Get Ready For A National Network

The success of the federal government’s plan for a national health information exchange rests, to a large extent, with IT pros.
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Mike Restuccia, Penn Medicine

Providing clinicians across the country with on-demand healthcare information is often difficult, if not impossible--even though it could mean the difference between life and death. This situation will change in the next few years as the federal government gets ready to launch a healthcare information superhighway known as the Nationwide Health Information Network (NHIN). It will give caregivers Web-based access to patients' electronic medical records, no matter where they are.

The federal government is encouraging the establishment of regional and state health information exchanges (HIEs). It's providing funding to help states and healthcare organizations develop these networks. It's also establishing national standards to interconnect these exchanges so doctors using one HIE can share data with colleagues in a different state. States are at varying levels of preparedness in being able to support NHIN. Some already have an HIE in operation while others are just getting started.

I'm a strong supporter of the concepts underlying NHIN, such as electronic medical records. I've seen firsthand the benefits of EMRs. Nearly 1,800 physicians at the University of Pennsylvania Health System use a common EMR, and the physician portal we developed supports nearly 15 million clinician visits per year. Our physicians are virtually unanimous that electronic records have improved quality of care and patient safety.

We're planning to exchange information with other healthcare providers through state-level initiatives and also with other health systems that use the same EMR system we do--Epic's EpicCare Electronic Medical Record. Providing caregivers access to key clinical patient information will not only improve patient care, but reduce errors and drive costs out of the healthcare system.

Linking all the local, regional, and state exchanges together on a national network has the potential to improve operational efficiencies, reduce waste, and enhance physician and patient satisfaction. But its success will depend on the abilities of IT professionals to deal with several challenges.

First, there's the cost. Federal funds will offset some of this, but individual institutions must fund the rest. For example, they'll have to develop and populate standardized EMRs; ensure that the right data is captured; provide network connectivity to the state network; and comply with national testing and documentation requirements.

In addition, CIOs who've been working on regional health exchanges must broaden their focus and reach out to colleagues across their states. Participation in state-level governance and standards committees is critical to the success of these efforts.

National standards bring in an additional layer of complexity. Those working at the state and national levels must consider the format in which patient records are created, how they're secured, how patients are identified, and provide a standardized vocabulary for referring to data. Setting national standards won't be easy, and we can expect differences. We should aim to set appropriate standards while not losing sight of unique circumstances in each state. Vision, consensus building, clear communication, technical acumen, persistence, and teamwork will all be necessary.

Trying to be all-inclusive could slow progress and might even do more harm than good. For example, attempting to include too much data could make it harder to find information in an emergency.

With the technology now available to gather, store, and share patient information virtually instantaneously, the prospects for coordinated, safer, and more thorough care have never been better. HIEs will play a major role in making this happen.

Michael Restuccia is VP and CIO of Penn Medicine, a $3.8 billion-a-year academic health system with nearly 2,100 physicians providing services to the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Pennsylvania Hospital, and more than 250 ambulatory practices.

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