BETHESDA, MD – Four federal contractors this summer outlined various approaches to the architecture needed to develop a nationwide health information network capable of exchanging healthcare data.

While taking different paths to development of prototype NHINs, the contractors are all taking a federated, decentralized approach to creation of such networks.

The federal government last year awarded four contracts totaling $18.6 million to consortia that include Accenture, Computer Sciences Corp. IBM and Northrop Grumman to develop the data exchange networks.

The team led by Accenture is working with several healthcare players and regional health information organizations in Tennessee, Virginia, Kentucky and West Virginia to create a network to share data. The group will provide an interface to physicians and other providers to export a core data set that includes patient demographics, medication and lab history and some diagnosis information. The data would then be stored in a regional or community database.

“We think there are advantages to having a core set of data centralized at the RHIO level,” Brian Kelly, MD, clinical architect and senior executive for Accenture told attendees at a meeting on the nationwide health information network. The two-day meeting in Bethesda, Md., was designed to gather input on how such networks would work.

Kelly told attendees that the Accenture approach places a heavy emphasis on data standardization.

The CSC-led team that is testing data exchange between providers in Mendocino County, Calif., Massachusetts and Indiana is using a record locator service to electronically gather health information about patients. The network will also include sub networks that provide secure communications between any groups that agree to share data.

IBM is leading a team to work with New York’s Taconic Health Information Network and Community, North Carolina Healthcare Information and Communications Alliance and the North Carolina Healthcare Information and Communications Alliance in Rockingham County

The network, which would be built using open standards, would access patient information from a master patient index at the community level. Physicians could access patient information based on a demographic matching algorithm.

The group led by Northrop Grumman is relying on architecture based around “gateways” that connect to the larger NHIN. Each gateway would access a master patient index and would not rely on a national patient identifier. Wendell Ocasio, MD, principal clinical systems architect, said this approach to the network could help enforce nationwide healthcare IT standards.

The American Health Informa- tion Community, a federal advisory body made up of public and private sector members, has recommended several use cases for these networks.

The groups are slated by October to detail the revenue and costs models needed to make networks for exchanging healthcare data operational. The completed technical design for the networks is due in November.