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Information Exchanges Let Doctors Share Patient Data Efficiently

Several new networks are being launched across the country, and while they vary in size, scope, and clientele, the goals and challenges are similar.

As more doctors and hospitals make use of electronic health records, the next step in healthcare's transformation will be to ensure that doctors and other healthcare providers can exchange of patient data.

Multifaceted healthcare organizations are setting up internal data exchanges so their affiliated doctors, outpatient facilities, and hospitals can easily share data. But larger health information exchanges are also being launched that let unaffiliated providers within a state or region share patient information. All of these efforts potentially play a role in the federal government's vision of building a national health information network that would serve as a "network of networks."

Over the last decade, there have been dozen of efforts to create health information exchanges--even before President Bush in 2004 set the goal for most Americans to have e-medical records in ten years, and before President Obama signed the American Recovery and Reinvestment Act's $20-billion plus stimulus program for health IT into law in February.

Some of those projects ran out of funds in part because of business models that didn't make clear who pays to keep them running. In addition, healthcare providers have raised concerns about having to support a data network in which they share patient information with competing doctors.

However, recent efforts to create health information exchanges appear more promising, taking new approaches to data sharing. Also, federal and state grants tied to the stimulus legislation are providing funding for some of these new exchanges. And "meaningful use" criteria for e-health record systems being developed by the Department of Health and Human Services will likely require healthcare providers to electronically share certain data with public health and other agencies.

Statewide Network Goes Live

Maine went live in July with HealthInfoNet, the largest statewide health information exchange in the country to date. HealthInfoNet was launched in 2005, financed by grants and government funds. It will soon receive matching funds provided federal stimulus spending, and next year, healthcare providers who use the exchange will pay subscription fees.

The exchange has cost about $8 million to build so far. It will cost another $12 million to extend it to more rural providers and about $6 million a year to operate. The state of Maine has allotted $1.7 million for the exchange in its 2010-2011 budget to help get more healthcare providers on HealthInfoNet.

About 700 clinicians are using the network to share data on 560,000 of Maine's 1.3 million population. By next summer, it's expected that 1,200 to 1,500 clinicians will be using the network. Fifteen of the 39 hospitals in the state are connected, and one primary care organization has three locations contributing data to the Oracle data repository.

"Maine has as many people as one borough of New York City," says Devor Culver, executive director of HealthInfoNet. "Small has advantages."

Medical images aren't part of the exchange yet. Nevertheless, the data repository is expected to grow to 1 terabytes by the end of its first year of operation.

Maine is using a central data repository model, rather than the peer-to-peer, federated model used in some exchanges. In the federated model, data stays at the source, and doctors access it when needed. Physicians using those systems have raised concerns about being able to get the most up-to-date patient data, Culver said, because a clinician providing the data can block others' access to it or to the most recent versions of the data. With a centralized repository, all providers submit the same key data sets, and everyone has access to the data with faster response times, Culver said.

With federated models, "if there's a request for information, it could be blocked," preventing a doctor from accessing vital patient information from another healthcare provider," said Janie Tremlett, senior VP at Concordant, an IT services firm that supplied consulting and training for the HealthInfoNet project.

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