In an interview with physician-informaticist John Loonsk, Health IT Strategist asked the director of the office of interoperability and standards in the Office of the National Coordinator for Health Information Technology at HHS whether the government got its money's worth from the $18.5 million in contracts it issued in November 2005.
"I think we did, not just in what we saw the other day, but we have had many different deliverables over the course of the year," Loonsk said.
Four consortia of healthcare IT companies and healthcare providers won the contracts to develop prototypes of a national health information network. The four demonstrated their wares last week, initially on Jan. 23, at a meeting of the American Health Information Community, an IT advisory panel created by HHS Secretary Mike Leavitt, and on Thursday and Friday, at an HHS-sponsored IT meeting in Washington billed as the Third Nationwide Health Information Network Forum.
"What we saw wasn't the network, it was the applications that sit on the network," Loonsk said. "It was a very tangible way of showing people things, but it is really the EHRs and PHRs that will work through the network."
According to Loonsk, what wasn't shown, actually, was much greater than what was, sort of the tip of an IT iceberg, including standards and business models.
"There are a whole variety of things other than the software validations of their networks," he said. "Roughly speaking, that (demonstrated) was about a quarter of their work. The part that is under water is hard to see and hard to demonstrate, and it is critically important."
Loonsk said there was considerable effort made as the contractors developed their prototypes to keep them synchronized with work by other government-supported agencies, particularly the Health Information Technology Standards Panel, created by the American National Standards Institute in 2005 after it was awarded a $3.3 million HHS contract to develop a process for choosing and anointing IT standards to promote interoperability of disparate healthcare IT systems.
On Oct. 31, HITSP handed over to HHS its first batch of 30 "harmonized" standards. The standards were officially "accepted" by HHS Secretary Mike Leavitt last week, but, in a linguistic fandango, they were not deemed to be "recognized" by the secretary. According to the wording of an Aug. 22, 2006, executive order by President Bush, if Leavitt recognized the standards, all government healthcare agencies would be mandated to use the standards. Recognition is not expected to come until December and their mandated use by the government is not expected until 2008.
The AHIC laid out last year a number of expected IT usage "breakthroughs" and picked a series of specific data transactions or "use cases" and assigned them to various work groups to recommend ways to make the breakthroughs happen.
"The breakthroughs that created the use cases that fed the HITSP, those were also given to these NHIN consortia, so what they were putting on display was core infrastructure, but also how to implement those breakthroughs and use cases," Loonsk said. "There were some really good iterations along the course of the year. The consortia delivered to HITSP the standards they felt they needed to carry this out."
Loonsk explained the time gap between accepting and recognizing the HITSP standards "is to tweak the guidance on their implementation and to implement them."
To date, the work product of the four NHIN consortia has not been made public and not all of it may be, according to Loonsk.
"We anticipate putting up a number of deliverables up on a Web site," Loonsk said. The materials from the forum will go up in the next couple of weeks. There was a lot of interest in the business models. Those also will go up as soon as they can, and those should go up in a couple of weeks as well."
But all of the contractors hired by HHS are in business to make money, and will now use the systems they designed for the government to drum up future contracts.
"We're going to try to provide as many of the deliverables to make them as available as we can, but beyond that, these four consortia have value in partnership with some of the regional health information organizations, the state and regional health exchanges," Loonsk said.
Monday, for example, the California Regional Health Information Organization, or CalRHIO, announced three of the NHIN prime contractors, Accenture, Computer Sciences Corp. and IBM, had submitted proposals to build and finance a statewide health information exchange in California. Northrop Grumman, the fourth lead contractor on the NHIN prototype contract with HHS, did not submit a proposal on the CalRHIO project.
"There are commercial products in all of them to some extent," Loonsk said. "But they all got the idea that they were modular enough that one could substitute other commercial products to meet the need."
Loonsk said he was impressed that the four consortia came up with unique elements as well as "lots of commonality, and that the commonality was where they interfaced with others."
"Accenture did a lot of work on trying to normalize data and see how that data could be used for population health purposes," Loonsk said. "They did have a repository of summary data. It wasn't intended to be a national database, but something that could be implemented at a regional level.
"Northrop Grumman did a lot of work on consumers managing their information. It thought that was very positive.
"IBM worked with IHE (Integrating the Healthcare Enterprise) and some of their document standards, and they point out that they are an open approach. And CSC had some interesting things as well, how to protect metadata and to see that confidentiality was protected."
The next step for HHS is a review of what it bought. The government will have consultants from the Gartner Group to look at the four prototypes, focusing on their technical architectures, not their business models, "and try to describe the commonalities of the interfaces and identify where there are needs for standards and standardizations, from health exchanges to providers and personal health records," Loonsk said.
But the government won't pick one winner, he said.
"There won't be one architecture," Loonsk said. "There is a room for some variances in architectures. And I think that's OK, but what we need to do is standardize the interfaces."
A report from Gartner is due in March, Loonsk said. That will be followed by a second request for proposals to be issued by HHS in March or April for "trial implementations" of the NHIN.
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