Groups Endorse 'Common Framework' for National Health Information Network

January 18, 2005, New York, NY, and Washington, DC -- Thirteen major health and information technology organizations, in a joint collaboration, today endorsed a "Common Framework" to support improved health information exchange in the United States while protecting patient privacy. The collaborating organizations have identified the vital design elements - of standards, policies, and methods - for creating a new information environment that would allow healthcare 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 US Office of the National Coordinator for Health Information Technology (ONCHIT) within the Department of Health and Human Services (HHS) 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 US healthcare, 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
• 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 healthcare
• 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, coordinated 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. The 13 collaborating organization participants made the following comments:

From the American Health Information Management Association (AHIMA): "This request for information from ONCHIT provides an outstanding opportunity to gather and organize the industry's collective intelligence and begin mapping out a course of action. Creating a national health information network is a complex yet critical challenge but one that we must not wait any longer to address. The health of patients and the systems that serve them are depending on it." – Linda Kloss, RHIA, CAE, executive vice president and CEO

From the American Medical Informatics Association (AMIA): "Implementing information technology for the nation is an extraordinary challenge that must be addressed if we are to successfully solve the many problematic dimensions facing health care in America today. Through this recent collaborative effort, including the expert resources of AMIA, we have been able to suggest tested advice for David Brailer and his staff." – Don E. Detmer, AMIA President and CEO

From the American National Standards Institute, Healthcare Informatics Standards Board (ANSI HISB): "The collaboration among these industry groups demonstrates an unprecedented commitment to making the NHII a reality. It is my sincere hope that this will be the first of many collaborative efforts required for successful implementation of the NHII." – Robert L. Owens, Chair; Health Informatics Standards Board

From the Center for Information Technology Leadership (CITL): "The Collaborative Response to the ONCHIT RFI describes the critical technology requirements, and guiding principles -- a Common Framework -- to create a 21st century National Health Information Network. Without consideration of such a Common Framework for the NHIN we are at risk of implementing IT solutions in healthcare that can obtain only half their potential value. Without information exchange and interoperability between systems, we may implement islands of automation across clinics and hospitals that cannot communicate with each other, and thus cannot fully support the transformation of US healthcare." – Blackford Middleton, MD, MPH, MSc; Chairman of CITL Executive Committee

From Connecting for Health: "The principles developed by the collaborative will put patients and their families at the very center of the health care system, supported and surrounded by an information environment that they can use - or allow others to use - to make decisions, monitor health, provide feedback, and support strategic analytic functions that produce measurable improvements in health." – Carol Diamond, MD, Managing Director, Markle Foundation

From eHealth Initiative: "In working on this response, we found that we hold far more in common than we ever imagined. This represents the first-ever set of detailed recommendations regarding the specific attributes and principles of an environment for health information sharing developed by such a large and diverse group of stakeholders. Our collaborative response should lay the foundation for the actual execution of a 21st century healthcare system that will help us reduce medical errors, improve quality, and begin to tackle issues related to rising healthcare costs." – Janet Marchibroda, Chief Executive of eHealth Initiative and Executive Director of the eHealth Initiative Foundation

From Health Level Seven, Inc. (HL7): "HL7 is pleased to be included in the diverse group of healthcare industry and policy leaders contributing to a consensus response to this important RFI. We firmly believe that the goal of a National Health Information Network will be facilitated by this unprecedented collaborative effort. We look forward to continued work with the collaborative in support of this important national initiative. Our focus will be on ensuring that the Common Framework incorporates the tenets of semantic interoperability as implemented in our Version 3 standards; including the inherent need to bind standard vocabularies to information exchange models defined by use cases." – Mark J. Shafarman, Chair, HL7 Board of Directors

From the Healthcare Information and Management Systems Society (HIMSS), HIMSS EHR Vendor Association , and Integrating the Healthcare Enterprise (IHE), (American College of Cardiology, HIMSS, and Radiological Society of North America): "Each of the 13 organizations brings a unique perspective and targeted expertise related to the development of an interoperable health information environment. This collaborative response further strengthens and substantiates the industry's effort - and ability - to work together for the nationwide adoption of a 'common framework' for the electronic exchange of health information." – H. Stephen Lieber, President/CEO of HIMSS

From Internet2 consortium: "Ubiquitous and secure access to medical information and resources will lead to more timely, more accurate, and more cost-effective healthcare. By applying advanced information technology capabilities to the current healthcare architecture, we believe the entire industry - from patients to doctors to administrators - will greatly benefit." – Gary Bachula, vice president of external relations for Internet2

From Liberty Alliance: "As the only open standards body focused exclusively on the transaction of identity information, Liberty Alliance is pleased to have played a role in this significant collaborative submission. We firmly believe the adoption of federated identity is key to a viable national health network that protects the privacy and security of all members. A National Health Information Network would expand the reach of our healthcare system and help contain escalating healthcare costs. These are undeniable social benefits, and Liberty's members are proud to be associated with this effort as experts in federated identity." – Donal O'Shea, Executive Director of the Liberty Alliance

From the National Alliance for Health Information Technology: "Dr. Brailer is uniquely qualified to lead the government efforts and work with the private sector to develop information technology standards and infrastructure to enhance patient care and operating efficiencies. We applaud his commitment to seek responses from technology organizations, healthcare providers, industry associations and other stakeholders." – Scott Wallace, president and chief executive officer of the Alliance

Read the groups' collaborative response (PDF).

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