Transcript NHII Brief 5.1-2003
HIMSS Advocacy Day Washington, DC April 1, 2004
National Health Information Infrastructure (NHII): Moving Toward Implementation
William A. Yasnoff, MD, PhD, FACMI Senior Advisor National Health Information Infrastructure Department of Health and Human Services
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Overview
I.
II.
III.
IV.
V.
What is NHII?
NHII progress since last year HHS strategy to accelerate NHII How can you help with NHII?
Summary
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I. 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
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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
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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
What will NHII enable?
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1.
2.
3.
4.
5.
6.
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
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II. Progress Since Last Year
NHII 03 Recommendations
Requirements Cost/Benefit Data
Architecture Strategy
Funding
NHII 03
Views expressed do not necessarily represent U.S. Government policy
Final Recommendations
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I.
II.
1) 2) 3) 4) Management Governance Education Shared Resources Metrics 1) Enablers Financial Incentives* 2) Standards* 3) Legal Issues III.
1) Implementation Strategy Demonstration Projects 2) 3) Architecture* Identifiers IV.
1) Targeted Domains Consumer Health* 2) Research* *original breakout track
NHII Requirements: Functions
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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
No national database or identifier
Alignment of incentives Allow each care facility to maintain its own data Minimize cost & risk
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Use proven implementation strategies (where possible), e.g. incremental approach
Each implementation step benefits all participants
Implementation scope coincides with benefits scope
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NHII Net National Savings
Inpt EHR Community Health Information Exchange Outpatient EHR Source: Center for Information Technology Leadership, Partners Health Care, Harvard (2004) $ Billions
Inpatient EHR
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Inpt EHR Community Health Information Exchange Outpatient EHR $ Billions
•
Benefits go to hospital
•
Larger hospitals are investing
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Capital is obstacle for small & rural institutions
Outpatient EHR
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Inpt EHR Community Health Information Exchange Outpatient EHR $ Billions
•
Benefits go to payer
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No business case for physicians (especially small practices)
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Payer incentives needed (e.g. Maine)
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Community Health Information Exchange
•
Substantial benefits to all Inpt EHR Community Health Information Exchange Outpatient EHR
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First mover disadvantage
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Seed funding needed
•
Focus of current Federal initiatives $ Billions
community
Hospital Record Laboratory Results Specialist Record
Records Returned Requests for Records
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Clinical Encounter
Patient Authorized Inquiry Patient data delivered to Physician
Index of where patients have records Temporary Aggregate Patient History
LHII system
U.S.
Hospital Record Laboratory Results Specialist Record
Records Returned Requests for Records
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another LHII Authorized Inquiry from LHII Patient data delivered to other LHII
Index of where patients have records Temporary Aggregate Patient History
LHII system
Advantages of LHII Approach
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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
progress more rapid Use of standards allows connectivity between LHIIs
NHII
III. Accelerating NHII progress
Inform
Disseminate NHII vision
Catalog NHII activities Disseminate “lessons learned”
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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
III. Accelerating NHII progress
(2)
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Standardize
HL7, DICOM, IEEE 1073, NCPDP SCRIPT
SNOMED, LOINC HL7: EHR functions; interchange standard 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
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IV. How can you help with NHII?
Cost-benefit data needed
Good data hard to find
Consider making your internal studies available Consider starting an LHII
Convene community partners
Discuss information sharing Keep informed on these issues
Ask for periodic reports Make your views known
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V. Summary
Health care is in crisis NHII is needed for safety & efficiency
Anywhere, anytime health care information
Decision support
Communication HHS is working to accelerate the NHII: inform, collaborate, convene, standardize, demonstrate, evaluate
We are making progress together!
“The committee believes that establishing this information technology infrastructure [NHII] should be the highest priority for all health care stakeholders.”
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- Committee on Data Standards for Patient Safety: “Patient Safety: Achieving a New Standard for Care” Institute of Medicine, November, 2003 (Executive Summary)
Questions?
Mark Your Calendar NHII 04 Meeting July 21-23, 2004 Washington, DC For more information about NHII http://aspe.hhs.gov/sp/nhii
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William A. Yasnoff, MD, PhD [email protected]
202/690-7862
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