Sometime during the next two months, through grants totaling $1.7 million, the Washington State Health Care Authority, or WSHCA (pdf), will launch three consumer-controlled health record bank pilots in the communities of Bellingham, Spokane and Cashmere.


WSHCA’s efforts are part of a movement toward implementing health record banking, or HRB, systems, said William Yasnoff, MD, PhD, managing partner of NHII Advisors and founder of the Health Record Banking Alliance.


In October 2007, the Oregon Dept. of Human Services’ Medical Assistance Programs division received a $5.5 million Medicaid Transformation Grant from the Centers for Medicare and Medicaid Services, or CMS, to implement a Health Record Bank of Oregon. The Dept. is anticipating an extension of the program through the end of March 2010.


The Louisville Health Information Exchange, or LouHIE, is in the midst of selecting a technology partner to implement its HRB system. Meanwhile, Kentucky announced in mid-January a Request for Proposal to develop a statewide health information exchange. The RFP stipulates that the statewide health information infrastructure must support HRB, Yasnoff said.


In Kansas City, Mo., CareEntrust is actively signing up consumers in cooperation with its large employer groups, he said. Yasnoff likens CareEntrust, a nonprofit, employer-based organization that creates patient-controlled longitudinal health records storied in a repository for its employers and their members and dependents, as a loosely based HRB entity.


Finally, the Greater Ocala Health Information Trust, or Healthy Ocala, is in the pre-operational stage of developing an Integrated Community Health Information System in Florida’s Marion County. The system will comprise a health information exchange that links patients’ personal health records and physician offices’ electronic health records.


HRB systems around the country are off and running, and with President Obama’s commitment for all Americans to have electronic health records, HRBs stand to play an important role in reaching that goal, Yasnoff said. “This is exciting and a very reasonable goal,” he said. “You do have to spend money to do it and government has a role to improve privacy and regulate health record banks.”


He contends that HRB can solve the healthcare IT problem without money from the government. HRB systems are sustainable with four potential revenue streams, according to Yasnoff: subscription or sponsorship, consumer-targeted advertising, query fee with permission to support such things as medical or population health research, and reminders and alerts paid by such stakeholders as consumers and pharmacies.


The healthcare IT funding included in the economic stimulus package will likely help physicians implement EHRs, but the HRB system can create a revenue stream for physicians as well. “Health record banking is financially sustainable without reference to healthcare savings,” he said.


The HRB concept is popular in Congress. Although the Independent Health Record Bank Act of 2006, authored by House Representatives Dennis Moore (D-Kan.) and Paul Ryan (R-Wis.), ultimately didn’t become law, 70 members co-sponsored the bill, an indication of clear support in the House, he said.


“It’s very important to understand the goal,” Yasnoff said. “It’s not just to have an interoperable electronic health record. It’s good to have an EHR, but it wouldn’t solve the healthcare IT problem. You need to have access to the complete patient record at the point of care, and you need to have decision support to enable recommendations for care.”


“If you solve the real problem, you’re likely to succeed,” he said. The HRB model encompasses elements that are required for success, he said. “You have to have privacy,” he said, and that includes giving patients control. It includes a trusted institution, which a community can establish, that oversees and regulates, and a trusted architecture that is centralized and as classified as the military.


“You have to have information and you have to have providers use that information and the system,” he said. That requires that the information output by every system be electronic and interpretable by the HRB system. With only one connection to the HRB system, data only needs to be converted once. “You can make a lot of progress without standards in place now,” he said.


Physicians will use the information if they have incentives to implement EHR systems. The information needs to be used at the point of care, but if only a small percentage of their patients have HRB accounts the potential for process disruption in the office is great and for utilization is less. Yasnoff advocates for a community healthcare market, which would be created by providing incentives to physicians in the form of payment for transmitting and receiving data.


Yasnoff is quick to distinguish HRB’s architecture, which includes a repository, versus a query-based or “fetch and show” architecture, in which pointers and indexes let users know where data on a particular patient is located. “No one to my knowledge has a fetch-and-show system with a large number of data sources in production,” he said. “It’s becoming clear to people that it doesn’t work.”


One of the central points of HRB is making relevant data available in real time, which requires knowing exactly what type of information is in the data sources, he said. Yasnoff notes that data pointers only let the user know that data for the particular patient resides in this particular data source. So every query would create a huge computing load and overhead if there are a large number of data sources. The HRB concept works in the same way as credit reporting, he said. “Credit agencies have all the information in a database; they don’t query on the current status,” he said. Records of episodes of care are deposited into the HRB account, making all data readily accessible. “This is a more sensible system,” Yasnoff said.


While there is still education to be given on HRBs, a handful of communities and state organizations are already in pilot mode. With support from Congress and President Obama’s 2014 mandate, as well as the healthcare IT funding through the economic stimulus package, Yasnoff said that the growth of HRBs looks very promising.