Summary
We should applaud the State of Washington for taking initiative in this important area, but we must acknowledge that the health record bank is just the flip side of the coin regarding the question of centralized or federated models for HIE. Beginning with the CHINs of the early 90's until now, we see that all stakeholders in the system consider stewardship of health data to be an asset, and they do not readily see a sustainable ROI for investing in any methodology for exchange of the data with others. Success of Washington's efforts and those of the many other State and regional efforts depends, not on the efficacy of the model, but on the successful demonstration of HIE infrastruction via the NHIN projects and subsequent mandate and funding at the federal level.
Analysis
We should applaud the State of Washington for taking initiative in this important area. However laudable the effort, however, we must acknowledge that the health record bank is just the flip side of the coin regarding the question of centralized or federated models for HIE.
While both models have their merits, the real question, is not how to store or exchange health data but how to capture it in the first place. Beginning with the CHINs (Community Health Information Networks) of the early 90's until now, we see that all stakeholders in the system consider stewardship of health data to be an asset, and they do not readily see a sustainable ROI for investing in any methodology for exchange of the data with others.
It is, therefore, my belief, that success with Washington's health record bank or California's federated HIE (or any other of the laudable state and regional efforts) depends on successful demonstration of the NHIN (Nationwide Health Information Network) projects and subsequent mandates and funding at the federal level.
This opinion is not based on support for nationalized healthcare or single-payer (the federal government) coverage. Rather, it suggests that HIE is one area where the federal government can use its power to bring about appropriate change in the private system much like it has attempted to do with the significant HIPAA legislation. Forward-looking organizations like the four NHIN consortia (CSC, Northrop Grumman, IBM and Accenture) and those creating other health information infrastructure (Microsoft, Google, et al) stand to gain as the models mature and mandates for adoption advance.
