Health care and Information Technology groups endorse Common Framework for health information exchange

New York 18 January 2005Thirteen major health and information technology organisations, in an unprecedented joint collaboration, have endorsed a "Common Framework" to support improved health information exchange in the United States while protecting patient privacy. The collaborating organisations have identified the vital design elements - of standards, policies, and methods - for creating a new information environment that would allow health care professionals, institutions, and individual Americans to exchange health information in order to improve patient care. These recommendations were developed in response to the Request for Information related to a "National Health Information Network" issued by the United States Office of the National Co-ordinator for Health Information Technology (ONCHIT) within the Department of Health and Human Services in November 2004.


The collaborative foresees a new health information environment that would allow appropriate users to find, request and retrieve patient records rapidly and accurately, subject to patient authorization. This decentralized approach takes advantage of the significant investment already made in information technology in United States health care, protects the privacy of patient information, and allows rapid progress toward providing Americans with more reliable, higher quality care. The recommended approach does not require centralized national databases, replacement of existing information networks, or a unique national health identifier.

The new health information environment should be based on open, consensus-driven and non-proprietary standards and common methods for their adoption; connectivity built on the Internet and other existing networks; and uniform policies that protect privacy, assure security, and support existing trust relationships.

The collaborative also recommends the use of financial incentives for the adoption of standards-based information technology in health care, citing opportunities to leverage this environment to produce value for patients, consumers, professionals, researchers, the public health community and, indeed, all sectors of our health care system. Finally, the recommendations describe the roles and structure of both the national and regional elements of this environment.

The collaborators noted that the new information environment must facilitate effective connectivity for the delivery of high quality health care; provide timely access to information; empower patients to access and control their own information and contribute to the quality of care provided; support the application of "intelligent" tools to improve health and health care; facilitate the appropriate aggregation of data for public health, research, and quality assessment; and enable improvements in the quality of clinical care.

The group, co-ordinated by Connecting for Health, represents America's clinical leadership, academic institutions, health insurance plans, private industry, consumer and patient leaders, technology vendors, employers, and some of the foremost experts on health information management and information technology and includes:

  • The American Health Information Management Association (AHIMA): the national association of health information management professionals. AHIMA's 50.000 members are dedicated to the effective management of personal health information needed to deliver quality health care to the public.
  • The American Medical Informatics Association (AMIA): AMIA is dedicated to the development and application of medical informatics in support of patient care, teaching, research, and health care administration.
  • The American National Standards Institute, Healthcare Informatics Standards Board (ANSI HISB): ANSI HISB provides an open, public forum for the voluntary co-ordination of health care informatics standards among all United States standard-developing organizations, professional societies, trade associations, private companies, federal agencies and others with more than 100 participants.
  • The Center for Information Technology Leadership (CITL): CITL is a non-profit research group based at Partners HealthCare in Boston and supported by HIMSS that assesses the value of clinical information technologies to help provider organisations maximize the value of their IT investments, to help technology firms understand how to improve the value proposition of their health care products, and to inform national health care IT policy discussions.
  • The Connecting for Health Steering Group (CFH): Connecting for Health is a Public Private Collaborative that was conceived and is operated by the Markle Foundation and receives additional support from the Robert Wood Johnson Foundation. The Steering Group includes more than 60 diverse stakeholders from the public and private sector, committed to accelerating actions on a national basis to tackle the technical, financial and policy challenges of bringing health care into the information age.
  • The eHealth Initiative (eHI): eHI is an independent, non-profit consortium of practising clinicians, employers and health care purchasers, health plans, health care information technology vendors, hospitals and other health care providers, manufacturers, patient and consumer organisations, and public health agencies, whose mission is to improve the quality, safety and efficiency of health care through information and information technology.
  • The Healthcare Information and Management Systems Society (HIMSS): HIMSS is the health care industry's membership organisation exclusively focused on providing leadership for the optimal use of health care information technology and management systems for the betterment of human health.
  • Health Level Seven Inc. (HL7): HL7's comprehensive suite of ANSI accredited standards for the exchange of demographic and clinical information provides the syntax and semantics for interoperability in a large number of provider organisations in the United States and around the world.
  • HIMSS EHR Vendor Association (EHRVA): EHRVA represents more than 25 Electronic Health Record (EHR) vendors with a mission to address national efforts relative to health information interoperability, standards, EHR certification, performance and quality measures, and other evolving government, industry and physician association initiatives and requests.
  • Integrating the Healthcare Enterprise (IHE), (American College of Cardiology, Healthcare Information and Management Systems Society, and Radiological Society of North America): IHE drives standards adoption to address specific clinical needs, by creating a framework for passing vital health information seamlessly from application to application, system to system and setting to setting across the entire health care enterprise.
  • Internet2: Internet2 is a consortium led by over 200 universities working in partnership with industry and government to develop and deploy advanced network applications and technologies, accelerating the creation of tomorrow's Internet for a broad spectrum of organisations, including those in the health sciences.
  • The Liberty Alliance Project: Liberty Alliance is a consortium of more than 150 organisations from across the globe, committed to developing open standards for federated network identity that support all current and emerging network devices.
  • The National Alliance for Health Information Technology: The Alliance is a diverse partnership of influential leaders from all health care sectors working to achieve measurable improvements in patient safety, quality and efficiency through information technology.

The thirteen organisations involved in the initiative to create a national health information environment believe that general adoption of a common framework can permit health information to be delivered when and where it's needed in a private and secure manner and improve the quality of health care and have come together to recommend a consensus approach to the design of a national health information environment. Key elements of their approach are:

  • Establishing an information environment that facilitates and structures connectivity through encouraging adherence to precisely defined, uniform technical standards, common policies, and common methods, known as the "Common Framework".
  • Defining a Health Information Environment that allows diverse networks of users, grouped together through proximity, stakeholder trust and patient care needs, to exchange information efficiently.
  • Connectivity built on the Internet and other existing networks.
  • The "build" of the new information environment happens incrementally, through accretion of sub-networks - many of which already exist but need to have the ability to be linked together to provide maximum benefits to patient care.
  • The environment is private, secure, and is built on the premise of patient control and authorization.
  • Personal health information remains with health care providers, patients and other trusted partners and is accessed and exchanged only when it is needed, with proper authorizations and security.
  • Creating a national, public interest Standards and Policy Entity (SPE) that recommends the standards and policies that comprise the Common Framework and the ongoing requirements for interoperability.
  • Leveraging existing open, non-proprietary standards to enable the exchange of health information.
  • Accurate patient identification based on uniform and standardized methodologies but without a new, mandated, national, unique health identifier.
  • Record Locator Services (RLS) are created and controlled regionally or within other sub-networks, to help authorized parties learn where authorized and pertinent information is housed but never containing that information.
  • A mechanism for validating compliance with the standards of the Common Framework is required for the early phases, but the network becomes self-validating over time.
  • The information environment facilitates growth, innovation and competition in private industry.
  • Continuing investments in health information technology come from multiple, public and private sources. Incentives for adopting interoperable electronic records systems are built into routine payment and operations at the regional and local level and are tied to use of the Common Framework.

Leslie Versweyveld

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