Patients Await Ability to Share Records as NHIN Starts Pilots
An audience gathered for technical and policy updates on the Nationwide Health Information Network and the open source Connect software developed by more than 20 federal agencies got a personal view Monday of the problems that health information exchange is supposed to address. Sarah Wade, wife of retired Army Sgt. Ted Wade, spoke of the difficult medical journey she’s undertaken with her husband since he was severely injured in Iraq in 2004. In the past five years he’s been cared for at 15 facilities and is currently eligible for care through three government agencies -- the Departments of Defense, Veterans Affairs and Health and Human Services -- and through two government insurance programs -- Tricare and Medicare, she said. Yet none of those government agencies, and none of the civilian providers he sees, can share information or access each other’s records, she said.
Sign up for a free preview to unlock the rest of this article
Timely, relevant coverage of court proceedings and agency rulings involving tariffs, classification, valuation, origin and antidumping and countervailing duties. Each day, Trade Law Daily subscribers receive a daily headline email, in-depth PDF edition and access to all relevant documents via our trade law source document library and website.
Because three of her husband’s doctors want blood work on a regular basis -- which used to mean his blood was drawn every month and he was becoming anemic -- Wade now e-mails the neuropsychiatrist to alert him that the Walter Reed Army Medical Center endocrinologist is ordering blood work and to ask what tests he'd like to add. She then asks the Walter Reed doctor to add the appropriate tests. When the results come back, the case manager cuts and pastes the information into an e-mail to Wade, who then forwards it to the neuropsychiatrist, she said.
The tragedy of the lack of communication, aside from the duplication of time and resources, is that her husband’s doctors can’t fully capitalize on the capabilities of the DoD’s AHLTA or VA’s VistA electronic health records systems, Wade said. She also worries about what would happen if he had to go to the emergency room and she wasn’t there to inform the doctors of his medical history.
The NHIN began limited production pilots earlier this year, said Ginger Price, NHIN program director at HHS. Later this year its partners plan to demonstrate exchange, she said. She said the notion of personal health records somehow connecting to the NHIN is on the table, although the “how” has yet to be worked out.
Patient matching is an ongoing challenge, HHS speakers said. It’s a huge policy challenge, said Jodi Daniel, director of the Office of Policy and Research in the Office of the National Coordinator (ONC) at HHS, in part because Congress at first indicated it wanted a national patient identifier, then directed agencies not to spend any federal money on a national identifier after privacy concerns were raised. She said the agency will have a paper this summer that will catalog the various ways Health Information Exchanges match patients with the correct information, but the paper doesn’t pick a “best” way.
The office is also continuing work on a data use and reciprocal service agreement, Daniel said, which would provide the common legal framework for using the NHIN. In addition, it’s thinking of the future governance of the NHIN, the management of which will eventually exceed the grasp of the ONC, said John Glaser, senior special adviser in ONC.
Much of the morning discussion turned back to the Recovery Act and electronic health records. National Coordinator David Blumenthal told the group it’s “inconceivable” to him that in 10 years using an EHR won’t be as standard for doctors as any other piece of equipment. Doctors who decide they'd rather take the penalties than invest in EHRs are betting that health IT won’t become a necessity. “I think that, frankly, is a miscalculation,” he said. Small practices that think the incentives in the Recovery Act aren’t sufficient should consider that there was no financial help before February, he said. “From the standpoint of Congress, I suspect they view ($45 billion) as a pretty substantial offering,” he said. Federal CTO Aneesh Chopra said he expects new products to arrive in the marketplace as developers think of what health IT could do rather than think of it as mere hardware or software.