Transcript An Overview of the National Health Information

An Overview of the National
Health Information Infrastructure –
A Call to Action!
Helga E. Rippen, MD, PhD, MPH
NHII/ASPE/DHHS
Washington Area Health Tech Net
May 14, 2004
“Our
st
21
century health care
system uses a 19th century
paperwork system”
-- President George W. Bush
April 27, 2004
Overview
 The
case for an National Health Information
Infrastructure (NHII)
 NHII requirements & implementation
strategy
 Accelerating NHII progress
 Synopsis of the NCR-LHII activities
 Your role
An NHII is Needed to Address
Health Care System Challenges

Error rates are too high
 Quality is inconsistent
 Research results are not rapidly used
 Costs are escalating
 New technologies continue to drive up
costs
 Demographics of baby boomers will
greatly increase demand
 Capacity for early detection of
bioterrorism is minimal
The NHII Enables Anywhere,
Anytime Health Care Delivery

NOT a central database of medical records
 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”
The 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
Four Domains of NHII
NHII
Personal/
Consumer
Clinical
Public
Health/
Community
Research/
Policy
The NHII Will Improve the Health
Care 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
Overview

The case for an NHII
 NHII requirements & implementation
strategy
 Accelerating NHII progress
 Synopsis of the NCR-LHII activities
 Your role
Core 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
An Implementation Strategy that
Overcomes Potential Issues

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
–
Each implementation step benefits all participants
– Implementation scope coincides with benefits scope
The Overall NHII Net National
Savings is $131+ Billion a Year
TOTAL
TOTAL
$121.04
$131+
8.57
~10
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~77
$ Billions
~44
34.4
Source:
Center for
Information
Technology
Leadership,
Partners
Health
Care,
Harvard
(2004)
An Inpatient EHR Provides Some
Savings
• Benefits go to
hospital
~10
8.57
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~77
$ Billions
~44
34.4
• Larger
hospitals are
investing
• Capital is
obstacle for
small & rural
institutions
Incentives are Needed to Ensure
Outpatient EHR Savings
• Benefits go to
payer
8.57
~10
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~77
$ Billions
~44
34.4
• No business
case for
physicians
(especially small
practices)
• Payer incentives
needed (e.g.
Maine)
Most of the Savings Come from
Community Health Information Exchange
• Substantial
benefits to all
8.57
~10
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~77
$ Billions
~44
34.4
• First mover
disadvantage
• Seed funding
needed
• Focus of current
Federal initiatives
community
Hospital Record
Laboratory Results
Specialist Record
Records
Returned
Requests
for Records
Patient
Authorized
Inquiry
Index of where patients
have records
Temporary Aggregate
Patient History
LHII system
Clinical Encounter
Patient data
delivered to
Physician
U.S.
Hospital Record
Laboratory Results
Specialist Record
Records
Returned
Requests
for Records
Authorized
Inquiry
from LHII
another
LHII
Index of where patients
have records
Temporary Aggregate
Patient History
LHII system
Patient data
delivered to
other LHII
There are Many Advantages of an
LHII 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
Overview

The case for an NHII
 NHII requirements & implementation
strategy
 Accelerating NHII progress
 Synopsis of the NCR-LHII activities
 Your role
Accelerating NHII Progress
Through a Six Point Strategy

Inform
– Disseminate NHII vision
– Catalog NHII activities
– Disseminate “lessons learned”

Collaborate with Stakeholders
 Convene
– NHII 04: 7/21-23/2004 in D.C.
– National meeting to
 Refine the consensus action agenda for NHII
 Report on NHII progress
Accelerating 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
The President’s Goal:
Establishing EHRs for
Most Americans in 10
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
Executive Order Reinforces
the 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
Secretary Thompson’s May 6
Summit 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 9NDFRT)]
Human Gene Nomenclature
EPA’s Substance Registry systems for non-medicinal chemicals
SNOMED-CT
A Call to Action and Three
Tasks Directed by Secretary
Thompson

Call to action to accelerate progress
 Tasks:
– Adopt standards
– Wide adoption of e-prescribing and electronic
health records
– Development of local health information
exchanges
Overview

The case for an NHII
 Accelerating NHII progress
 NHII requirements & implementation
strategy
 Synopsis of the NCR-LHII activities
 Your role
The National Capital Region –
LHII 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
Overview

The case for an NHII
 NHII requirements & implementation
strategy
 Accelerating NHII progress
 Synopsis of the NCR-LHII activities
 Your role
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
“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)
Questions?
Mark Your Calendar
NHII 04 Meeting
July 20-23, 2004
Washington, DC
For more information about
NHII
http://aspe.hhs.gov/sp/nhii
Helga E. Rippen, MD, PhD, MPH
[email protected]
202/205-8678