By Chris Dimick
Washington State’s experiment in consumer-controlled health records has moved into a pilot phase, transforming the health record banking model from theory to testing. Earlier this month the Washington State Health Care Authority (HCA) announced the launch of three pilot sites that will try out the feasibility of a permanent statewide health record bank network.
Health record banks centrally store copies of consumer’s health records, which providers “deposit” into the accounts. Consumers control which providers can contribute information and which providers and individuals can view their records.
This model of health information exchange, where many providers send patient information to one central location, is seen as an alternative to the many-to-many exchange model, where several organizations directly exchange copies of patient’s records. If the pilot project is successful, Washington State hopes to show by example that health record banks are the ideal model for nationwide information exchange, says Juan Alaniz, health record bank pilot project manager for HCA.
Advocates for the health record banks agree that the pilot is an important demonstration of the model. William Yasnoff, MD, PhD, is managing partner of National Health Information Infrastructure Advisors and CEO of the Health Record Banking Alliance. “As the first operational health record bank, the Washington State pilots represent an important step in demonstrating how this approach addresses the key challenges of making comprehensive electronic medical records available at any point of care,” he says.
A main goal of the pilot is to show that health information can get into the hands of patients and providers, Alaniz says, which will reduce redundant medical procedures and costs and improve the quality and safety of care provided. “By having this information available, I think that we are arming consumers with valuable information they can use in a timely basis,” he says.
Three Pilot Sites
The Washington State pilot is the first large-scale testing of the health record bank model. The test contains three projects across the state, which will target 18,000 participants who have specialized healthcare needs such as chronic-illness patients, families with children, and caregivers.
The banks are managed by local community healthcare facilities, which identified and recruited patients to take part in the pilot, Alaniz says. The state contributed $1.7 million to the pilot, with participant healthcare communities also pitching in funds.
The three pilot sites are in the following locales:
- Bellingham, with St. Joseph Hospital Foundation and the Critical Junctures Institute
- Cashmere, with Community Choice Healthcare Network
- Spokane, with Inland Northwest Health Services.
“High Value” Data
Participating providers will begin by loading five types of “high value” data into consumers’ health record banks: medication history, immunization records, allergy information, family history, and a health status synopsis.
The pilot will end in July, when a preliminary results analysis will be conducted, Alaniz says. The project will test the financial sustainability of the banks, their ability to provide public health data, and how the banks should be organized and governed.
But most importantly, the pilot is meant to see if consumers and providers find health record banks valuable and would sign up for a fully-integrated, statewide health record banking system. “If it is of no value to consumers or providers, then we certainly don’t want to do this,” Alaniz says.
At the end of the pilot, the health record banks will continue to operate if funding can be secured. The goal is to have the banks financially self-sustainable by 2011.
The pilot banks run PHR programs from Microsoft Health Vault and Google Health. Each site chose between the two programs, which Alaniz describes as PHRs “on steroids.” When data are uploaded into the bank, the information is automatically organized in specialized ways useful to patients and providers.
Having private companies provide the infrastructure saved HCA the cost of developing its own software. In addition, the banks benefit from the companies’ work to make the interfaces consumer friendly, says Alaniz. If the health record bank project was to advance, Alaniz says banks would have their choice between using existing products and developing platforms from scratch.
Prior to the pilot, it was unclear who would build or provide the technical infrastructure for health record banks. The choice of Google and Microsoft isn’t surprising, says Yasnoff—the majority of health information infrastructures are built and operated from systems developed by private firms. Each of the health record bank pilots is governed by the local community, which he says will provide a watchful eye on how the records are managed.
Washington State officials plan to share the information they obtain from the pilots with interested parties. HCA has already talked with Oregon and New York state officials about sharing pilot data. Other communities including Louisville, KY, Ocala, FL, and Kansas City, MO, are also interested in pursuing health record banks, Yasnoff says.
The pilots are only the “test and learn” phase of building a state-wide health record bank system, which officials hope to launch in 2012, Alaniz says. If the results of the pilot support moving forward, the project will begin implementing lessons learned and develop the basic bank infrastructure.