Common Framework Is 'First Step' Toward Interoperability

Some of the top players in e-health development came to Washington, D.C., on April 6 to unveil a Common Framework for pushing e-health interoperability forward. But nearly everyone speaking at the press conference said unbidden that the Framework was some variation of "a first step." Zoe Baird, the president of Markle, went as far as to say, "We have a really long way to go together. I really can't tell you the healthcare system has been transformed as a result of what we are releasing today."

The Framework was developed by Connecting for Health, a group of 100-plus organizations that included representatives of the four IT contractors selected by the Department of Health and Human Services to develop prototypes for a Nationwide Health Information Network (NHIN) architecture, physicians, health systems, federal officials, and others. The Framework includes technical documents and specifications, testing interfaces and code, as well as a companion set of privacy and security policies and model contractual language to help organizations interested in information exchange move quickly toward the necessary legal agreements for private and secure health information sharing. So it is essentially a template.

Mark Frisse, M.D., director of regional informatics programs at the Vanderbilt Center for Better Health, told the audience crammed into a small conference room at the Ronald Reagan Building and International Trade Center two blocks from the White House that the Framework had allowed the city of Memphis to accelerate by six months to a year its efforts at connecting all residents to an e-health system. "The framework was just that -- a great framework to organize discussions, a great set of references, and a great 'first cut' at the data-sharing agreements," Frisse said in a follow-up interview. "Without this, we would have spent far more time just trying to make sure we discovered all of the issues. In addition, we could have focused too intensively on one issue, not recognizing a whole body of concerns that must be addressed."

In the technical realm, the Framework architecture recommends use of a record locator service (RLS), an index that identifies where specific patient records are kept, but not what information the records contain. Those records would remain with the physician or hospital who created them and would not be shipped to a third party. Elements of that record could move around, but only with the consent of the patient.

That emphasis on patient empowerment won the endorsement of Janlori Goldman, director of the health privacy project, a Washington, D.C., advocacy group that has played a high-visibility role in the political debate over issues such as HIPAA information privacy. "The fact that the Framework avoids the use of a unique health identifier for every person is a major advantage," she said.

The Framework was tested in 2005 in Boston, Indianapolis, and Mendocino, Calif. The teams in each city, composed of technology vendors and health systems, demonstrated that completely different 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.

Daniel Garrett, vice president and managing director of global health solutions, Computer Sciences Corporation, one of the NHIN contractors, said the Framework's publication means the four NHIN consortia "will compete on projects, but we won't compete on policies."
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