NHIN standards for health data exchange ease physical storage burden

Nationwide Health Information Network standards let providers exchange patient records and images electronically, eliminating the need to fill file cabinets.

According to a congressional conference report released Feb. 12, 2009, the Social Security Administration (SSA) "has a vital interest in exploring how health information technology can be integrated into the disability process through the widespread adoption of electronic medical records." Congress may not have known it at the time, but Nationwide Health Information Network (NHIN) standards are playing an increasingly important role in the way the SSA and other health care providers share EMRs -- and that, in turn, is reducing the need to store hard copies of images and paper records for long periods of time.

As part of the American Recovery and Reinvestment Act of 2009 (ARRA), Congress appropriated $1 billion to the SSA -- $500 million to replace the 30-year-old SSA National Computer Center and $500 million for health IT resources to facilitate the adoption of EMR systems in disability claims. Fifteen percent of Social Security taxes are allocated to disability claims, making the SSA one of the largest disability insurers in the world, as well as the keeper of the world's largest medical image repository.

In the past, when X-ray film was lost or damaged there was no choice but to duplicate the procedure; that would delay the availability of information and leave patients frustrated. On the other hand, it is very difficult to lose an image stored in a picture archiving and communication system (PACS). The image can be copied and electronically transferred many times without degradation. It can be stored for minimal cost and is easily retrievable. Transferring PACS images through NHIN standards is therefore an important step in lowering the cost of health services in the United States.

To that end, for the past year the SSA has been running tests to obtain EMRs and PACS images from sites in Virginia and Massachusetts for processing disability claims through the NHIN. The SSA has found that disability claims filed electronically take less time to process than claims filed on paper.

The NHIN enables a common, Web-based platform for health information exchange by providing the services, protocols, standards, specifications and legal agreements for the secure transmission of health information. An NHIN Workgroup, which is part of the Health IT Policy Committee chaired by the Office of the National Coordinator for Health Information Technology (ONC), is drafting recommendations to extend the use of NHIN standards for health information exchange.

The SSA announced on Feb. 1 the extension of claims processing using EMRs and NHIN standards to 15 organizations. These private groups, listed below, received a total of $17.4 million in ARRA funds to set up their systems.

California Regional Health Information Organization
San Francisco $1,625,000
Kingsport, Tenn.
Center for Healthy Communities, Wright State University
Dayton, Ohio
Central Virginia Health Network/MedVirginia
Richmond, Va.
Community Health Information Collaborative
Duluth, Minn.
Douglas County Individual Practice Association
Roseburg, Ore.
EHR Doctors Inc.
Pompano Beach, Fla.
Lovelace Clinic Foundation
Albuquerque, N.M.
Marshfield Clinic Research Foundation
Marshfield, Wis.
Memorial Hospital of Gulfport Foundation Inc.
Gulfport, Miss.
Oregon Community Health Information Network
Portland, Ore.
Regenstrief Institute Inc.
Science Applications International Corp.
McLean, Va.
Southeastern Michigan Health Association

SSA Commissioner Michael J. Astrue estimated that more than 15 million paper request packages are sent to health care providers annually; this represents the most time-consuming portion of the disability process, he said. Allowing providers to use their own computer systems to perform the electronic transfer reduces the amount of time it takes the provider's staff to process paper records manually. It also cuts the cost and time it takes for the SSA to make a decision about a disability claim.

NHIN standards come with several key benefits

The NHIN Workgroup has identified several other benefits of using this infrastructure for information exchange:

• Improved care quality and lower health disparities.

• Lower costs resulting from inefficiency, errors, inappropriate or duplicative care, and incomplete information.

• Improved coordination among hospitals, laboratories, physician offices and other entities.

• Faster response to threats and emergencies.

Through $560 million in HITECH Act funding, the ONC worked with 19 other federal agencies to develop open source software known as Connect to help health care organizations exchange information at the local and national level using Health Level Seven International (HL7) and NHIN standards. Connect was originally set up for federal agencies to support health-related missions. It is now available to any organization for health information exchanges that use national standards; in fact, the SSA is using Connect to exchange data with the private organizations listed above.

As the Connect community portal explains, the software has three components that enable health care information exchange. (All the components and documentation are provided as downloads on the Connect website.)

• The Core Services Gateway, which implements NHIN Interface specifications, helps providers locate patients at other organizations, request and receive documents associated with the patient, and record these transactions for subsequent auditing. This component also authenticates network participants, authorizes the release of medical information and tracks consumers' preferences for sharing their information.

• The Enterprise Service Components provide default implementations of enterprise components required to support electronic health information exchange. These include a Master Patient Index, XDS.b Document Registry and Repository, Authorization Policy Engine, Consumer Preferences Manager, and a HIPAA-compliant Audit Log.

• The Universal Client Framework contains applications that can be adapted to create edge systems, reference systems, test systems or demonstration systems on top of the existing Connect platform.

Transferring PACS images through NHIN standards is an important step in lowering the cost of health services in the United States.

Connect is one of the smartest initiatives to emerge from Washington. Usually each government agency develops its own gateway in a nonpublic bubble, and the final product is little more than a bunch of nonfunctioning links. In this case, however, 20 federal offices defined their needs, jointly developed a system through the Federal Health Architecture, tested its connective features and made it available for any public health care organization within a year's time.

As a result, every health care organization in the nation now has access to a system through which medical information follows an individual, clinicians can have readily available medical data and duplicate medical procedures can be kept to a minimum. And thanks to Connect and the adoption of NHIN standards, providers can retrieve and store data digitally, without information piling up in bulky file cabinets.

About the author
Al Gallant is the director of technical services at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. Let us know what you think about the story; email [email protected].

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