WASHINGTON – The Office of the National Coordinator for Health-care Information Technology is sifting through volumes of responses to the idea of a national health information network.

In November, healthcare IT czar David J. Brailer, MD, made a formal request for information on its proposal for a national network, giving organizations until Jan. 18 to make formal responses. The request prompted a flood of responses.

At the time this article was written, Brailer's staff could not provide the exact number of responses, saying only that they numbered more than 500. Brailer is expected to describe the responses in an address at the HIMSS 2005 Annual Conference in Dallas this month.

One of the industry's largest responses was funneled through The Markle Foundation, which collected opinions from a 13-organization collaborative.

Released on Jan. 18, the cross-industry response said the network should:

- Use open, consensus-driven, non-proprietary standards, and encourage connectivity through the Internet and other existing networks.

- Give patients access and control of their own information, while supporting the application of intelligent tools to improve care and aggregating data for research.

- Protect privacy, ensure security and support existing trust relationships.

Another set of responses from across the industry was expected from the College of Healthcare Information Management Executives, or CHIME.

John Glaser, CIO of Partners HealthCare System in Boston, said that individual responses varied slightly, but typically focused around the themes of incentives and funding, the need for local and national mechanisms to manage the effort, standards and distributed architecture.

John Halamka, CIO of Care-Group Health System and Harvard Medical School, said he participated in responses from national, regional and local organizations. A significant concern to him was circumventing the need for creation of a national patient identifier, a critical component for data sharing but a significant bone of contention for several years.

Halamka suggested the use of a regional master patient index to provide "pointers" to local hospital and physician offices, which store data. He also wants to see the system develop into a federated, decentralized model for peer-to-peer secure data exchange among healthcare entities.

"In a sense, this is like secure Napster for healthcare, creating a virtual medical record via standards-based real-time data ex-change," he said.

Finally, chain of trust relationships are needed for authentication, for example having hospitals and physician offices assign specific users to access the system.

John Hummel, CIO at Sutter Health, said he supports the concept in theory, but believes the large number of issues could slow down implementation.Paying for the network will be expensive, but Hummel said he was confident that improved data exchange could provide a business case to build and operate a healthcare information network.