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.

An Overview of the National An Overview of the National Health Information Infrastructure – Health Information Infrastructure –

A Call to Action!A Call to Action!

Helga E. Rippen, MD, PhD, MPH

NHII/ASPE/DHHS

Washington Area Health Tech Net

May 14, 2004

“Our 21st century health caresystem uses a 19th century

paperwork system”

-- President George W. BushApril 27, 2004

OverviewOverview

The case for an National Health Information Infrastructure (NHII)

NHII requirements & implementation strategy

Accelerating NHII progressSynopsis of the NCR-LHII activitiesYour role

An NHII is Needed to Address An NHII is Needed to Address Health Care System ChallengesHealth Care System ChallengesError rates are too highQuality is inconsistentResearch results are not rapidly usedCosts are escalatingNew technologies continue to drive up

costsDemographics of baby boomers will

greatly increase demandCapacity for early detection of

bioterrorism is minimal

The NHII Enables Anywhere, The NHII Enables Anywhere, Anytime Health Care DeliveryAnytime Health Care Delivery

NOT a central database of medical recordsComprehensive knowledge-based network of

interoperable systemsCapable 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 ITThe 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 NHIIFour Domains of NHII

Personal/Consumer

PublicHealth/

Community

NHII

Research/Policy

Clinical

The NHII Will Improve the Health The NHII Will Improve the Health Care SystemCare 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

OverviewOverview

The case for an NHII NHII requirements & implementation

strategyAccelerating NHII progressSynopsis of the NCR-LHII activitiesYour role

Core Requirements are NeededCore 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 An Implementation Strategy that Overcomes Potential IssuesOvercomes Potential Issues

No national database or identifierAlignment of incentivesAllow each care facility to maintain its own dataMinimize 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 The Overall NHII Net National Savings is $131+ Billion a YearSavings is $131+ Billion a Year

Source:Center forInformationTechnologyLeadership,PartnersHealthCare,Harvard(2004)

Community Health

InformationExchange

Outpatient EHR

InptEHR

TOTAL$121.04

~10

~44

~77

TOTAL $131+

An Inpatient EHR Provides Some An Inpatient EHR Provides Some SavingsSavings

• Benefits go to hospital

• Larger hospitals are investing

• Capital is obstacle for small & rural institutions

Community Health

InformationExchange

Outpatient EHR

InptEHR

~10

~44

~77

Incentives are Needed to Ensure Incentives are Needed to Ensure Outpatient EHR SavingsOutpatient EHR Savings

• Benefits go to payer

• No business case for physicians (especially small practices)

• Payer incentives needed (e.g. Maine)

Community Health

InformationExchange

Outpatient EHR

InptEHR

~10

~44

~77

Most of the Savings Come from Most of the Savings Come from Community Health Information ExchangeCommunity Health Information Exchange

• Substantial benefits to all

• First mover disadvantage

• Seed funding needed

• Focus of current Federal initiatives

Community Health

InformationExchange

Outpatient EHR

InptEHR

~10

~44

~77

community

Clinical Encounter

Index of where patients have records Temporary Aggregate

Patient History

Patient Authorized

Inquiry

Hospital Record Laboratory Results Specialist Record

Patient data delivered to Physician

LHII system

RecordsReturned

Requests for Records

U.S.

Index of where patients have records Temporary Aggregate

Patient History

Authorized Inquiry

from LHII

Hospital Record Laboratory Results Specialist Record

Patient data delivered to other LHII

LHII system

RecordsReturned

Requests for Records

anotherLHII

There are Many Advantages of an There are Many Advantages of an LHII ApproachLHII 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

OverviewOverview

The case for an NHIINHII requirements & implementation

strategy Accelerating NHII progressSynopsis of the NCR-LHII activitiesYour role

Accelerating NHII Progress Accelerating NHII Progress Through a Six Point StrategyThrough a Six Point Strategy

Inform– Disseminate NHII vision– Catalog NHII activities– Disseminate “lessons learned”

Collaborate with StakeholdersConvene

– 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 ProgressAccelerating 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: The President’s Goal: Establishing EHRs Establishing EHRs

for Most Americans in for Most Americans in 10 Years10 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 Executive Order Reinforces the NHIIthe 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 Secretary Thompson’s May 6 Summit MeetingSummit 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 9NDF-RT)]– Human Gene Nomenclature– EPA’s Substance Registry systems for non-medicinal chemicals

SNOMED-CT

A Call to Action and Three A Call to Action and Three Tasks Directed by Secretary Tasks Directed by Secretary

Thompson Thompson Call to action to accelerate progressTasks:

– Adopt standards– Wide adoption of e-prescribing and electronic

health records– Development of local health information

exchanges

OverviewOverview

The case for an NHII Accelerating NHII progressNHII requirements & implementation

strategy Synopsis of the NCR-LHII activitiesYour role

The National Capital Region –The National Capital Region –LHII Initiative is Moving ForwardLHII 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

OverviewOverview

The case for an NHIINHII requirements & implementation

strategyAccelerating NHII progressSynopsis of the NCR-LHII activities Your role

How can you help with the NHII?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?Questions?

Helga E. Rippen, MD, PhD, [email protected]/205-8678

For more information about NHII

http://aspe.hhs.gov/sp/nhii

Mark Your CalendarNHII 04 MeetingJuly 20-23, 2004Washington, DC

Mark Your CalendarNHII 04 MeetingJuly 20-23, 2004Washington, DC