Will Ross is a veteran in the world of health information exchange (HIE). Ross is project manager at Redwood MedNet, a nonprofit group of physicians and technologists developing IT solutions for the healthcare community in Mendocino, Calif.


In 2005, Ross participated in the Mendocino Health Records Exchange (HRE), a two-year demonstration project to build a prototype record locator service based on open-source software and following the Technical Roadmap and Common Framework published by the Markle Foundation’s Connecting for Health.


Using the CONNECT software, Ross recently demonstrated connectivity of Redwood MedNet to the Nationwide Health Information Network (NHIN) infrastructure. He will repeat the connectivity demonstration at the HIMSS10 Healthcare Conference and Exhibition in early March.


Ross said he’s struck by the number of newcomers building HIEs. “As we ramp up the ARRA (American Recovery and Reinvestment Act) funding, we are revisiting the lessons learned in earlier projects around decentralization and centralization, identity management, authentication and consent,” he said.


Two of the four prototype architectures in the Connecting for Health RLS demonstration project were decentralized, he pointed out. In fact, the current approach, which is institutionalized in the CONNECT software, is decentralization, Ross said. “The data doesn’t have to be centralized in one big data warehouse,” he argued. As far as Ross is concerned, questions about whether to centralize or decentralize patient data were answered with the 2005 demonstration project.


One of the key points coming out of Connecting for Health is technology is policy, Ross said. “You develop trust in your relationship with your local provider,” he said. “Creating a national warehouse of all trusted relationships is a bad idea.”


The California Office of Health Information Integrity (OHII) is collaborating with stakeholders to develop new privacy and security standards to foster adoption and application of health information exchange in the state. OHII’s California Privacy and Security Advisory Board is wrestling with whether patient consent should be centralized. “That’s not the right question (to ask),” Ross said. He doesn’t believe the state should manage consent decisions on medical records. “The answer is a clear no,” he said. “It’s too cumbersome as a technology solution and it’s not the correct policy, either.” Ross pointed out: “We didn’t use that approach in the paper world and there’s no need to create it in the digital world.”


Ross believes the industry needs to think through trust relationships when dealing with privacy of data in the current world. “Understanding these relationships has huge implications for the technology we adopt,” he said. “We have to preserve the existing trust; it’s valuable and fragile.” He also believes in the importance of policy before technology decisions.


While emphasizing the importance of trust, Ross acknowledged, “We can have trust, but we need a business reason to exchange data.” The current reimbursement paradigm imposes limitations on stakeholders that prohibit cost justification of health information exchange, he said.


The collapse of the Portland RHIO rested on one of their very goals, to reduce the cost of healthcare, which impacted provider revenue streams. While the incentives have changed the landscape, it will take payment reform to enable providers to participate in HIEs.


That said, Ross highlighted the success of HealthBridge, which worked through it business case and identified data elements that participants were willing to pay for. “Find data that makes business sense to exchange,” he said. “You have to find a reason to exchange for stakeholders.”


Ross reminds us that “this is a marathon, not a sprint.” Long-term IT management requires keeping user expectations to the level of software achievements. “Don’t over promise and don’t under deliver,” he said. And don’t believe that EHRs are ready. “If EHRs were ready for adoption, why do we need incentives?” he said. “We’re not ready and it’s not easy.” While the work being done by HITSP (Healthcare Information Technology Standards Panel) has been “such a boon” to the industry, Ross said, “We’re still inventing how it works. It’s a scavenger hunt.”


Ultimately, though, the industry needs to keep its eyes on the prize of improving quality of care and deploying electronic business processes to reduce medical errors, he said.