Transcript T Gerber - European Health Forum Gastein

Establishing an American Health Information
Infrastructure: Domestic Experience and
Global Implications
Ticia Gerber, Vice President, International Programs
eHealth Initiative and Foundation
European Health Forum Gastein
October 2005
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Overview of Discussion
• Synopsis of eHealth Initiative
• Examine current bi-partisan e-Health (HIT)
efforts within the United States and
chronicle their global implications
• Compare/contrast these efforts with
European e-Health developments
• Discuss opportunities for mutual learning,
collaboration and partnership
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Increased Momentum in the U.S.
Enormous momentum around e-Health
(HIT) and health information exchange
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U.S. Congress
Administration
Private Sector
States and Communities
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eHealth Initiative - Role and Mission
• eHealth Initiative has been critical driver in creating and
cultivating e-Health policy change in U.S. (community, state,
federal activities)
• We are extending our reach to collaborate with and learn
from key healthcare stakeholders around the globe through
the Leadership in Global Health Technology (LIGHT) Initiative
• eHealth Initiative (eHI) is an independent, non-profit, multistakeholder consortium whose mission is to improve the
quality, safety, and efficiency of healthcare through
information and information technology
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eHealth Initiative Membership
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Consumer and patient groups
Employers, healthcare purchasers, and payers
Health care information technology suppliers
Hospitals and other providers
Pharmaceutical and medical device manufacturers
Pharmacies, laboratories and other ancillary providers
Practicing clinicians and clinician groups
Public health agencies
Quality improvement organizations
Research and academic institutions
State, regional and community-based health information
organizations
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eHealth Initiative Driving Change
CCBH Program
• $11 million program in cooperation with U.S. Health
Resources and Services Administration/DHHS
• Provides seed funding to regional and communitybased multi-stakeholder collaboratives that are
mobilizing information across organizations
• Mobilizes pioneers and experts to develop
resources and tools to support health information
exchange: technical, financial, clinical,
organizational, legal
• Disseminates resources and tools and creates a
place for learning and dialogue across communities
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Communities Being Funded
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Connecting Colorado (Denver, CO)
Indiana Health Information Exchange (Indianapolis, IN)
MA-SHARE MedsInfo e-Prescribing Initiative (Waltham, MA)
MD/DC Collaborative for Healthcare Information Technology
(Baltimore/Washington Metro Area)
Santa Barbara County Care Data Exchange (Santa Barbara,
CA)
Taconic Health Information Network and Community
(Fishkill, NY)
Tri-Cities TN-VA Care Data Exchange (Kingsport, TN)
Whatcom County e-Prescribing Project (Bellingham, WA)
Wisconsin Health Information Exchange (National Institute
for Medical Informatics – Midwest) (Milwaukee, WI)
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Origins of Increased Momentum in the
U.S.
• IOM To Err is Human Report (November 1999)
• NCVHS NHII Workgroup report Information for
Health: A Strategy for Building the National
Health Information Infrastructure (November
2001)
• Sunsetting of managed care and managed
competition as panacea for health system ills
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Origins of Increased Momentum in the
U.S.
9/11/01 placed increased emphasis on:
• Need to fund and implement electronic,
interoperable exchange of health
information, particularly for public health
and bioterrorism surveillance (CHI)
• Importance of cooperation between
federal agencies and the public and
private sector (CFH)
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Origins of Increased Momentum in the
U.S.
Example of post 9/11 momentum
Bioterrorism Preparedness Act of 2001 (PL
107-188)
• Introduced 12/4/01, enacted 6/12/02
• Establishes intergovernmental Working Group
On Bioterrorism
• Calls for development of national public health
communications and surveillance network
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Momentum in U.S. Congress
A multitude of legislation is being considered in the House
and Senate includes support for e-Health (HIT)
These bills call for:
– More coordination and leadership within government
– Federal adoption of data exchange standards
– Revolving loan funds, loan guarantees, competitive
grants to eligible entities for the acquisition,
development of qualified informatics systems ($50
million - $125 million in first year)
– Demonstration programs for linking payment to HIT,
usage of HIT for chronic care management
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Momentum in U.S. Congress
First e-Health (HIT) bill introduced in May
2001 – The Medical Errors Reduction Act
(S. 824)
Called for:
• HHS grant program for purchasing,
leasing, developing, and implementing
standardized clinical health care
informatics systems
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Momentum in U.S. Congress
Medicare Prescription Drug, Improvement and
Modernization Act (Enacted 12/8/03)
Contains:
• Demonstration project linking Medicare payment
to better outcomes and use of HIT (Section 649)
• National Chronic Care Improvement Program
(CCIP) pilot to establish payments for outcomes
based on clinical quality improvement measures
where HIT is essential to success (Section 721)
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Momentum in U.S. Congress
Legislation Introduced in 2005
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S. 16 - Affordable Health Care Act (1/05)
HR 747 - National Health Information Incentive Act (2/05)
S. 544 - Public Health Service Act (3/05)
Budget Reserve Fund included in Budget Conference
Report (4/05)
• HR 2234 - 21st Century Health Information Act (5/05)
• S 1227 Health Information Technology Act of 2005 (6/05)
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Momentum in U.S. Congress
Legislation Introduced in 2005
• S 1262 - Health Technology to Enhance Quality Act of
2005 (6/05)
• S 1355 - Health Information Technology Quality and
Improvement Act (6/05)
• S 1356 - Medicare Value Purchasing Act (6/05)
• S 1416 – Wired for Health Care Quality Act (7/05)
• HR 3617 – Medicare Value-based Purchasing for
Physician Services Act (7/05)
• Health Information Technology Promotion Act (draft-7/05)
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Momentum in U.S. Congress
Active legislation includes:
HIT bills
• Senate
S 1416 – Wired for Health Care Quality Act
• House
Health Information Technology Promotion Act (draft-7/05)
Medicare Pay for Performance
• Senate
S 1356 - Medicare Value Purchasing Act
• House
HR 3617 – Medicare Value-based Purchasing for Physician
Services Act
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Momentum in U.S. Congress
Common Legislation Themes
• Need for standards—public-private sector collaboratives
designed to achieve consensus on and drive adoption of
interoperability standards
• Grant and loan programs, for providers and regional
health information technology networks – most link to
use of standards and adoption of “quality measurement
systems”
• Value-based purchasing programs – measures related to
reporting of data, process measures including HIT, and
eventually outcomes
• Role of government – catalyst, driver of change
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Momentum in U.S. Congress
FORECAST
• Action on HIT legislation this year not likely, physician payment bill possible
Important characteristics of bill negotiation process
• Bi-partisan HIT issue support
• 108th Congress spans both 2005 and 2006
• Multi-committee discussions and drafting
• House and Senate have very different solutions that must be worked out in
conference
• Budget deficit environment (challenge of adequate funding, meaningful
incentives)
• Lack critical mass of economic research on impact of HIT
• Federal priority-shifting in wake of Hurricane Katrina
• Congressional efforts must integrate with current Administration initiatives
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Momentum in U.S. Administration
• Leadership on all Sides
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Office of Secretary of DHHS
Office of the National Coordinator for HIT
Agency for Healthcare Research and Quality
Centers for Disease Control and Prevention
Centers for Medicare and Medicaid Services
Department of Defense
Department of Veterans Affairs
Office of Personnel Management
• Executive and cabinet-level leadership critical in advancing the
issue
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Momentum in U.S. Administration
President George W. Bush, April 26, 2004
“The 21st century health care system is using a 19th century
paperwork system. These old methods of keeping records are real
threats to patients and their safety and are incredibly costly. Modern
technology hasn't caught up with a major aspect of health care and
we've got to change that. We need a system where everyone has
their own personal electronic medical record that they control and
they can give a doctor when they need to.
“The federal government must create the incentives for health care
providers involved with the federal government to use medical
records, and in doing so, will go a long way toward introducing IT,
information technology, into a part of medicine that desperately
needs it.
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Momentum in U.S. Administration
Former U.S. HHS Secretary Tommy Thompson, May 6, 2004
"Health information technology promises huge benefits, and we
need to move quickly across many fronts to capture these benefits.
But the task is also enormously complex. We need more than a
business-as-usual approach.”
Current U.S. HHS Secretary Mike Leavitt, June 6, 2005
“The use of electronic health record and other information
technology will transform our healthcare system. We will bring
together the public and private health care sectors to transform
health care as we know it.”
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Momentum in U.S. Administration
• President George W. Bush announces in April 2004
plan for most Americans to have an electronic
health record in ten years
• May 2004 appointment of sub-cabinet level position
– National Health Information Technology
Coordinator David J. Brailer, MD, PhD
• In February 2, 2005 State of the Union Address
President Bush declares continuing support for IT
to improve healthcare, by asking Congress to move
forward on “…improved health information
technology to prevent medical errors and needless
costs.”
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Momentum in U.S. Administration
• Summary of over 500 Responses to RFI
for National Health Information Network
released in 5/05
• HHS Secretary Michael Leavitt releases
four RFP’s re Interoperability and Health
Information Sharing Policies in 6/05
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Momentum in U.S. Administration
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Four RFP’s on Interoperability and Health
Information Sharing Policies
Contract to develop, prototype, and evaluate
feasibility and effectiveness of a process to
unify and harmonize industry-wide health IT
standards development, maintenance and
refinements over time – awarded by Fall 2005
Contract to develop, prototype, and evaluate
compliance certification process for EHRs,
including infrastructure or network components
through which they interoperate – awarded by
Fall 2005
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Momentum in U.S. Administration
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Four RFP’s on Interoperability and Health
Information Sharing Policies
Contract to assess and develop plans to address
variations in organization-level business policies and
state laws that affect privacy and security practices,
including those related to HIPAA – awarded by Fall
2005
Six contracts for the development of designs and
architectures that specify the construction, models of
operation, enhancement and maintenance, and live
demonstrations of the Internet-based NHIN prototype –
awarded in FY 2006
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Momentum in U.S. Administration
• Creation of American Health Information Community
(AHIC)
– Formed under auspices of FACA, it will provide input and
recommendations to HHS on how to make health records
digital and interoperable and assure that privacy and
security are protected
– 17 Commissioners – solicited nominations from consumer
groups, providers, payers, hospitals, vendors, privacy
interests, and any other member of public
– Dissolution within two to five years with goal of creating selfsustaining, private sector replacement
– American Health Information Community (AHIC)
Commissioners announced 9/05
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Momentum in U.S. Administration
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American Health Information Community
deliverables include:
Adoption of non-governmental standard-setting and
certification processes
Groundwork for a national architecture that allows data
to be shared securely using the Internet
Applications that provide immediate benefits (drug
safety, lab results, bioterrorism surveillance, etc.)
Transition to a private-sector health information
community initiative that will provide long-term
governance
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Momentum in U.S. Administration
AHIC Commissioners (9/13)
• Scott P. Serota, President and CEO, Blue Cross Blue Shield
Association
• Douglas E. Henley, M.D., Executive Vice President, American
Academy of Family Physicians
• Lillee Smith Gelinas, R.N., Chief Nursing Officer, VHA Inc.
• Charles N. Kahn III, President, Federation of American Hospitals
• Nancy Davenport-Ennis, CEO, National Patient Advocate
Foundation
• Steven S Reinemund, CEO and Chairman, PepsiCo
• Kevin D. Hutchinson, CEO, SureScripts
• Craig R. Barrett, Chairman, Intel Corporation
• U.S. Government: CMS, CDC, VA, DoD, Treasury, OPM, Commerce
and IFSSA
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Momentum in U.S. Administration
U.S. Agency for Healthcare Research and Quality
• FY04: $139 million in grants and contracts for HIT
• Over 100 grants to support patient safety and HIT – 38
states with special focus on small and rural hospitals and
communities - $96 million over three years
• Five-year contracts to five states to help develop
statewide networks – CO, IN, RI, TN, UT - $25 million
over five years
• National HIT Resource Center: collaboration - $18.5
million over five years
• Currently in process of awarding up to $11.5M for statelevel privacy and security practices research and
proposed solutions
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Momentum in U.S. Administration
CDC
• Launched Biosense Program
• National initiative to enhance nation’s capability
to rapidly detect, quantify, and localize public
health emergencies by accessing and analyzing
health data
• This program will establish near real-time
electronic transmission of data to local, state and
federal public health agencies from national,
regional and local health data source (RFP
expected soon)
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Policy Change: Role of Health
Information Exchange (HIE)
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US contains more than 100 multi-stakeholder state, regional or
community HIEs in 45 states and the District of Columbia
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HIE provides capability to electronically move clinical information
between disparate healthcare information systems
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Community HIE organizations are geographically-defined entities
which develop and manage a set of contractual conventions and
terms, arrange for the means of electronic exchange of information,
and develop and maintain HIE standards
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More than half of HIEs in a recent August 2005 eHI Foundation
survey indicated they were in an advanced stage of development
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91% of survey respondents cited “securing upfront funding” as
either a very difficult or moderately difficult challenge
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Hurricane Katrina and Its Aftermath
Hurricane Katrina affected geographic area size of Great
Britain. Federal disaster has been declared over 90,000 square
miles.
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Hurricane Katrina and Its Aftermath
U.S. shelters are currently housing 89,400 survivors.
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Hurricane Katrina and Its Aftermath
It is estimated that as many as 1 million
individuals’ paper medical records have
been lost due to Hurricane Katrina.
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Hurricane Katrina and Its Aftermath
• Responding to urgent need, David Brailer, MD
(ONCHIT) and John Loonsk, MD (CDC) and a
number of public/private sector individuals are
developing and implementing plans to support
health information needs (electronically) of
hurricane evacuees and survivors
• Four expert work groups launched: evacuee
registry, information access, field medical record
support and communication and dissemination
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Hurricane Katrina and Its Aftermath
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Federal government facilitated making prescription medication record
information on Katrina evacuees available to authorized health
professionals and pharmacists on-line (www.KatrinaHealth.org)
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Public-private sector effort involving more than 150 organizations
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Nearly 40% of evacuees taking prescription drug medications before Katrina
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As of 9/14/05 doctors in eight shelters could perform Internet prescription
record search on more than 800,000 evacuees
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Evacuee medication and dosage information now accessible from anywhere
in the country for purposes of prescription submission, renewal and care
coordination (nationwide service launched 9/22/05)
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Medicaid, Veterans’ health and lab information may also soon be available
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Hurricane Katrina and Its Aftermath
Katrina has fundamentally altered the U.S. political landscape and
national policy priorities.
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Momentum in U.S. Private Sector
The U.S. private sector has launched a variety of initiatives
focused on HIT and better health
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Hospital-based – The Leapfrog Group has launched a new
national program that rewards good outcomes and adoption
of CPOE systems
• Health Plan-based – UHC, CIGNA, Aetna – they are all
recognizing physicians that adopt and use HIT to varying
degrees
• Physician-based Bridges To Excellence has a program
focused on adoption of systems of care, including HIT
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Opportunities for Collaboration
and “Partnerships for Health”
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Global Partnerships for Health
Leadership in Global Health Technology (LIGHT) Initiative Background
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eHI and its Foundation founded LIGHT Initiative in 2004
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eHI LIGHT’s purpose is to facilitate learning and information sharing among
HIT innovators and other nations, in both the developed and developing
world
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Focus of these activities is to identify the key barriers, workable strategies
and imperatives for implementing an interconnected, electronic health
information infrastructure to support better health and healthcare
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Participants include high-level healthcare officers and executives from the
public and private sectors around the globe
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eHI LIGHT’s project work and interests span six continents
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Global Partnerships for Health
eHI LIGHT has:
• Hosted two global HIT conferences involving over 17 nations (Geneva,
Washington DC)
• Begun discussions about mutual lessons learned and other issues with
government health, science and technology representatives (England,
Finland)
• Sponsored regional health improvement discussions and HIT summits for
different epicenters around the globe (Example: Finland, Japan)
• Developed an inventory of HIT-related efforts from different countries
across the world
• Launched an on-line Resource Center with global HIT information
• Arranged “site visits” for global partners who are interested in learning
from the U.S. HIT
• Convened eHI Working Group on LIGHT – meets monthly
• Initiated outreach to relevant policymakers to increase global HIT
collaboration and funding in the long-term.
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Global Partnerships for Health
In addition to current activities, in early 2006 eHI LIGHT
will:
• Release a “global who’s who” directory designed to help
those involved in HIT across the globe connect
• Host ambassadorial health event (100 nations targeted)
in Washington
• Host Asian HIT Summit in Tokyo
• Release 30-nation survey on HIT and better health
• Undertake project on electronic, interoperable digital
signatures and identity assurance in the global
biopharmaceutical environment
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Global Partnerships for Health
In Europe specifically, we desire to:
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Engage with European health and technology leaders (EU, EHTEL,
individual nations) to share current HIT policy and market developments
and lessons learned
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Fill knowledge gaps, facilitate targeted and helpful collaboration
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Crosswalk progress on EU eHealth Action Plan and EU eHealth I2 project
with US HIT agenda
*Note: Growing interest in US about how domestic HIT policy
aligns/compares with EU policy
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Share information gained from US community HIE projects (legal, technical,
financial, clinical, consumer)
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US-European summit on health improvement and HIT discussed
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Summary
• US is moving in a targeted, coordinated and expeditious
way towards implementation of HIT and health
information exchange in 2005 and 2006
• EU and Member States are also at critical point in eHealth, interoperability and connectivity efforts
• eHI and its LIGHT Initiative enthusiastically seek out
collaborative endeavors and partnerships
• Look forward to the opportunity for mutual learning
between the US and European nations
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Ticia Gerber
Vice President, International Programs
eHealth Initiative and Foundation
www.ehealthinitiative.org
1500 K Street, N.W., Suite 900
Washington, D.C. 20005
202.624.3264
[email protected]
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