hipaa - global health care · • nanda* •nic* • nmmds •noc* •omaha* • pcds* • pnds...
TRANSCRIPT
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HIPAAHIPAA
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NCVHS NCVHS --HIPAA TransactionsHIPAA Transactions
and and the National Health Information the National Health Information
InfrastructureInfrastructure
John R. Lumpkin, MD, MPHChairman,
National Committee on Vital and Health StatisticsSenior Vice-President
Robert Wood Johnson Foundation
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NCVHS MissionNCVHS Mission
• The mission of the National Committee on Vital and Health Statistics (NCVHS) is to advise on shaping a national information strategy for improving the population’s health.
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NCVHS NCVHS
• Formed in 1949• Refined and expanded ICD• 1969 Uniform Hospital Discharge Data Set• 1974 Uniform Ambulatory Care Data Set• 1980 Long Term Care Data Set• 1996 Core Data Set
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1974 1974 -- Kerr WhiteKerr WhiteChairman NCVHS Chairman NCVHS
• “With the advent of new technology, data can be collected in any format, aggregated by the computer and arrayed in any desired
output … collecting masses of data untouched by human thought
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“Perfect Storm” Forming Around “Perfect Storm” Forming Around Health and Health CareHealth and Health Care
•• 41 Million + Uninsured in America41 Million + Uninsured in America•• Health Care Costs Rapidly RisingHealth Care Costs Rapidly Rising•• Those Covered Paying More for Their Those Covered Paying More for Their
Coverage and More OutCoverage and More Out--ofof--PocketPocket•• State Budget Crises Threatening CoverageState Budget Crises Threatening Coverage•• Quality is not a givenQuality is not a given•• Public Health System is StressedPublic Health System is Stressed•• Seeking Health Information is a Major Internet Seeking Health Information is a Major Internet
TaskTask
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Medicare Reimbursements (Part A and B) in Medicare Reimbursements (Part A and B) in Relation to the National Average (2000)Relation to the National Average (2000)
More than 15% Above AverageMore than 15% Above Average (36)(36)00 -- 15% Above Average15% Above Average (68)(68)00 -- 15% Below Average15% Below Average (112)(112)More than 15% Below AverageMore than 15% Below Average (90)(90)Not PopulatedNot Populated
Jack WennbergDartmouthAtlas of Health Care
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R2 = 0.49Num
ber o
f Vis
its to
Car
diol
ogis
tsN
umbe
r of V
isits
to C
ardi
olog
ists
0.00.0
0.50.5
1.01.0
1.51.5
2.02.0
2.52.5
0.00.0 2.52.5 5.05.0 7.57.5 10.010.0 12.512.5 15.015.0
Number of Cardiologists per 100,000Number of Cardiologists per 100,000
Capacity Determines Need?Capacity Determines Need?
Jack WennbergDartmouthAtlas of Health Care
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What does Greater Per Capita Spending What does Greater Per Capita Spending BUY?BUY?
not more effective or preference sensitive carenot more effective or preference sensitive care1.
00
1.00
1.001.
18
0.98 1.04
1.38
0.97 1.03
1.66
1.00
0.99
0.00.0
0.40.4
0.80.8
1.21.2
1.61.6
2.02.0
Medicare ReimbursementsMedicare Reimbursements Effective CareEffective Care PreferencePreference--Sensitive CareSensitive Care(Discretionary Surgery)(Discretionary Surgery)
Rat
io to
Low
est S
pend
ing
Reg
ion
Rat
io to
Low
est S
pend
ing
Reg
ion
More than 15% Below Average0-15% Below Average0-15% Above AverageMore than 15% Above Average
Jack WennbergDartmouthAtlas of Health Care
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Asthma: Outpatient FollowAsthma: Outpatient Follow--upupAfter Acute EpisodesAfter Acute Episodes
•• Core concept: Core concept: Outpatient followOutpatient follow--up up after either ER visit or after either ER visit or admissionadmission
•• Children 5Children 5--17 years old17 years old•• Standard based on Standard based on
national expert panel national expert panel guidelinesguidelines
0
10
20
30
40
50
60
70
80
90
100
Follow-up Rate
White
African-American
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Quality of Health Care in US??Quality of Health Care in US??
• Overall Care 54.9%• Preventive 54.9%• Acute 53.4%• Chronic 56.1%• History 43.4%• Counseling or Ed 18.3%• Immunization 65.7%Elizabeth McGlynn, et al NEJM June 26, 2003 348:26
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A. Sehgal- JAMA 2003;289:996-1000
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The focus must shift from blaming The focus must shift from blaming individuals for past errors to a focus on individuals for past errors to a focus on
preventing future errors by designing safety preventing future errors by designing safety into the systeminto the system
To Err is Human- Institute of Medicine
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Current practice depends upon the Current practice depends upon the clinical decisionclinical decision--making capacity and making capacity and reliability of autonomous individual reliability of autonomous individual practitioners, for classes of problems practitioners, for classes of problems that routinely exceeds the bounds of that routinely exceeds the bounds of
unaided human cognitionunaided human cognition
Daniel R. Masys, M.D.2001 IOM Annual Meeting
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HIPAAHIPAA
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Health Insurance Portability Health Insurance Portability and Accountability Act 1996and Accountability Act 1996
• PUBLIC LAW 104-191• Title II Subtitle F• It is the purpose of this subtitle to improve the Medicare
program under title XVIII of the Social Security Act, the Medicaid program under title XIX of such Act, and the efficiency and effectiveness of the health care system, by encouraging the development of a health information system through the establishment of standards and requirements for the electronic transmission of certain health information
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Transaction Standards Transaction Standards Claims or equivalent encounter information
Coordination of benefits information
Referral certification and authorization
Enrollment & disenrollment in a health plan
Eligibility for a health plan
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Transaction Standards Transaction Standards Health care payment & remittance advice
Health plan premium payments
First report of injury
Health claims status
Health claims attachments
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Supporting Standards Supporting Standards Privacy
Security
Code sets
Unique identifiers (including allowed uses) for:– Individuals– Employers– Health Plans– Health Care Providers
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"Darmok and Jalad at Tanagra"Darmok and Jalad at Tanagra
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ConversationConversation
• Vocabulary– What words you choose
• Grammar– How you put the words together
• Context– What environmental factors are influential
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Data Flow as ConversationData Flow as Conversation
• Vocabulary (software-independent)– Content Standards: SNOMED, LOINC
• Grammar (software-independent)– Transmission/Structure Standards: HL7,
ASTM, X12• Context
– Conceptual Data Model• HL7 EHR• ISO/TC 215
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We stand on the “tipping point” of We stand on the “tipping point” of the rapid enhancement of the health the rapid enhancement of the health
care system into a high quality, care system into a high quality, efficient and effective system. efficient and effective system.
Automation of information systems is Automation of information systems is the transforming technologythe transforming technology
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Vision of the NHIIVision of the NHII
• The set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health.
• NOT a centralized database.• Connects distributed health information in
the framework of a secure network with strict confidentiality protections.
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NHIINHII
• THE GOAL IS TO PUSH KNOWLEDGE TO THE POINT OF SERVICE (CONTACT)– EXPERT SYSTEMS– DECISION SUPPORT– PRACTICE GUIDELINES
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AMERICAN APPROACHAMERICAN APPROACH
• RESPECT INDIVIDUAL PRIVACY• ASSURE CONFIDENTIALITY• ENGINEERED FOR SECURITY
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NHIINHII
Population Health
(Preparedness)
Healthcare ProviderPersonalHealth
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NHIINHII
Population Health
(Preparedness)
Healthcare ProviderHealthcare ProviderPersonalHealth
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Health Care Provider Health Care Provider DimensionDimension
• Encompasses information to enhance the quality and efficiency of health services for individual
• Includes information captured during patient care process
• Integrates clinical guidelines and protocols, specific information from PHD, as authorized, and from Community Health Dimension
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Framework for Framework for PMRI (Patient Medical Record PMRI (Patient Medical Record
Information) StandardsInformation) Standards
InteroperabilityInteroperabilityData
Data
Quality
Quality
ComparabilityComparability
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HL7 &DICOM HL7 & ASTM
HL7
HL7
ASTM& HL7
IEEE
PMRIPMRI
Laboratories
ASCX12N &
NCPDP
NCPDP &ASC X12N
NCPDP &X12N
Radiology
HospitalPharmacy
Knowledgebases
Physiologicalmonitors
Medicaldevices
Bedsidecomputer
PatientRegistration/Admissions
Billing
Clinicalcontent
Orders&results
CommunityPharmacies
PharmacyBenefits Mgrs
Payers
HL7
HL7&
ASTM
HL7
IEEE
(Adapted from Electronic Health Records: Changing the Vision, Eds. GF Murphy,MA Hanken, and KA Waters. Philadelphia: W. B. Saunders Company, 1999)
Interoperability StatusInteroperability Status
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Comparability StatusComparability Status
ConvergenceSNOMED RT/NHS Clinical Terms
Message Specific Codes• DICOM• NCPDP• IEEE• HL7*• X12N
Nursing Codes• HHCC*• NANDA*• NIC*• NMMDS• NOC*• OMAHA*• PCDS*• PNDS
Drug Codes
•First Data Bank*•Multum *•NDC
Diagnoses & Procedure Codes• Alternative Link*• CDT-2*• CPT-4*• HCPCS*• ICD-9-CM/ICD-9-V3*• ICD-10-CM*• ICD-10- PCS• ICIDH-2
Other Codes•Health Language Center•UMDNS (ECRI)*•DEEDS•UPN (HIBCC)/UPC (UCC)
Clinically Specific Codes• DSM*• Gabrieli• LOINC*• MEDCIN• MedDRA• SNOMED V3*• NHS Clinical Terms*
* Fully or partially included in theUMLS Metathesaurus as of March 1, 2000
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The Health Informatics The Health Informatics PipelinePipeline
Foundation Foundation HIPAA StandardsHIPAA Standards
Financial &
Administrative
Interoperability
Comparability
Data
Qua
lity
Privacy &Security
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NHIINHII
Population Population HealthHealth
(Preparedness)(Preparedness)
Healthcare ProviderPersonalHealth
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Population Health DimensionPopulation Health Dimension
• Supports the identification of health threats, assessment of population health status, focussing programs and services, research and evaluation
• Encompasses population-based health data and resources, statutorily authorized data in public health systems and the Health Care Provider Dimension, and other anonymous data
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SNOW AND CHOLERASNOW AND CHOLERA
• DATABASE ANALYSIS
• GIS SYSTEM
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The Need for The Need for Solutions is UrgentSolutions is Urgent
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ClincalSite
State PHDept
LocalPH Dept
CDC
CDCResponse
Team
LocalResponse
Team
FBIResponse
Team
ContractorResponse
Team
HHSLRN
Level ALab
LRNLevel B,C
Lab
Contaminated Bldg.Outbreak Community
RegularLab
2.1 - suspicion
1
2N
34N
4.11
4P
4.124.1 - suspicion
5
6N6P
6.1 - new case
4.13
4.2
6.116.12
6.2
6.13
0 - specimen
2P
FBI
7 8 9
1010
11
12
13
10 - New Event
14
1415
14
15
15
Hospital
Vaccination Center
Example Data Flow
C. Broome - CDC
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A Word of CautionA Word of Caution
The real danger is not that computers will begin to think
like men, but that men will begin to think like computers
Sidney J. Harris
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NHIINHII
Population Health
(Preparedness)
Healthcare ProviderPersonalPersonalHealthHealth
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Pew Internet Project
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Personal Health DimensionPersonal Health Dimension
• Supports the management of individual wellness and health care decision-making
• Includes a personal health record, created and controlled by the individual or family
• Includes non-clinical information such as self-care trackers, health materials, local public health and health care services
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Consumer attitudes Consumer attitudes towards PHR towards PHR
• Consumers are eager to obtain health information online and facilitate transactions
• Consumer concerns about Internet privacy are strong and well-documented
• Users will want to be able to control their PHR as much as possible
• The more educated about PHR, and the more experience consumers have with it, the more open they are to the concept
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“We have wonderful technology, but some grocery stores have better technology than our hospitals and
clinics.”Secretary Tommy ThompsonChicago Medical School CommencementJune 7, 2002
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Arthur C. Clarke LawsArthur C. Clarke Laws
Third Law:"Any sufficiently advanced technology is
indistinguishable from magic."