U.S. Piloting New Health Care Records Program - 02/03/2011

U.S. Tries Open-Source Model for Health Data Systems

The government’s lofty vision of bringing health care into the computer age to improve care and curb costs will come to nothing, unless some mundane technical problems can be solved.

A basic challenge is for doctors, hospitals, patients and public health authorities to be able to easily and securely share information — things like a person’s vital signs, diagnosis, lab tests and drugs prescribed. A fancy electronic patient record, unconnected, is just an expensive way to capture data.

The government’s office of national health information technology announced on Wednesday an important step toward the goal of widespread sharing of health data. Two pilot projects, the government said, have successfully used new government-endorsed Internet-based tools for exchanging health information among institutions.

The two pilot projects are in Minnesota and Rhode Island, and the information includes immunization records sent to a public health authority and patient data sent from general practitioners to specialists. Other pilot projects will soon be started in New York, Connecticut, Tennessee, Oklahoma and California.

The billions of dollars in planned federal incentive payments over the next five years are meant to spur the adoption of electronic patient records. But the investment will pay off only if the data is shared, so everyone in the health care system — including patients — can make smarter decisions about care and preventive health measures. Getting many different health care providers and suppliers of specialized software to agree on how to do that is no simple task.  

The government did not do it by fiat, but by taking a page from the open-source model of collaboration. Several dozen companies — competitors in the health information technology market — and organizations were brought together in an initiative, calledthe Direct Project, begun last March.

The companies participating in the standard-setting effort included Allscripts, Cerner, Epic, General Electric, Google, IBM, Intel, Microsoft, NextGen, Siemens and Surescripts.

The Direct Project, officials say, is not a conventional standards-setting group with committees, meetings and rounds of voting. "We won’t see the rapid innovation we want to see using the traditional way,” said Dr. Douglas Fridsma, head of standards at the federal health information technology office.

An open-source pioneer, Brian Behlendorf, was recruited as an adviser on how to set up and govern the project. Mr. Behlendorf, now the chief technology officer for the World Economic Forum, was a creator the Apache Web server, one of the most widely used open-source software programs.

The health project’s work was guided by a principle Mr. Behlendorf calls "do-ocracy” — convince people not with words, but with working code.

The solution the group agreed to is essentially Internet-based e-mail and public key encryption technology, tailored for health care. Using the new standard, no personally identifiable information is in the header, where any recipient might read it. The new technology allows for attachments, but an attachment can only be opened by the intended recipient.

"It builds on proven technology that people are accustomed to using,” said Arien Malec, coordinator for the Direct Project.

For health care technology companies, the data-sharing standards, experts say, should stimulate the market for electronic health records and allow them to focus their efforts on making their individual offerings more affordable and easier to use.

"They don’t have to tie up engineers working on data-sharing and hand-crafting software interfaces,” said Dr. Farzad Mostashari, deputy national coordinator in the federal health information technology office. "That’s not where they want to compete.”

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