At the close of a meeting today that brought together some of the nation’s most experienced and knowledgeable people to discuss financing of health information technology, the experts had more questions than answers on how to pay for the National Health Information Network.
Representatives of the four contractor teams that have worked on NHIN development for the past year presented their analyses of how the network should be financed. Three said that within two to eight years, it could generate enough revenues to pay its own operating costs. But those forecasts were based on some assumptions and did not include the initial capital costs of building the network.
A fourth contractor team, that Computer Sciences Corp. led, did not forecast a breakeven point because use of the network it advocates is free at the national level. Dr. Marc Overhage, president and chief executive officer of the Indiana Health Information Exchange, spoke for the CSC team.
Like the other teams, the CSC team advocates a standards-based network of networks that would run on top of the Internet. CSC would provide all services at the local, regional or state level. The other teams proposed providing some centralized services, such as a medical records locator service.
The Office of the National Coordinator for Health IT convened the meeting in Washington, D.C., to review results of its program to build NHIN prototypes. Because ONCHIT has decided that the federal government will not build and pay for the NHIN, the contractors looked to other revenue sources.
For the most part, they determined that simply charging fees for delivery of data could not finance the NHIN. The network’s ability to pay its own way would depend on selling data about patients’ health to drug makers, researchers and the federal government, which needs that data for disease and bioterrorism surveillance.
Names and other identifying information would be stripped from the data. But questions remain about whether anonymization techniques are always effective. In addition, data sales would require patients to agree that their records could be released in this way.
Even if those hurdles are overcome, no one knows whether there is a market for such data.
Two speakers, who were not associated with the NHIN prototypes, were asked to comment on the contractors’ business analyses. They expressed doubts about the financial feasibility of the NHIN.
Stephen Parente, associate professor of finance at the University of Minnesota, said planning for the NHIN has focused too much on the national network and not enough on the potential users of the network, especially individual doctors.
Widespread electronic medical records use “is really fundamental to making this thing work,” said Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative. He said adoption of EMRs by doctors and hospitals is proceeding too slowly to engender optimism about readiness to use the NHIN.
“The only business case for a national network is for the federal government to create and sustain it,” Tripathi said.
Richard Steen, NHIN business leader at contractor IBM Corp., also said government would have to invest in the network to give it a chance to become viable. Dr. Scott Cullen, NHIN clinical architect at contractor Accenture, agreed that “there’s going to have to be some level of government support.”
Government Health IT presents Liesa Jo Jenkins, executive director of CareSpark, in this recent eSeminar, where she shared her experiences and insight into building a health information exchange that enhances community health, rewards regional collaboration and drives economic progress.
