privacy, and sustainability; the above initiatives, in conjunction with posturing by the Bush administration, led to the initiation or augmentation of several municipal and private foundation grant sponsored programs to foster local CDE/HIE/RHIO development. (NOTE: These terms are largely interchangeable and stand for Clinical Data Exchange, Health Information Exchange, and Regional Health Information Organization respectively). These efforts are generally directed toward two synergistic goals: 1) improve health care locally via the provision of valuable historical patient information at the point of care and 2) further the development of a larger regional or national infrastructure (such as the NHIN) which could lead to public health benefits in the form of improved research, quality metrics, and surveillance. The State of NY, under Governor Pataki, followed suit with the creation of a statewide grant program under the New York State Department of Health (DOH) and the Dormitory Authority of the State of New York (DASNY) called HEAL NY. Phase 1 of this grant program appropriated $53 million for HIT projects specifically focused on the implementation of interoperable clinical IT systems to enable the sharing of clinical information amongst unrelated health care provider entities.