Publication Date: April 6, 2006
WASHINGTON, DC—Markle Connecting for Health, a public-private collaborative of more than 100 organizations, today released its Common Framework: Resources for Implementing Private and Secure Health Information Exchange. The Common Framework provides the initial elements of a comprehensive approach for secure, authorized, and private health information sharing, so that patients and their authorized providers can have access to vital clinical data when and where they are needed. This capability is essential for providing high-quality care and reducing medical errors.
The Common Framework includes 16 technical and policy components, which were developed by experts in information technology, health privacy law, and policy. This initial set of critical technical and policy components demonstrates how various health information networks can share information while protecting privacy and allowing for local autonomy and innovation. The components being released today include technical documents and specifications, testing interfaces, and code, as well as a companion set of privacy and security policies and model contractual language to help organizations interested in information exchange move quickly towards the necessary legal agreements for private and secure health information sharing. The components were tested since mid-2005 by Markle Connecting for Health teams in Indianapolis, Boston, and Mendocino County, Calif., the three communities in which the prototype was developed.
“We have long believed that personal privacy and security, values that are prized by the American people, must inform the design and functionality of new health information-sharing networks,” said Zoë Baird, president of the Markle Foundation, which leads and manages Markle Connecting for Health. “We put the patient at the center of this effort, and the Common Framework demonstrates that we can achieve state-of-the-art access to life-saving health information without sacrificing privacy and security.”
Work on what has become the Common Framework was initiated in 2003, when the Markle Connecting for Health collaborative began to create a Roadmap that called for the public and private sectors to work together to build an infrastructure that would allow for the rapid, accurate, and secure exchange of health information, essential for improving health care quality and safety. The collaborative recognized that protecting the privacy of personal information needed to be foundational to the design of any system for sharing health information, if it was to earn the public’s trust. Markle Connecting for Health understood that achieving that goal would require everyone committed to information sharing to make specific decisions about the technology approaches and policies that would ensure privacy protections.
“We believe it was critical that these technology and policy resources be designed in tandem. Together, they protect patient privacy while enabling the authorized exchange of medical records,” said Carol Diamond, MD, MPH, managing director of the Markle Foundation and chair of Markle Connecting for Health. “Our approach to a technical architecture for health information exchange started with a set of policy principles for keeping information private and secure. With that goal and those principles in mind, we tested the technical architecture and developed a set of specific policies that are critical to implementation of the Common Framework.”
To protect privacy, the Markle Connecting for Health Common Framework architecture recommends use of a record locator service (RLS), an index that identifies where specific patient records are kept, but not what information the records contain. This approach allows records to be stored locally by doctors and hospitals and only shared electronically with other providers when appropriate and authorized by the patient. The Common Framework also relies on common, open web standards, making this approach both affordable and achievable.
“We demonstrated the exchange of clinical information, by using a critical set of common, open technical standards,” said Clay Shirky, who directs the technical work for Markle Connecting for Health and teaches at New York University. “The Common Framework avoids large-scale disruption and huge upfront capital investments by allowing the use of existing hardware and software. It is compatible with current methods of institutional and provider record keeping, while enabling existing systems to exchange information.”
“The Common Framework identifies a number of policies which should be commonly adopted to assure that personal health information is managed securely and remains protected,” said Mark Frisse, MD, director of regional informatics programs through the Vanderbilt Center for Better Health and co-chair of Markle Connecting for Health’s Policy Subcommittee. “These include an overall privacy ‘architecture,’ policy recommendations regarding patient notification, how users are correctly identified, the audit responsibilities of health information exchanges, how patient information from multiple sources can be linked, and what to do in the event of breaches of confidentiality.”
“By participating in the Markle Connecting for Health framework, we demonstrated the tremendous potential of this approach to health information sharing for improving care and sharing life-saving information in our community,” said J. Marc Overhage, MD, PhD, senior investigator, Regenstrief Institute and president and CEO, Indiana Health Information Exchange, Indianapolis, Ind. “The Common Framework focuses on how to share information securely, without specifying the features and functions of the medical record systems that it connects. This gives maximum flexibility to local organizations and private companies to shape their own systems and be innovative in creating new products, while connecting to health information networks.”
“In developing the policy guidelines for the Common Framework, we wanted to ensure that this approach to health information sharing leaves decisions regarding the sharing of health information exactly where it should be – with patients and their health care providers,” said John Halamka, MD, CEO of MA-SHARE and emergency physician, Beth Israel Deaconess Medical Center, Boston, Mass. “This approach protects patient privacy by keeping information with the doctors and institutions that patients know and trust, eliminating the need for national patient identifiers or central databases. The policy components of the Common Framework can save time and effort on the part of many organizations and networks working on health information exchange by providing them with a jump-start in their efforts to address the key policy topics related to sharing health information.”
The Markle Connecting for Health Common Framework was tested in 2005 in Boston, Indianapolis, and Mendocino, Calif. The Connecting for Health teams in each of the three communities include: MA-SHARE and its technology partner, Computer Sciences Corporation, in Boston; the Regenstrief Institute and the Indianapolis Health Information Exchange in Indianapolis; and the Mendocino Health Records Exchange and its technology partner, Browsersoft Inc., in California. Together these teams demonstrated that completely different health information networks can communicate with one another and exchange information, even if they operate on different technological platforms, use different registration systems, and organize patient data differently.
“The Common Framework is ideal for our small, rural health care providers,” said Will Ross, project manager, Mendocino Health Records Exchange. “Using software based on open standards to achieve interoperability, our network connects a group of community health centers. With this approach, other health providers caring for the most vulnerable Americans or those in rural communities can afford to deliver better care to those who may need it the most.”
Markle Connecting for Health believes that the organizations that will benefit most from the Common Framework are those that are prepared and committed to creating private and secure health information exchange through a decentralized approach. To benefit fully, such organizations should be capable of using digital information from remote sources, be in compliance with HIPAA and state rules governing privacy and security of health information, and have Internet access in place and the hardware and software to establish secure communications. These entities should also have an electronic method for accurately linking or separating the records of patients who share the same or similar names within their own enterprise. For these groups, the resources in the Common Framework can reduce the many existing, financial, legal, and technical barriers to achieving private and secure health information sharing, thus encouraging new entrants into the field.
One of the key functions of the Common Framework is to enable a diverse group of existing and developing networks to have a common way to share health information. The Common Framework makes it possible for health organizations working within regions, as well as those that are not limited to one geographic region, such as a group of specialty providers in multiple regions, to have a common way to communicate with one another.
“The Common Framework enables industry to innovate approaches to information exchange to improve health care quality,” said Wes Rishel, managing vice president, Gartner Research. “Because it was developed to apply to very diverse communities, it can stimulate private sector development that will greatly reduce the cost, delay, and risk for each individual community.”
The broad array of stakeholders participating in Markle Connecting for Health are confident that the Common Framework can accelerate and provide structure to the development of health information exchange, but they also recognize that this approach is still evolving and much remains to be done.
“The resources being released today bring us closer to achieving the great promise that health information technology has to improve the quality, safety, and effectiveness of health care.” said John Lumpkin, MD, MPH, senior vice president of the Robert Wood Johnson Foundation and vice chair of Markle Connecting for Health. “The Markle Connecting for Health Common Framework provides a foundation that everyone can build on. Soon we will see doctors, hospitals, pharmacies, software companies, consumer groups, and others adding to and improving the framework. It is a very significant contribution to the development of private and secure exchange of health information nationwide to improve care for each patient.”
Markle Connecting for Health is a public-private collaborative with representatives from more than one hundred organizations across the spectrum of health care and information technology specialists. Its purpose is to catalyze the widespread changes necessary to realize the full benefits of health information technology while protecting patient privacy and the security of personal health information. Markle Connecting for Health tackles the key challenges to creating a networked health information environment that enables secure and private information sharing when and where it is needed to improve health and health care. Learn more about Markle Connecting for Health at www.markle.org/health.