WASHINGTON – When the federal government gets involved, speed to market is not the first thing that comes to mind. The Federal Health Architecture (FHA), however, is a game changer.
The FHA coordinates federal efforts for national healthcare IT initiatives under the Office of the National Coordinator for Health Information Technology. It brought together CIOs and business leaders of 20 federal agencies with health-related functions to build software that would enable the federal agencies and 16 private-sector entities to exchange health information and eventually become one of the building blocks to help connect to the nationwide health information network (NHIN).
"You build the software once under the FHA and agencies can use it multiple times," explained Vish Sankaran, program director.
The FHA looked at open source and service-oriented architecture and awarded a contract to the Harris Corp. in March 2008. By September 2008, the Department of Defense, Department of Veterans Affairs and Social Security Administration had demonstrated health information exchange with 16 private-sector entities using the NHIN-Connect software. In December, the demonstration was expanded to include three more federal agencies – the Centers for Disease Control and Prevention, Indian Health Services and National Cancer Institute.
This past February, the NHIN-Connect went into limited production, with MedVirginia and the Social Security Administration exchanging health information to determine disability benefits.
The MedVirginia/SSA demonstration is the first business case that brings quantifiable value to the provider, said Debbie Somers, senior adviser to the Deputy Commissioner Office of Systems for SSA. Automating the process of accessing records in the physician office has reduced the retrieval time from up to 90 minutes to real time, she said. With SSA paying upwards of $30 per request, physicians can create an income stream without needing to invest a lot of time.
For beneficiaries, the time it takes to determine disability eligibility has been reduced from weeks to days. The ability to retrieve and analyze data from patients' electronic health records ensures that the patient is given the "right treatment at the right location and at the appropriate cost," Somers said.
"Everyone is excited to see federal agencies coming together to collaborate," Sankaran said. "We can all be proud of that. We expect our government to function that way." It helps tremendously that the Obama administration, Congress, states, patients and the industry itself are aligned with the goal to improve the delivery of healthcare services, he said.
Sankaran prefers to look at FHA's work in human terms – serving the needs of disabled citizens, wounded warriors and children with cancer – all beneficiaries of the federal agencies involved in the FHA. Putting real faces on the FHA's goals resonates with the general public and drives greater public support, he said.
While the FHA has made significant progress in little more than a year, Sankaran said there is still much work to be done before moving from limited health information exchange production to full production. Governance, trust, policy and operational infrastructure need to be addressed, he said.
One of the biggest policy challenges involves the privacy and security of federal data, which is tightly controlled through the Federal Information Security Management Act (FISMA). The FHA must determine what to do when the Department of Defense moves federal data into the private sector. If the data is still deemed federal, FISMA must be implemented on the receiving end and required controls need to be determined – no small act, said Sankaran.
Through its healthcare IT partners, the FHA has developed the technology for health information exchange, but Sankaran emphasized that technology is first and foremost an "enabler." The platform is for collaboration and innovation; technology is the enabler to collaborate and innovate, he said.
"Technology cannot be ahead of policy; policy will drive the technology."
