Privacy key for US electronic health records

US health information technology interests have expressed great concern about guarding the privacy of patient data in building a National Health Information Network (NHIN) in America, Neil Versel reports from Dallas.

At the annual Healthcare Information and Management Systems Society (HIMSS) annual meeting in Dallas last week, US national health information technology co-ordinator Dr David Brailer (right) revealed some of the broad themes from a recent public request for information on the proposed NHIN.

"Privacy was on the forefront of nearly all responses, focused on how the NHIN should ensure that patients have control over who has access to their data," Dr Brailer said in his keynote address on the final day of the conference.

"Many respondents recommended that the NHIN be a virtual network that leverages the public Internet. Security to ensure protection of patient data was almost universally mentioned," Dr Brailer added.

A significant number of the more than 500 responses received called for a regional approach to building a national network and suggested that the US government must work with states and the private sector to finance health information technology on a wide scale, Dr Brailer said.

The Office of the National Co-ordinator of Health Information Technology (ONCHIT), which Dr Brailer heads, will develop a strategic plan from the information gathered. Per an April 2004 executive order from US President George W. Bush, ONCHIT will release its road map within the next two to three months.

Bush has stated the goal of interconnecting healthcare information for the majority of Americans by 2014. Dr Brailer said that the forthcoming report should “sharpen our focus” on reaching that ambitious goal in a nation of 295 million people.

"We have a long road ahead, but we have real urgency. Time is running short," Dr Brailer said. “We can’t wait until the end to make the tough decisions to get the results we all want. We need to attack the core issues and barriers right now."

With this in mind, Dr Brailer specifically said that the strategic plan will include EHRs, interoperability and the streamlining of health IT within the federal government.

"If interoperability is not solidified and built into EHRs, a generation of investment will be lost and an opportunity for fundamental improvement in care delivery will be gone," he cautioned. He also said that standards for interoperability “require immediate attention” from the private sector as well as from government.

Dr. Brailer further indicated that planning will be divided into three areas: Legal, regulatory, policy and financial issues; technology and architecture; and business operations, including governance and oversight.

Still to be determined is who will pay for proposed regional health information organisations (RHIOs) that Dr Brailer says will form the backbone of an interconnected national system in the United States.

Currently, hospitals and medical offices are footing the lion’s share of investment in healthcare technology in the US, but public and private health plans reap the greatest financial rewards from efficiency gains and quality improvements that result from IT.

"The biggest problem is the disconnect between those who invest time, money, blood, sweat and tears and those who get the benefits," explained Dr Manuel Lowenhaupt, national practice leader in clinical transformation for the US consulting operations of Capgemini.

Some at HIMSS, including HIMSS Analytics chief executive David Garets, expressed doubts about the viability of the RHIO concept itself. "I don’t think that scepticism is inappropriate at the moment," Dr Brailer said.

"Regardless of what we call them, they are happening," Dr Brailer noted, however. He said that more than 100 first-generation RHIOs are in progress and that at least another one hundred are being planned.