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Our 21st century health caresystem uses a 19th centurypaperwork system". -- President George W. BushApril 27, 2004. Overview. The case for an National Health Information Infrastructure (NHII)NHII requirements
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1. 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
3. 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
4. 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
5. 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
6. 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
7. Four Domains of NHII
8. 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
9. Overview The case for an NHII
NHII requirements & implementation strategy
Accelerating NHII progress
Synopsis of the NCR-LHII activities
Your role
10. 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
11. 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
12. The Overall NHII Net National Savings is $131+ Billion a Year
13. An Inpatient EHR Provides Some Savings
14. Incentives are Needed to Ensure Outpatient EHR Savings
15. Most of the Savings Come from Community Health Information Exchange
18. 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
19. Overview The case for an NHII
NHII requirements & implementation strategy
Accelerating NHII progress
Synopsis of the NCR-LHII activities
Your role
20. 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
21. 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
22. The Presidents Goal: Establishing EHRs for Most Americans in 10 Years President Bushs 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
23. 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 patients individually identifiable health information is secure and protected
24. Secretary Thompsons 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 [FDAs names and codes, RxNORM for clinical drugs, VAs National Drug File Reference Terminology 9NDF-RT)]
Human Gene Nomenclature
EPAs Substance Registry systems for non-medicinal chemicals
SNOMED-CT
25. 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
26. Overview The case for an NHII
Accelerating NHII progress
NHII requirements & implementation strategy
Synopsis of the NCR-LHII activities
Your role
27. 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
28. Overview The case for an NHII
NHII requirements & implementation strategy
Accelerating NHII progress
Synopsis of the NCR-LHII activities
Your role
29. 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
31. Questions?