The federal government continues to pursue the laudable goal of a national electronic healthcare infrastructure in which care sites share information electronically. The wisdom of that goal seems clear. In theory, healthcare will be improved and costs will go down if there is better coordination and more efficient data-sharing between providers.

But there are several hurdles to overcome before this e-fantasy becomes reality.

David Blumenthal, the National Coordinator for Health Information Technology, spoke about some of those challenges, and progress to date on addressing them, at a Jan. 20 conference sponsored by the eHealth Initiative, a health IT advocacy group (www.ehealthinitiative.org).

According to a story by Mary Mosquera on govhealthit.com (Jan. 11), highlights of Blumenthal's presentation included:

• State of the Union: The U.S. lags way behind nations such as the Netherlands and Canada when it comes to adoption of electronic health records (EHRs). But even those countries struggle with the same problem facing the U.S.: How to develop standards for interoperability that are not only reliable but also flexible and dynamic so that providers can share data in multiple ways. A national e-health infrastructure needs this level of sophistication to reach its full potential, Blumenthal said.
• Nationwide Health Information Network (NHIN): NHIN is a set of government-developed standards and services for complex, secure data exchanges between large organizations. Blumenthal touted a recently launched pilot project in San Diego in which clinicians at Kaiser Permanente and the U.S. Department of Veteran Affairs are sharing patient information on health issues, medications, and allergies. The Kaiser-Veterans Affairs project employs NHIN.
• Direct Project: ONC is also promoting its Direct Project, which the article describes as “a streamlined version of NHIN to send data through a version of secure email.” ONC is now holding demonstrations of the Direct Project for simple data exchanges. Some pilot sites are already using Direct to share information.
• Healthcare Information Exchanges (HIEs): ONC is helping states form HIEs by offering planning grants. Plans are already completed in 25 states, some of which have established HIEs), with the remaining 25 expected to finish plans in the spring.
• Meaningful use: Under the current program, the Centers for Medicare and Medicaid Services is offering financial incentives to Medicare providers for adopting EHRs. But this should only be seen as a beginning step toward a national electronic healthcare system, Blumenthal said. He sees the next stage of meaningful use as emphasizing even greater health information exchange, more computerized decision support, and an increased focus on process and care, as opposed to technology capabilities and data entry.