History of Health Information Exchange

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).

Specifically, in 2005, the Department of Health and Human Services (HHS) created an oversight committee named the American Health Information Community (AHIC) and awarded three contracts totaling $17.5 million to the following public-private groups: 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 exchange

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.

NSLIJ in conjunction with NUMC, SNCH, the NS-IPA, Nassau and Suffolk DOH's and Cold Spring Nursing Home responded to the RGA with a proposal to develop a Long Island Patient Information eXchange (LIPIX). LIPIX was awarded $5 million; the equivalent to the top award in the state. As outlined in its formal mission statement LIPIX will accomplish the following four goals:

• Design and implement an HIT project that will develop community-wide clinical data-sharing, by creating and operating a Clinical Information Data Exchange.
• Assist in building an infrastructure in New York State to share clinical information among patients, providers, payers and public health entities.
• Support the statewide adoption of systems compatible with the Strategic HIT Plan that is being developed at the federal level.
• Be able to be a part of the planned national network for sharing patient data.

LIPIX's basic vision is to create the foundation for a Long Island based RHIO with an emphasis on achievability, scalability, and sustainability. LIPIX is similar to many other RHIO projects (including those planned by other HEAL NY winners) in that it intends to implement a hybrid architecture which consists of a central Record Locating Service (RLS) with federated access to clinical information. That is, clinical information remains behind the firewalls of the participating entities only to be shared at the time of a specific request from a provider at the point of care. LIPIX, however, differentiates itself from other RHIO projects in its emphasis on providing rapid and concrete value to participating organizations via the implementation of a federated Master Patient Index (MPI). This meta-MPI which will not only allow for the identification of patients across multiple institutions to support regional data interchange, but will also provide extensive patient indexing and identification services to the individual member organizations for patients seen within those organizations.