As we look to the future to develop a National Health Information Network (NHIN), I think that the first piece needs to be accomplished locally. Using a community based Electronic Health Record (EHR), with possibly a Record Locator Service (RLS) to aggregate the data from disparate systems. I envision the beginnings of a regional Health Information Exchange (HIE) as a sort of virtual EHR. A key infrastructure component, after deployment of an Electronic Medical Record (EMR) system, would be a RLS that presents a unified view to clinicians at the point of care.
RLS code and message schemas are made available below courtesy of Connecting for Health.
I think it will be very important that we include all stakeholders and care providers in the discussions. Long-term care, public health, hospitals, clinics and physician practices will need to cooperate to create a meaningful system that will allow the data to be approriately and securely shared, with the result of better care and lower costs.
Once true EHRs are connected through an HIE a robust NHIN can develop, possibly including a web based Personal Health Record (PHR). A PHR has the ability to transcend local networks, but I do not think we should wait for these products to mature before developing EHRs connected via HIE at the local level.