Feds Call on Google and Microsoft to Breathe Life into the NHIN

Vince Kuraitis and David C. Kibbe, MD MBA

Who is the federal  government calling on to breathe life into the Nationwide Health Information Network (NHIN)? Google and Microsoft.

In our first article of this series describing the Personal Health Information Network (PHIN), we noted early entrants as Google Health, Microsoft HealthVault, and Dossia.  We also noted that the network could grow rapidly, and that others would want to join or link to the PHIN.

With Uncle Sam announcing plans to link to the PHIN, even we are surprised at the speed at which developments are occurring.

Government Executive reports:

The federal office in charge of creating a national network of electronic health records plans to integrate the system with the health care databases that Google and Microsoft launched last year, on which individuals can store their health records, a top official with the Health and Human Services Department said….

(The HHS official) provided few details on how the office would incorporate personal health records….

Federal interfaces to the health network will be through an entity called NHIN Connect.

Here’s a simplified diagram of our current understanding of how NHIN Connect will link to the Personal Health Information Network (click on the diagram for a larger version):

Commentary

Public/Private Partnership.  The PHIN and the NHIN can be highly complementary. Think of the PHIN as a private sector lead initiative, while the NHIN is a government sponsored network.

Here’s the picture we’re seeing:

• A collaborative government and private sector partnership
• Focused on portable and interoperable personal health information (PHI) and electronic health records.
• Having potential for rapid growth

Benefits to Patients and Families. If the feds are really serious about connecting to the PHIN in the same way that Mayo Clinic is connecting to HealthVault, or the Cleveland Clinic is connecting to Google Health Services, or CVS/MinuteClinic pharmacies and clinics are connecting to both of these — then there could be significant benefit to many hundreds of thousands of patients and beneficiaries of the VA, DOD, and IHS facilities.

For the very first time, those individuals would be able to move their health information electronically from the VA, for example, to the physicians and pharmacies outside the VA, where they receive a lot of their ongoing care.

The same would be true for those who have DOD health benefits and their dependents, who routinely receive care in local and community facilities, where their doctors have often been frustrated by not having the DOD records they need for quality continuity care.

And, this is really interesting, this might establish for the first time a means for the DOD and VA to exchange personal health record data and information with one another!  Wouldn’t that be cool!

So, this could be really good for soldiers and for veterans, their families, and for beneficiaries of the Indian Health Services system, who, for the very first time, would be able to move their health information electronically with them as they move from place to place and require care outside the governmental programs.

Network Effects and Network Growth. This announcement also increases the likelihood that the PHIN will have high levels of portability, interoperability, and data liquidity from Day 1.

If you recall our first article describing the PHIN, we speculated about whether market forces would create:

1. Two or more competitive, non-interoperable networks — more like the parallel platforms created today in credit cards offered by Visa, American Express, and MasterCard
2. One network that is collaborative and interoperable at the level of sharing data, but competes at other levels.  An example is the telephone network — Verizon and Sprint compete for subscribers, but you can make calls (i.e., exchange information) across platforms with ease.

While we believe there will be strong market forces pushing toward Scenario 2, we recognize that this is not a done deal.

The Federal Government’s joining the PHIN further strengthens the likelihood of Scenario 2 — one collaborative and interoperable network. Public policy interests of improving quality and reducing health care costs are much more congruous with high levels of portability and interoperability. Through NHIN Connect, the Federal Government could be able to exert significant buying power to avoid the development of multiple, non-interoperable networks (the credit card network example).

What’s the Tail and What’s the Dog? The federal government and the private sector are taking different approaches toward health information exchange.

The federal government has been in “ready, aim, fire” mode.  The federal government’s efforts have focused on “harmonizing” standards, in the process setting up a complex bureaucracy in Washington that holds meetings and deliberates on a multitude of “use cases”.

Private sector consumer access services companies (Google, Microsoft, Dossia, others) have been much more in “ready, fire, aim” mode.  The global Internet brands and a number of large employers have concentrated on actually building out the network components for health data exchange on a massive scale, confident the standards issue will work itself out after data exchange becomes the norm.  This has been a “action versus talk” strategy.

As of today, the federal government has really only four systems of health information to integrate — the VA, the Department of Defense, the Indian Health Services, and Social Security.  None of these talks with the other at this juncture.

On the other hand, the private sector aims at a network several orders of magnitude larger, including thousands of hospitals, hundreds of thousands of medical practices, tens of thousands of pharmacies, and, most importantly, many millions of individual citizens.

What about RHIOs?  What about the Regional Health Information Organizations (RHIOs)/Health Information Exchanges (HIEs)?  How do they fit?

The Government Executive article alludes to RHIOs, but they don’t appear to be included in the first phase of NHIN Connect. However, there is nothing to preclude a) RHIOs joining NHIN Connect in the future, and/or b) RHIOs connecting directly to the PHIN in the future.

Also, recall that RHIOs are focusing primarily on electronic health records, not on personal health information (PHI) or personal health records (PHRs). Consumers are not central in these models.

Many also doubt whether RHIOs will succeed.  While there are some examples of success, many RHIO efforts are struggling.  For RHIOs that are successful, the PHIN can be highly complementary

To sum up:  the PHIN + NHIN Connect linkage promises to be very powerful!

Additional information about NHIN Connect: