Dossia

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The Dossia Founders Group is a consortium of large employers united in their goal of providing employees with an independent, personal health record (PHR). The Dossia Founders Group includes AT&T, Applied Materials, BP America, Inc., Cardinal Health, Intel Corporation, Pitney Bowes, sanofi-aventis and Wal-Mart. It is projected that this initiative could provide benefit to more than 5 million employees, dependents and retirees. [1]

Background

The impetus behind the initiative is to curb health care costs by cutting down on administrative costs, reduce medical errors and costs associated with duplicate tests, and offer convenience to people wanting access to their own records.

Legal Issues

While this landmark consortium was introduced in 2006 with much anticipation, initial efforts were dampened by ongoing litigation issues with Omnimedix Institute, the not-for-profit organization designated to develop the personal health-record system for the consortium. In June 2007, Dossia filed a restraining order and injunction against Omnimedix. These filings have remained sealed due to the sensitivity of the contract terms between both organizations. With the founder's initial contribution of $1.5 million apiece, the Dossia consortium is still committed to moving forward with providing their employees with PHRs and hope to make them available within 2007.

Technology Partner

Dossia recently announced a new technology partnership between the Dossia Founders Group and Children’s Hospital Informatics Program (CHIP), based at Children’s Hospital Boston and affiliated with Harvard Medical School and with the Harvard-MIT Division of Health Sciences and Technology. Through this partnership, Dossia will use Indivo, the personally controlled health record [www.indivohealth.org], to allow patients to integrate their health information across sites of care.

Technical Details

The Indivo architecture system provides a framework to gather information and documents from various sources, including claims based data systems and hopefully EHR systems, and store them centrally within the Dossia database.

Data model

The Indivo data model employs an XML structure that allows them to capture the benefits of pre-defined document types such as the HL7 Clinical Document Architecture (CDA) while also allowing flexibility to accept other document types that are then wrapped in XML “meta-data that describes how that document is classified within the record, the type of document that it is, a brief description of the documents contents, and its creation and modification time.”

Personally Controlled Access Control

The Indivo authorization module is based on the Organization for the Advancement of Structured Information Standards (OASIS) extensible access control markup language (XACML). This XML encoded access control information allows for individually expressed privacy policies. For example, a patient may wish to keep certain information private from their healthcare provider that another patient with similar type of information may wish to share. Additionally, a patient may wish to share a certain piece of information with one healthcare provider while not disclosing to another. The user is not forced to grant access for all role types at the same time.

Privacy Concerns

Privacy advocates have voiced their concerns over the use of health information technology and employer sponsored personal health records. According to Austin, Texas-based psychiatrist Deborah Peel, founder of the Patient Privacy Rights Foundation, “PHRs will never truly be safe, secure or private until federal law protects the privacy of Americans' health information wherever it is stored and no matter what databank holds it.”

Conclusion

Because of the support from the Founders Group, Dossia presents a unique opportunity to provide personally controlled electronic health records for its large employee base. Another notable PHR effort that was recently announced is Microsoft HealthVault. Both initiatives hope to forge change in healthcare by providing patients with easily managed and access to their personal health information. While some still argue the benefits of PHR systems and raise concerns over privacy issues, the Dossia platform provides an opportunity for patients to start managing their health information and to help manage the costs of healthcare.


References

  1. Dossia Site: http://www.dossia.org
  2. Conn, J. (2007, July 17). Dossia wants PHR deal kept under wraps. Retrieved November 13, 2007, from Modern Healthcare: http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070717/FREE/70717002/1029/FREE
  3. Major U.S. Employer Group Announces Two Founding Members, Collaborator for Building Dossia Infrastructure. (2007, September 17). Retrieved November 2007 [2]
  4. Retrieved Novenber 2007, from Indivo: http://www.indivohealth.org/pages/docstandard