In doing so, some of the five founding health systems of the consortium—Geisinger Health System in Pennsylvania, Group Health Cooperative in Washington state, Intermountain Healthcare in Utah, Kaiser Permanente in California and Mayo Clinic in Minnesota—have yet to decide whether to cooperate with their local, state-based health information exchanges.
Mayo Chief Medical Information Officer Dr. Dawn Milliner said the state and local HIEs are developing different standards and that organizations with patients in multiple states would face widely varying data requirements for each one. Mayo, which has not decided whether to work with the Minnesota Health Information Exchange, sees patients from all 50 states.
“We’d have to work through 50 HIEs with the complexities of data standards for each of them. That is untenable. What we need is a national network,” Milliner said. “HIEs are a first step, and I think it’s better to begin that conversation than not begin it. But those regional and local HIEs are not going to get us where we want to be as a country.”
Each of the five systems will bear its own share of the costs of establishing the Care Connectivity Consortium network, though the price tag has yet to be determined. Also unanswered is whether the consortium will establish an independent organization to administer the network. Data will be kept locally, not aggregated to a database, and only shared after patient consent.
Like all information exchanges, the consortium’s network is intended to allow patients to access their clinical data while traveling or if they move, though participants say long-range goals might potentially include wider data-mining to find trends and develop evidence-based practices.
“Right now we are not looking to do that. This is really aimed at caring for the patients the right way,” said Dr. Gwen O’Keefe, chief medical informatics officer for Group Health.
Initially, three kinds of patient data would be exchanged over the consortium’s network: allergies, medications and medical histories. However, that list is considered a starting point that could be expanded.
Jennifer Driscoll-Chippendale, a healthcare antitrust attorney with Sheppard Mullin Richter & Hampton who is not involved with the consortium, said the consortium could attract scrutiny from regulators if the health systems intended to exchange data on their prices through the network.
But even if claims data were shared, the members could pass muster by putting an independent organization in charge, de-identifying the data, and releasing it at least three months after services are provided, she said.
Last year, the Justice Department’s antitrust division approved an information-sharing network in California called the Hospital Value Initiative that included pricing data, saying the sharing would actually increase procompetitive forces by improving transparency that would inform purchasing decisions.
The decision not to include claims data is being held up as one key advantage of the consortium. Phil Fasano, chief information officer and executive vice president with Kaiser Permanente, said many of the local and state-based HIEs are basing their networks on claims data, not actual patient medical records.
“We believe the medical record is a gold standard,” Fasano said. “With claims-based information, you tend to have to infer some pieces of what has occurred. In the medical record you can get down to the physician’s notes.”
Also, unlike the provider-only consortium, the local and state HIEs have advisory boards with heavy representation by insurers and state officials. The Pennsylvania Health Information Exchange has representatives from six health plans and numerous lawmakers on its advisory council, and only three healthcare providers.