The Transformation of The Transformation of Health and Health Care Health and Health Care The Role of the NHII The Role of the NHII John Lumpkin, M.D., M.P.H., John Lumpkin, M.D., M.P.H., Senior Vice President, Senior Vice President, Director of Health Care Group Director of Health Care Group Robert Wood Johnson Foundation Robert Wood Johnson Foundation June 10, 2003 June 10, 2003
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The Transformation of Health and Health Care The Role of the NHII
The Transformation of Health and Health Care The Role of the NHII. John Lumpkin, M.D., M.P.H., Senior Vice President, Director of Health Care Group Robert Wood Johnson Foundation June 10, 2003. IOM Panel Reports November 2002. “The American health care system is confronting a crisis.” - PowerPoint PPT Presentation
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The Transformation of Health and The Transformation of Health and Health CareHealth Care
The Role of the NHIIThe Role of the NHII
John Lumpkin, M.D., M.P.H., John Lumpkin, M.D., M.P.H.,
Senior Vice President, Senior Vice President,
Director of Health Care GroupDirector of Health Care Group
Robert Wood Johnson FoundationRobert Wood Johnson Foundation
June 10, 2003June 10, 2003
IOM Panel ReportsIOM Panel Reports November 2002November 2002
• “The American health care system is confronting a crisis.”
• “The health care delivery system is incapable of meeting the present, let alone the future, needs of the American public.”
““Perfect Storm” Forming Around Perfect Storm” Forming Around Health and Health CareHealth and Health Care
• 41 Million + Uninsured in America41 Million + Uninsured in America• Health Care Costs Rapidly RisingHealth Care Costs Rapidly Rising• Those Covered Paying More for Their Those Covered Paying More for Their
Coverage and More Out-of-PocketCoverage and More Out-of-Pocket• State Budget Crises Threatening CoverageState Budget Crises Threatening Coverage• Quality is not a givenQuality is not a given• Public Health System is StressedPublic Health System is Stressed• Seeking Health Information is a Major Internet Seeking Health Information is a Major Internet
Medicare Reimbursements (Part A and B) in Medicare Reimbursements (Part A and B) in Relation to the National Average (2000)Relation to the National Average (2000)
More than 15% Above AverageMore than 15% Above Average (36)(36)00 - 15% Above Average- 15% Above Average (68)(68)00 - 15% Below Average- 15% Below Average (112)(112)More than 15% Below AverageMore than 15% Below Average (90)(90)Not PopulatedNot Populated
Jack WennbergDartmouthAtlas of Health Care
Quality of Health Care in US??Quality of Health Care in US??
• Overall Care 54.9%
• Preventive 54.9%
• Acute 53.4%
• Chronic 56.1%
• History 43.4%
• Counseling or Ed 18.3%
• Immunization 65.7%
Elizabeth McGlynn, et al NEJM June 26, 2003 348:26
The focus must shift from blaming The focus must shift from blaming individuals for past errors to a focus on individuals for past errors to a focus on
preventing future errors by designing safety preventing future errors by designing safety into the systeminto the system
To Err is Human
- Institute of Medicine
Back Surgery per 1,000 Medicare Enrollees Back Surgery per 1,000 Medicare Enrollees on a Race-Specific Basis (1999-2000)on a Race-Specific Basis (1999-2000)
1.01.0
2.02.0
3.03.0
4.04.0
5.05.0
6.06.0
7.07.0
8.08.0
9.09.0B
ac
k S
urg
ery
(19
99-2
000
)B
ac
k S
urg
ery
(19
99-2
000
)
Black Non-Black
A. Sehgal- JAMA 2003;289:996-1000
Current practice Current practice depends upon the depends upon the
clinical decision-making clinical decision-making capacity and reliability capacity and reliability
of autonomous of autonomous individual practitioners, individual practitioners, for classes of problems for classes of problems that routinely exceeds that routinely exceeds the bounds of unaided the bounds of unaided
human cognitionhuman cognitionDaniel R. Masys, M.D.
2001 IOM Annual Meeting
“We have wonderful technology, but some grocery stores have better
technology than our hospitals and clinics.”
Secretary Tommy ThompsonChicago Medical School CommencementJune 7, 2002
We stand on the “tipping point” of We stand on the “tipping point” of the rapid enhancement of the health the rapid enhancement of the health
care system into a high quality, care system into a high quality, efficient and effective system. efficient and effective system.
Automation of information systems is Automation of information systems is the transforming technologythe transforming technology
Framework for Framework for PMRI StandardsPMRI Standards
InteroperabilityInteroperability
Data
Data
Quality
Quality
ComparabilityComparability
HL7 &
DICOM HL7 & ASTM
HL7
HL7
ASTM
& HL7
IEEE
PMRIPMRI
Laboratories
ASC
X12N &
NCPDP
NCPDP &
ASC X12N
NCPDP &
X12N
Radiology
Hospital
Pharmacy
Knowledge
bases
Physiological
monitors
Medical
devicesBedside
computer
Patient
Registration/
Admissions
Billing
Clinical
content
Orders
&
results
Community
Pharmacies
Pharmacy
Benefits Mgrs
Payers
HL7
HL7
&
ASTM
HL7
IEEE
(Adapted from Electronic Health Records: Changing the Vision, Eds. GF Murphy,MA Hanken, and KA Waters. Philadelphia: W. B. Saunders Company, 1999)
Interoperability StatusInteroperability Status
Comparability Comparability IssuesIssues
• Comparability requires that the meaning of data is consistent when shared among different parties
Vocabulary Set of highly granular, specialized terms
ClassificationOrganization of related terms
Coderepresentation
of term
Terminology
The Health Informatics The Health Informatics PipelinePipeline
Foundation Foundation HIPAA StandardsHIPAA Standards
Financial &
Administrative
Interoperability
Comparability
Dat
a Q
ualit
y
Privacy &Security
NHIINHII
Population Population HealthHealth
(Preparedness)(Preparedness)
Healthcare ProviderPersonalHealth
ClincalSite
State PHDept
LocalPH Dept
CDC
CDCResponse
Team
LocalResponse
Team
FBIResponse
Team
ContractorResponse
Team
HHSLRN
Level ALab
LRNLevel B,C
Lab
Contaminated Bldg.Outbreak Community
RegularLab
2.1 - suspicion
1
2N
34N
4.11
4P
4.124.1 - suspicion
5
6N6P
6.1 - new case
4.13
4.2
6.11
6.12
6.2
6.13
0 - specimen
2P
FBI
7 8 9
1010
11
12
13
10 - New Event
14
1415
14
15
15
Hospital
Vaccination Center
Example Data Flow
C. Broome - CDC
The Need for The Need for Solutions is UrgentSolutions is Urgent
Third Wave of Public Health Information Third Wave of Public Health Information System DevelopmentSystem Development
• Federal Centric– State developed prototype – Installed in many states
• State Centric– System Development by Consortium of States
• Web enabled Immunization Registry
• Reuse Model
• ASP Model
NHIINHII
Population Health
(Preparedness)
Healthcare ProviderPersonalPersonalHealthHealth
Personal Health DimensionPersonal Health Dimension
• Supports the management of individual Supports the management of individual wellness and health care decision-makingwellness and health care decision-making
• Includes a personal health record, created and controlled by the individual or family
• Includes non-clinical information such Includes non-clinical information such as self-care trackers, health materials, as self-care trackers, health materials, local public health and health care local public health and health care servicesservices
General attitudes toward PHRGeneral attitudes toward PHR
When asked about specific aspects of a PHR, consumers react favorably:
• 83% of healthcare consumers want lab tests available online (Harris)
• 69% want online charts for managing chronic conditions (Harris)
• 80% want to receive personalized medical information online from their doctor after an office visit (Harris)
I always knew that Data was a I always knew that Data was a four letter word, four letter word,
I just never knew it was spelled I just never knew it was spelled
T-U-R-FT-U-R-F
Phil Lee, MD
HHS Agencies with NHII HHS Agencies with NHII ResponsibilitiesResponsibilities
• AHRQ
• ASIRM
• ASPE
• CDC
• CMS
• Data Council
• FDA
• HRSA
• NCHS • NIH• NLM• OCR• OPHS
In the modern era, every century has had its
major advance that has brought medical
science another giant step forward. …. What will
the major advance of the 21st century be?
I am convinced that the medical revolution
of our children’s lifetimes will be the
application of information technology to
health care.
Secretary ThompsonMarch 21, 2003
A Word of CautionA Word of Caution
The real danger is not that computers will begin to think
like men, but that men will begin to think like computers