HIE Pioneers to Securely Share Data

Geisinger, Mayo, Others Hope to Provide a Model
Five leading healthcare organizations are collaborating to demonstrate the secure national exchange of health information, hoping to pave the way for others, says James Walker, M.D., of Geisinger Health System.

The organizations that formed the Care Connectivity Consortium plan to develop policies, procedures and tools that others can use for health information exchange, explains Walker, Geisinger's chief health information officer.

In addition to Geisinger, the consortium participants include Mayo Clinic, Kaiser Permanente, Intermountain Healthcare and Group Health Cooperative.

The mission of the consortium, Walker says in an exclusive interview (transcript below) with Howard Anderson, executive editor of HealthcareInfoSecurity, is "to work among the five of us to establish simple, robust, safe, private methods for sharing patient information with each other. We believe our ability to share information among the five of us will create a usable, implementable standard that other organizations will find attractive."

Consortium members hope their efforts will help cut the time it takes to enable "all healthcare organization in the United States to share information so that patients get better care where they need it and when they need it," Walker says

The consortium will use all available standards, including the Nationwide Health Information Network standards. By jointly implementing standards and documenting the process, the consortium hopes to give other organizations "the confidence that if they implement the model that we've created, they'll be able to interoperate easily," Walker says.

Walker also notes:

  • The multi-year project will be conducted in phases, starting out with the simplest exchanges of information and progressing to more complex data sharing.
  • Participants will "make sure we maintain a very high level of security so that patients' records genuinely are more secure next year than they were five years ago."
  • In addition to implementation guidelines, the consortium will create several applications, including one that provides a method for identifying patients and linking them to the right records from multiple organizations. All the technologies will be made available in the public domain.

Walker has been chief health information officer at Geisinger Health System since 2001, providing executive leadership on clinical information systems for the Pennsylvania integrated delivery system.

A physician specializing in internal medicine, Walker formerly was senior clinical information architect at the M. S. Hershey Medical Center and Penn State College of Medicine.

HOWARD ANDERSON: Geisinger is one of five organizations that recently launched the consortium. Please explain the mission of the consortium, and how did the five member organizations get together?

JAMES WALKER: The mission of the consortium is to work among the five of us to establish simple, robust, safe, private methods for sharing patient information with each other. We believe that our ability to share information among the five of us will create a useable, implementable standard that other organizations will find attractive. And we hope, by doing that, to speed the time when all healthcare organizations in the United States can share information so that patients get better care where they need it, when they need it, in a secure and safe way.

All of us have extensive experience with sharing information across the regions and states where we operate, and it seemed to us that it made sense for the five of us to do this together. We all agree that it needs to be done, and we thought if we did it together, we could do it in a practical, cost-effective, easily reproducible way.

Developing an HIE Standard

ANDERSON: Will the consortium eventually be open to other members, and how long will the project last?

WALKER: The project is projected to have a number of phases. So we're starting simple, getting the basics of working out our working arrangements with each other, and over several years, we intend to move from simple identification of patients and sharing basic information to the ability to share more and more information in more and more useable forms. The consortium was designed from the beginning to be extensible to every healthcare organization in the United States. We believe that is in our interest, but also something that we can give back to the country to create what we hope will become a simple, implementable standard for sharing information.

Privacy and Security

ANDERSON: In announcing the consortium, the members stressed that patient privacy and security are overarching priorities, so how will the consortium go about demonstrating the secure exchange of health information on a national level?

WALKER: Well, this is something that all of us take very seriously and have for years, so that we, and I'm sure all of the other members of the consortium, meet and exceed the information security and patient privacy requirements and all state and national standards. And so that's part of the work of the consortium - to make sure that as we share the information together we maintain that very high level of security so that patient's records generally are more secure next year than they were five years ago.

NHIN Standard

ANDERSON: Will the consortium be using the Nationwide Health Information Network standards and other standards as members exchange data? And can you give us a few examples of the kinds of data exchanges you will be accommodating, at least at first?

WALKER: We intend to use every applicable national standard.

It's interesting; the standards, for the most part, exist. The trick comes because with every standard, you need to make implementation decisions. And what can happen is if organizations make those implementation decisions, even though they're using national standards, if they make those implementation decisions individually, they can end up being unable to share information. And so, part of the point of the consortium is that we'll make those implementation decisions together, document those carefully, and save other organizations, we hope, the effort of having to make those decisions and also give them the confidence that if they implement the model that we've created they'll be able to interoperate easily.

We think the national health information exchange is critical infrastructure to exchanging information. Obviously, if we have patients who come to us in central Pennsylvania in the summer and go to Florida in the winter, it's important to have that national infrastructure so that we can share information as the patient requests us to wherever they are, wherever they need care.

ANDERSON: Can you give us some examples of the kinds of simple data exchanges that you'll accommodate in phase one?

WALKER: In the first phase, we will share core information - medication lists, vital signs, allergies - that sort of core information. And part of our plan is to start with the most important information and then extend out to larger and larger groups of information as we go forward.


ANDERSON: One of the consortium's goals is to develop interoperability tools. Please explain what those are, and will they eventually be available to others to use as open source tools?

WALKER: They will take different forms, but one of the most important is those implementation guidelines that tell an organization which choices to make [so that they] are able to make the standard actually work for them and to make it so they can actually share information. Another is a set of tools that help identify patients, so that if a patient is a Geisinger patient and they're being seen at Group Health Seattle, there are algorithms or formulas that can attempt to match patients based on name and date of birth and address and other characteristics. And so we'll be using those tools to help identify patients across all of our organizations, and there's a whole set of other tools like that.

ANDERSON: Will these interoperability tools eventually be available to others in the public domain, or how is that going to work?

WALKER: Yes. Everything we do that can be shared we will share. This is designed to be of public good. There is no business venture lurking in the shadows.

HIE Lessons

ANDERSON: Finally, what does Geisinger Health System hope to gain from its participation in this project, and what might other organizations learn from your experiences about how to address privacy and security issues for health information exchange?

WALKER: What we intend to gain is we are already in the process of sharing information with patients' caregivers around our region. We lead the Keystone Health Information Exchange, which has 17 different healthcare companies and multiple hospitals and scores of office practices and nursing homes participating. So we share information in that setting, again, with very careful attention to protection of the patient's information and the patient's privacy.

We lead the Keystone Beacon Community, which is a group of hospitals and practices and nursing homes in a five-county area of Central Pennsylvania, and there we're again trying to create a community of care so that wherever the patient goes -- to a hospital, an emergency room, a nursing home, a doctor's office, or being seen by home health -- wherever the patient is, if they approve, that their information is available so they get better care faster and more conveniently. And so this consortium is just an extension of efforts like that.

Obviously, patients have to know that their information is secure and that it will only be revealed to their caregivers who need the information to provide care.

ANDERSON: And what might other organizations learn from your experience, do you think?

WALKER: Well, what we intend is that they first will see that we are able to share the information in a meaningful and cost-effective way. And then we intend to make available our policies and procedures so that if they've found what we're doing compelling, they would be able to reproduce it for themselves at far less cost than it cost us, because we will have worked out a lot of the details that will be useable by anyone who wants to share information.

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