an overview of the national health information infrastructure – a call to action! helga e. rippen,...
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An Overview of the National An Overview of the National Health Information Infrastructure – Health Information Infrastructure –
A Call to Action!A Call to Action!
Helga E. Rippen, MD, PhD, MPH
NHII/ASPE/DHHS
Washington Area Health Tech Net
May 14, 2004
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“Our 21st century health caresystem uses a 19th century
paperwork system”
-- President George W. BushApril 27, 2004
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OverviewOverview
The case for an National Health Information Infrastructure (NHII)
NHII requirements & implementation strategy
Accelerating NHII progressSynopsis of the NCR-LHII activitiesYour role
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An NHII is Needed to Address An NHII is Needed to Address Health Care System ChallengesHealth Care System ChallengesError rates are too highQuality is inconsistentResearch results are not rapidly usedCosts are escalatingNew technologies continue to drive up
costsDemographics of baby boomers will
greatly increase demandCapacity for early detection of
bioterrorism is minimal
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The NHII Enables Anywhere, The NHII Enables Anywhere, Anytime Health Care DeliveryAnytime Health Care Delivery
NOT a central database of medical recordsComprehensive knowledge-based network of
interoperable systemsCapable of providing information for sound
decisions about health when and where needed
“Anywhere, anytime health care information and decision support”
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The NHII in More Than ITThe NHII in More Than IT
Includes technologies, practices, relationships, laws, standards, and applications, e.g.– Communication networks– Message & content standards– Computer applications– Confidentiality protections
Individual provider Electronic Health Record (EHR) systems are only the building blocks, not NHII
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Four Domains of NHIIFour Domains of NHII
Personal/Consumer
PublicHealth/
Community
NHII
Research/Policy
Clinical
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The NHII Will Improve the Health The NHII Will Improve the Health Care SystemCare System
Linkage between medical care & public health (e.g. for bioterrorism detection)
Test results and x-rays always available eliminate repeat studies
Complete medical record always available Decision support always available:
guidelines & research results Quality & payment information derived
from record of care – not separate reporting systems
Consumers have access to their own records
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OverviewOverview
The case for an NHII NHII requirements & implementation
strategyAccelerating NHII progressSynopsis of the NCR-LHII activitiesYour role
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Core Requirements are NeededCore Requirements are Needed
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
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An Implementation Strategy that An Implementation Strategy that Overcomes Potential IssuesOvercomes Potential Issues
No national database or identifierAlignment of incentivesAllow each care facility to maintain its own dataMinimize cost & risk Use proven implementation strategies (where
possible), e.g. incremental approach– Each implementation step benefits all participants– Implementation scope coincides with benefits scope
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The Overall NHII Net National The Overall NHII Net National Savings is $131+ Billion a YearSavings is $131+ Billion a Year
Source:Center forInformationTechnologyLeadership,PartnersHealthCare,Harvard(2004)
Community Health
InformationExchange
Outpatient EHR
InptEHR
TOTAL$121.04
~10
~44
~77
TOTAL $131+
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An Inpatient EHR Provides Some An Inpatient EHR Provides Some SavingsSavings
• Benefits go to hospital
• Larger hospitals are investing
• Capital is obstacle for small & rural institutions
Community Health
InformationExchange
Outpatient EHR
InptEHR
~10
~44
~77
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Incentives are Needed to Ensure Incentives are Needed to Ensure Outpatient EHR SavingsOutpatient EHR Savings
• Benefits go to payer
• No business case for physicians (especially small practices)
• Payer incentives needed (e.g. Maine)
Community Health
InformationExchange
Outpatient EHR
InptEHR
~10
~44
~77
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Most of the Savings Come from Most of the Savings Come from Community Health Information ExchangeCommunity Health Information Exchange
• Substantial benefits to all
• First mover disadvantage
• Seed funding needed
• Focus of current Federal initiatives
Community Health
InformationExchange
Outpatient EHR
InptEHR
~10
~44
~77
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community
Clinical Encounter
Index of where patients have records Temporary Aggregate
Patient History
Patient Authorized
Inquiry
Hospital Record Laboratory Results Specialist Record
Patient data delivered to Physician
LHII system
RecordsReturned
Requests for Records
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U.S.
Index of where patients have records Temporary Aggregate
Patient History
Authorized Inquiry
from LHII
Hospital Record Laboratory Results Specialist Record
Patient data delivered to other LHII
LHII system
RecordsReturned
Requests for Records
anotherLHII
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There are Many Advantages of an There are Many Advantages of an LHII ApproachLHII Approach
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
LHIIs NHII
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OverviewOverview
The case for an NHIINHII requirements & implementation
strategy Accelerating NHII progressSynopsis of the NCR-LHII activitiesYour role
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Accelerating NHII Progress Accelerating NHII Progress Through a Six Point StrategyThrough a Six Point Strategy
Inform– Disseminate NHII vision– Catalog NHII activities– Disseminate “lessons learned”
Collaborate with StakeholdersConvene
– NHII 04: 7/21-23/2004 in D.C.– National meeting to
Refine the consensus action agenda for NHII Report on NHII progress
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Accelerating NHII ProgressAccelerating NHII Progress Standardize
– 20 standards adopted by CHI: e.g., HL7, DICOM, IEEE 1073, NCPDP SCRIPT
– SNOMED, LOINC– HL7: EHR functions; interchange standard coming next
Demonstrate– $50 million in FY 04 budget for NHII demonstration projects
(AHRQ)– President has requested additional $50 million for FY 05 for
LHIIs
Evaluate– Rigorous assessment of NHII benefits– Policy options for aligning financial incentives
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The President’s Goal: The President’s Goal: Establishing EHRs Establishing EHRs
for Most Americans in for Most Americans in 10 Years10 Years
President Bush’s Executive Order April 27, 2004 – HHS – report on options for providing incentives in the
HHS programs promoting adoption of interoperable HIT– Director of OPM – options to provide incentives in the
Federal Employee Health Benefit Program promoting interoperable HIT
– VA and DoD approaches to working with private sector to make their HIT systems available as an affordable option
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Executive Order Reinforces Executive Order Reinforces the NHIIthe NHII
Establish the position of National Health Information Technology Coordinator
Work to be consistent with a vision of developing a nationwide interoperable health information technology infrastructure– Ensure appropriate information to guide medical decisions is
available at the time and place of care– Improves health care...– Promote an effective marketplace... – Improves coordination of care and information among providers...– Ensure patient’s individually identifiable health information is
secure and protected
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Secretary Thompson’s May 6 Secretary Thompson’s May 6 Summit MeetingSummit Meeting
Dr. Brailer named Additional standards adopted
– CHI [HL7-demographics, units of measure, immunization, clinical encounters, and clinical document architecture standard for text based reports]
– SNOMED CT [lab result contents, non-lab interventions and procedures, anatomy, diagnosis and problems, nursing]
– HIPAA transaction and code sets for billing or admin– Medications [FDA’s names and codes, RxNORM for clinical drugs,
VA’s National Drug File Reference Terminology 9NDF-RT)]– Human Gene Nomenclature– EPA’s Substance Registry systems for non-medicinal chemicals
SNOMED-CT
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A Call to Action and Three A Call to Action and Three Tasks Directed by Secretary Tasks Directed by Secretary
Thompson Thompson Call to action to accelerate progressTasks:
– Adopt standards– Wide adoption of e-prescribing and electronic
health records– Development of local health information
exchanges
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OverviewOverview
The case for an NHII Accelerating NHII progressNHII requirements & implementation
strategy Synopsis of the NCR-LHII activitiesYour role
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The National Capital Region –The National Capital Region –LHII Initiative is Moving ForwardLHII Initiative is Moving Forward Not a Federal project; HHS is playing a
facilitating role First stakeholder meeting April 26, 2004 at the
Council of Governments– Agreement to move forward
Volunteers for core group to move the process forward (20 people)
Council of Governments to provide support for developing the business plan
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OverviewOverview
The case for an NHIINHII requirements & implementation
strategyAccelerating NHII progressSynopsis of the NCR-LHII activities Your role
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How can you help with the NHII?How can you help with the NHII? Volunteer to participate in the NCR-LHII Developers should incorporate standards in
systems to promote interoperability Attend the July 20-23 meeting Cost-benefit data needed
– Good data hard to find– Consider making your internal studies available
Keep informed on these issues– Ask for periodic reports
Make your views known
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“The committee believes that establishing this information
technology infrastructure [NHII] should be the highest priority
for all health care stakeholders.”
-- Committee on Data Standards for Patient Safety: “Patient Safety: Achieving a New Standard for Care”
Institute of Medicine, November, 2003(Executive Summary)
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Questions?Questions?
Helga E. Rippen, MD, PhD, [email protected]/205-8678
For more information about NHII
http://aspe.hhs.gov/sp/nhii
Mark Your CalendarNHII 04 MeetingJuly 20-23, 2004Washington, DC
Mark Your CalendarNHII 04 MeetingJuly 20-23, 2004Washington, DC