People say the darnedest things. Take Ken Olsen, whose cap sports such feathers as founding Digital Equipment Corporation, membership in the National Inventors Hall of Fame and receiving the National Medal of Technology. In 1977, the information technology guru declared famously, �There is no reason for any individual to have a computer in his home.�
Legions have enjoyed chuckling ironically at Olsen�s wide-of-the-mark assessment of where our society was (or wasn�t) heading. But today, another of his notable IT quips��The nicest thing about standards is that there are so many of them to choose from.��would make at least two key government players prick up their ears and shout, �This isn�t a laughing matter!�
Why? Because creating well-defined, unified standards for health IT interoperability is currently of the utmost importance for both Mike Leavitt, secretary of the Department of Health and Human Services, and Dr. David Brailer, head of the Office of the National Coordinator for Health IT (ONCHIT).
The federal government deems a standardized, interoperable health IT system crucial to the nation�s welfare, saying it will help reduce medical errors, improve quality, lower costs and eliminate paperwork, and wants to be a first-mover in getting it up and running. The strategy calls for federal agencies to collaborate with private payers in developing and adopting an architecture, standards, certification process and a method of governance.
Secretary Leavitt has said, to paraphrase Kevin Costner, if we build it, the public sector will come. He�s reminded many audiences that the federal government foots 46 percent of the nation�s health care bill, telling one gathering at the Stanford University School of Medicine, �If we adopt standards, it will move the market.�
Brailer, whom some have dubbed the national health IT czar, echoes this. �We�re not going to put out a mandate. We�re going to use the purchasing power of the government to make sure this happens.�
The bud of a Nationwide Health Information Network (NHIN) blossomed after an Executive Order of April 2004 essentially called for such a system to be up and running and for every American to have an electronic health record (EHR) within a decade. In November of the same year, ONCHIT issued a request for information seeking public comment on how widespread interoperability of health IT and health information exchange could be achieved through NHIN. As many as six contracts to develop prototypes and operational models are to be awarded by Sept. 30, 2005.
Two key components of this massive work in progress are the Federal Health Architecture (FHA) and the American Health Information Community (AHIC).
�The FHA is the health line of business initiative that was launched by the original e-gov efforts that go back maybe six or eight years,� Brailer explains. At first, it was intended to create a framework to allow all health care concerns to communicate and collaborate to expedite people�s access to health-related information and services; now, Brailer says, �It�s evolved toward being a mechanism by which standards and common architecture are agreed to across the federal sphere involved in health care.�
AHIC, or the Community, is a collection of stakeholders charged with advising HHS on how to make health records digital and interoperable while assuring iron-clad security and unsullied privacy. On Sept. 13, 2005, Secretary Leavitt selected 16 AHIC commissioners; they range from Steven S. Reinemund, chairman and CEO of PepsiCo, and Craig R. Barret, chairman of Intel Corporation, to Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, and Dr. William Winkenwerder Jr., the assistant secretary of defense.
�My aspiration is for the Community to provide stakeholders with a meaningful voice in a federal process that will ultimately shape health care for generations,� Leavitt said in an HHS press release. The first meeting is scheduled for Oct. 7, 2005, in Washington, D.C. It will be open to the public.
Brailer says these government initiatives are continuing to evolve. The FHA, for example, �used to be really the only game in town,� he explains. �Now it has a home within [NHIN]. I think that steps up the whole thing one order of magnitude. It doesn�t push the FHA aside�it gives [it] a mechanism for having substance to grind through it.�
Because the parties involved are still finding their sea legs, it�s not quite certain how the adoption of standards and interoperability�as well as other practical considerations, particularly privacy and security issues�will affect federal agencies and their employees.
David Powner, director of IT management issues at the Government Accountability Office, says IT purchasing could be one area to watch.
�If you�d look at any investments in technology, whether it�s through HHS, [Veteran�s Affairs] or DOD, [agencies would have to] align those investments with this future architecture and then also to the standards that would fall out of that architecture.�
Dr. John Loonsk, acting director of the New National Center for Public Health Informatics (NCPHI), an arm of the CDC that provides national leadership in the application of IT in public health, says that the development of NHIN and other federal health IT systems is creating demand for a new breed of government employee.
�There�s a new area�a new discipline, if you will�for federal employees,� Loonsk says. They must have �medical knowledge, public health knowledge and also be able to know enough about the technology to be able to bridge those disciplines. It�s not just about programming software anymore.�
Just how useful a standardized, interoperable national health care information network would be was illustrated in the days and weeks after Hurricane Katrina decimated New Orleans and other Gulf Coast communities. Doctors couldn�t access patients� medical histories�many of which were at best hundreds of miles away or at worst destroyed�or verify prescriptions, and patients couldn�t provide accurate, up-to-date information.
�People are injured and doctors need information acutely,� Brailer says of a disaster scenario. �People become mobile and we have to be able to have information to follow them, so that�s what we�re focused on now as a crash effort because this infrastructure�s not up and running. Will we learn things from it? Absolutely. It�s creating a great test for whether or not the ideas and plans we�ve laid out really could past muster.�
The Centers for Disease Control and Prevention is getting an information technology facelift of sorts, a reorganization that has created four new coordinating centers and two national offices to address 21st-century health concerns.
The formation of the Coordinating Center for Health Information and Services (CCHIS) and the National Center for Public Health Informatics (NCPHI) in April 2005 �is a recognition of the importance of health IT in public health,� says Dr. John Loonsk, acting director of the NCPHI. Both were created to improve coordination and communication�within the CDC itself and to the public.
According to Loonsk, this means �making sure that the people who need information to carry out public health purposes have access to that information. It�s also about the systems that need to support that activity. And then it�s also about how [we] can do more from a public health standpoint on the basis of what the technology affords.�
The CDC uses the Internet as a method of intercommunication. Loonsk says this requires scrutinizing the systems used to exchange data to make sure they are able to meet the demands of protecting public health. �It�s [about] the systems� capabilities as well as their ability to work and share information appropriately and securely across the Internet.�
Being able to coordinate and communicate with state and local health departments is another concern Loonsk is addressing. He says the NCPHI is working with those partners to help define the specific information systems that need to be in place to support public health practice, as well as developing software solutions that can help them meet their goals. �We�re also working with them to make sure that the systems that they develop all fit together in this broad network that is the public health information network.�
Like the initiatives for a National Health Information Network coming from the Department of Health and Human Services, the reorganization at the CDC is a work in progress. But Loonsk is full of energy and optimism for what the future holds. �It�s an exciting time. As in other industries, if you take advantage of the technology, you can do so much more; you can extend the reach of what everyone does.�
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