MEDINFO 2004 September 8 2004 Developing National Health
MEDINFO 2004 September 8, 2004 Developing National Health Information Infrastructure (NHII) in the U. S. n n William A. Yasnoff, MD, Ph. D, FACMI Senior Advisor National Health Information Infrastructure Department of Health and Human Services
Overview I. III. IV. V. VI. 2 Organization of U. S. health care “system” History of NHII What is NHII? NHII Challenges Accelerating NHII Presidential Attention
I. Organization of U. S. Health Care “System” n n 3 Employer-based coverage l Limited consumer choice of plans l Diversity of pricing/covered services Multiple competing systems l Hospitals l Health plans Government is major payer (~50%) l Medicare l Medicaid (shared with states) Minimal centralized control
II. History of NHII: Reports 4 IOM 1991 1997 Computer-Based Patient Record IOM 2000 To Err is Human NRC/ CSTB IOM 2001 Networking Health: Prescriptions for the Internet 2001 Crossing the Quality Chasm PITAC 2001 Transforming Health Care Through Information Technology NCVHS 2001 NHII
III. What is NHII? n n 5 Comprehensive knowledge-based network of interoperable systems Capable of providing information for sound decisions about health when and where needed “Anywhere, anytime health care information and decision support” NOT a central database of medical records
What is NHII? (continued) n n 6 Includes technologies, practices, relationships, laws, standards, and applications, e. g. l Communication networks l Message & content standards l Computer applications l Confidentiality protections Individual provider Electronic Health Record (EHR) systems are only the building blocks, not NHII
NHII Requirements: Functions n n n 7 Overall: “Anytime, anywhere health care information and decision support” Immediate availability of complete medical record (compiled from all sources) to any point-of-care Enable up-to-date decision support at any point of care Enable selective reporting (e. g. for public health) Enable use of tools to facilitate delivery of care (e. g. e-prescribing) Allow patients to control access to their information
NHII Requirements: Implementation Strategy n n n 8 No national database or identifier Alignment of incentives Allow each care facility to maintain its own data Minimize cost & risk Use proven implementation strategies (where possible), e. g. incremental approach l Each implementation step benefits all participants l Implementation scope coincides with benefits scope
IV. NHII Challenges n n n Health care information is very complex IT systems more expensive and difficult to build Health care is highly fragmented Organizational and change management issues from IT systems are difficult to manage in clinical environment l l n Difficult to generate capital needed for IT investment l 9 Physicians are independent contractors Reimbursement does not provide ROI for IT IT is regarded as an add-on cost, not an investment for competitive advantage
V. Accelerating NHII progress n n n 10 Inform l Disseminate NHII vision l Catalog NHII activities l Disseminate “lessons learned” Collaborate with Stakeholders Convene l NHII 03: 6/30 -7/2/2003 – Develop a consensus agenda l NHII 04: 7/21 -23/2004 in D. C. – Release strategic framework – More stakeholder feedback
Views expressed do not necessarily represent U. S. Government policy NHII 03 Final Recommendations I. II. 11 Management 1) Governance 2) Education 3) Shared Resources 4) Metrics Enablers 1) Financial Incentives* 2) Standards* 3) Legal Issues III. IV. Implementati on Strategy 1) Demonstration Projects 2) Architecture* 3) Identifiers Targeted Domains 1) Consumer Health* 2) Research* *original breakout track
V. Accelerating NHII progress (2) n n n 12 Standardize l HL 7, DICOM, IEEE 1073, NCPDP SCRIPT l SNOMED, LOINC l HL 7 projects: EHR functions, EHR interchange format Demonstrate l $50 million in FY 04 budget for NHII demonstration projects (AHRQ) l President has requested additional $50 million for FY 05 Evaluate l Rigorous assessment of NHII benefits l Policy options for aligning financial incentives
community Hospital Record Laboratory Results Specialist Records Returned Requests for Records Patient Authorized Inquiry Index of where patients have records Temporary Aggregate Patient History Info exch system 13 Clinical Encounter Patient data delivered to Physician
U. S. Hospital Record Laboratory Results Specialist Records Returned Requests for Records Authorized Inquiry another Info Exch System 14 Index of where patients have records Temporary Aggregate Patient History Info exch system Patient data delivered
Advantages of Local Approach n n n n n 15 Existing HII systems are local Health care is local benefits are local Facilitates high level of trust needed Easier to align local incentives Local scope increases probability of success Specific local needs can be addressed Can develop a repeatable implementation process Parallel implementation more rapid progress Use of standards allows connectivity between local info exchanges NHII
VI. Presidential Attention “Our 21 st century health care th system uses a 19 century paperwork system” -- President George W. Bush April 27, 2004 16
President’s Executive Order April 27, 2004 n n 17 Creates position of National Health IT Coordinator in HHS l David Brailer MD, Ph. D l Reports to HHS Secretary l New Office in HHS (ONCHIT) Responsible for l Coordinating all Federal and private sector efforts toward NHII l Developing and monitoring strategic plan
Strategic Framework (7/21/2004) n n 18 EHR Adoption & Use l Incentives Interconnecting Clinicians l RHIOs Personalize Care l Develop personal health records Improve Population Health l Use electronic health information for public health & research
Questions? For more information about NHII http: //aspe. hhs. gov/sp/nhii For more information about ONCHIT http: //www. hhs. gov/onchit/index. html William A. Yasnoff, MD, Ph. D william. yasnoff@hhs. gov 202/690 -7862 19
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