There's consensus that the architecture of a nationwide health information network (NwHIN) is shifting. But there's less agreement as to whether this change is a favorable development.
That's the upshot of a panel of experts, addressing the issue in a roundtable discussion held this week by the National e-health Collaborative, a public-private partnership established by a grant from the Office of the National Coordinator for Health IT (ONC) to foster national health information exchange (HIE).
According to the panel, the NwHIN originally was designed to operate via a hub-and-spoke model, using Regional Health Information Organizations (RHIOs) acting like public utilities and offering universal access for the public good. But under the Obama administration, the model for the NwHIN is more internet-based and involves private enterprise, said Leslie Lenert, professor of medicine and biomedical informatics at the University of Utah. (Lenert recently had a well-publicized article published in the Journal of the American Medical Informatics Association on the subject.) The shift is based, not on science, but on "political leadership" and may limit opportunities to subsidize activities for the public good, such as patient record locator services, he warned.
But others didn't see either model as being mutually exclusive. "We don't want to throw out what we've done in the past," noted Brian Ahier, a renowned health IT blogger and president of Gorge Health Connect, Inc. "We can use the hub and spoke combined with the internet," he said.
Claudia Williams, director of ONC's state HIE program, agreed. "The current rates of exchange are terribly low," she said. "We need to make all different forms of exchange. All of them will exist side by side. Our job is to reduce cost, complexity and risk."
Many of the panelists were more concerned with issues like data hoarding and lack of standardization of electronic health records as impeding HIE, not the model itself.
"I don't know of any technology better for the public good than the internet," David Kibbe, senior advisor to the American Academy of Family Physicians, said.