William A. Yasnoff, MD, PhD, FACMI
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William A. Yasnoff, MD, PhD, FACMI Senior Advisor National Health Information Infrastructure Department of Health and Human Services. MEDINFO 2004 September 8, 2004. Developing National Health Information Infrastructure (NHII) in the U.S. Overview. Organization of U.S. health care “system”

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Developing national health information infrastructure nhii in the u s

William A. Yasnoff, MD, PhD, FACMI

Senior Advisor

National Health Information Infrastructure

Department of Health and Human Services

MEDINFO 2004

September 8, 2004

Developing National Health Information Infrastructure (NHII) in the U.S.


Overview

Overview

  • 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

I. Organization of U.S. Health Care “System”

  • Employer-based coverage

    • Limited consumer choice of plans

    • Diversity of pricing/covered services

  • Multiple competing systems

    • Hospitals

    • Health plans

  • Government is major payer (~50%)

    • Medicare

    • Medicaid (shared with states)

  • Minimal centralized control


Ii history of nhii reports

II. History of NHII: Reports


Iii what is nhii

III. What is NHII?

  • 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

What is NHII? (continued)

  • 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


Nhii requirements functions

NHII Requirements: Functions

  • 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

NHII Requirements: Implementation Strategy

  • 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


Iv nhii challenges

IV. NHII Challenges

  • 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

    • Physicians are independent contractors

    • Reimbursement does not provide ROI for IT

  • Difficult to generate capital needed for IT investment

    • IT is regarded as an add-on cost, not an investment for competitive advantage


V accelerating nhii progress

V. Accelerating NHII progress

  • Inform

    • Disseminate NHII vision

    • Catalog NHII activities

    • Disseminate “lessons learned”

  • Collaborate with Stakeholders

  • Convene

    • NHII 03: 6/30-7/2/2003

      • Develop a consensus agenda

    • NHII 04: 7/21-23/2004 in D.C.

      • Release strategic framework

      • More stakeholder feedback


Nhii 03 final recommendations

Management

Governance

Education

Shared Resources

Metrics

Enablers

Financial Incentives*

Standards*

Legal Issues

Implementation Strategy

Demonstration Projects

Architecture*

Identifiers

Targeted Domains

Consumer Health*

Research*

Views expressed do not necessarily

represent U.S. Government policy

NHII 03Final Recommendations

*original breakout track


V accelerating nhii progress 2

V. Accelerating NHII progress (2)

  • Standardize

    • HL7, DICOM, IEEE 1073, NCPDP SCRIPT

    • SNOMED, LOINC

    • HL7 projects: EHR functions, EHR interchange format

  • Demonstrate

    • $50 million in FY 04 budget for NHII demonstration projects (AHRQ)

    • President has requested additional $50 million for FY 05

  • Evaluate

    • Rigorous assessment of NHII benefits

    • Policy options for aligning financial incentives


Developing national health information infrastructure nhii in the u s

community

Hospital Record

Records

Returned

Laboratory Results

Specialist Record

Requests for Records

Temporary Aggregate Patient History

Patient Authorized Inquiry

Index of where patients

have records

Info exch system

Patient data delivered to Physician

Clinical Encounter


Developing national health information infrastructure nhii in the u s

U.S.

Hospital Record

Records

Returned

Laboratory Results

Specialist Record

Requests for Records

Temporary Aggregate Patient History

Authorized Inquiry

Index of where patients

have records

another

Info Exch

System

Info exch system

Patient data delivered


Advantages of local approach

Advantages of Local 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 local info exchanges  NHII


Vi presidential attention

VI. Presidential Attention

“Our 21st century health care

system uses a 19th century

paperwork system”

-- President George W. Bush

April 27, 2004


President s executive order april 27 2004

President’s Executive Order April 27, 2004

  • Creates position of National Health IT Coordinator in HHS

    • David Brailer MD, PhD

    • Reports to HHS Secretary

    • New Office in HHS (ONCHIT)

  • Responsible for

    • Coordinating all Federal and private sector efforts toward NHII

    • Developing and monitoring strategic plan


Strategic framework 7 21 2004

Strategic Framework (7/21/2004)

  • EHR Adoption & Use

    • Incentives

  • Interconnecting Clinicians

    • RHIOs

  • Personalize Care

    • Develop personal health records

  • Improve Population Health

    • Use electronic health information for public health & research


Questions

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, PhD

[email protected]

202/690-7862


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