Information Technology Reference
In-Depth Information
in a later chapter, for patients to gain access to it. At present, it does not deal with a
number of fairly complex issues that CONNECT specifically does manage.
Since it is politically impossible to have a universal health ID number in the US,
and social security numbers cannot legally be used for this purpose, there is always
the problem of accurately identifying patients and correctly linking their data across
health organizations. CONNECT includes a cross organizational Master Patient
Index (sometimes called an XMPI) to resolve patient identity. The term MPI (or
Enterprise MPI) has typically meant an index of patients within a health system. If
health information exchange encompasses multiple health systems then an MPI
designed for this purpose is needed. As we discussed, in the IHIE it is possible for
a provider to see all clinical data about a patient in one view, including actual medi-
cal images. CONNECT can support a similar capability by maintaining what is
often called a document locator service, essentially an index to where specific data
about each patient is stored. Finally, CONNECT has facilities for describing and
managing institutional privacy and security policies as well as patient-specific
authorization decisions with respect to access to their data.
CONNECT is free and can be downloaded by any health system or HIE. However,
like all centralized health information exchange platforms, it is complex, and both
installing and maintaining CONNECT requires significant technical expertise and
ongoing people and technical resources. A current list of CONNECT installations is
posted on the project's web site. [ 7 ]
Commercial Solutions: There are a number of commercial systems that provide
tools or complete systems to support a centralized or federated model of health
information exchange. The two largest providers are OptumInsight™ and Medicity.
OptumInsight (formerly Axolotl) is part of a wholly owned subsidiary of
UnitedHealth whose goal is to provide an integrated technology solution for the
delivery of care under outcome-based contracts. Medicity, now a wholly owned
subsidiary of Aetna, has similar goals. It is very significant that two of the four larg-
est commercial health insurance companies 8 are now major providers of health
informatics solutions for creating a more integrated and coordinated form of health-
care. By all appearances we have crossed an important bridge and there may be no
turning back.
A number of enterprise health system software solutions now also provide their
own technology for health information exchange, even if they contain third party
system components such as EHRs from a competing company. Siemens, for exam-
ple, acquired MobileMD™ to provide these capabilities. Cerner has partnered with
Certify Data Systems to utilize its HealthDock™ described by Cerner as an “intel-
ligent appliance that enables the secure electronic flow of clinical data between
hospitals and provider offices”. Its push technology sends results and clinical docu-
ments to the provider's EHR saving time spent checking to see if they are available.
It can also be used to place orders.
8 WellPoint and Kaiser are the others but Kaiser has a substantially different business model and
would not likely consider becoming a technology supplier.
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