How NHIN will change health care communications

If the retail catalog industry has kept the U.S. Postal Service on life support during the past decade or so, then doctors, hospitals and pharmacies certainly must be given credit for sustaining the dying — but not yet dead — prospects of landline phone companies.

How else to explain the fact that simply renewing a standing prescription can involve a series of phone calls to, between and among these three high exemplars of the health care industry? Mind you, it’s not as if any human beings are talking to each other over these voice-to-voice carriers — these are modern industries after all! Computer-generated voices manage nearly every transaction while you, dear consumer, dutifully press “1” for yes and “2” for no.

How quaintly 20th century, now that we’re looking at Year 10 of the 21st.

The Nationwide Health Information Network, or NHIN for short (say “nin”), promises to change all that. NHIN was created five years ago by the Health and Human Services Department to establish a mechanism, along with a set of technology conventions and interoperability functions, for the exchange of confidential patient information to various points along the health care continuum. Quite naturally, the Internet, not the Postal Service or Ma Bell, provides the means of communication among the various health care providers, be they down the street or across the country.

It’s not there yet, by any stretch of the imagination. A couple dozen public and private entities are participating, from federal agencies such as the Social Security Administration to some state and local jurisdictions and a handful of hospitals and insurers. More pilot projects are under way. But the basic architecture has been laid out and, thanks to a $47 billion stimulus provided in the $787 billion Recovery Act, the money is now there to press ahead with full speed.

And there’s the rub. As staff writer Alice Lipowicz reports in this week’s cover story, a number of experts are seriously worried that NHIN's architecture might not be the proper foundation for the creation of a robust and secure information exchange — i.e., one that provides a “meaningful use” of patient care. It’s one thing to get doctors to use e-mail to share information, they say, but quite another to deliver life-saving information to the actual point of care.

But scrapping the current system and retooling the NHIN architecture carries huge fiscal and political consequences. As Alice’s story points out, concerns about competition, innovation and the larger issues of health care reform could stand in the way of achieving the full deployment of electronic health records.

So don’t give up your phone just yet, Doc. There may yet be a day when we’ll need you to pick up and press or say “1.”