Transcript NHII Brief 5.1-2003

Fifth Annual Public Health Data Standards Consortium
Steering Committee Meeting
Bethesda, Maryland; March 17, 2004
The Future of Health Data
Standards and the Business
Perspective:
The National Health Information
Infrastructure (NHII)
Helga E. Rippen, MD, PhD, MPH
Deputy Senior Advisor
National Health Information Infrastructure
Department of Health and Human Services
“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)
2
Overview
I.
II.
III.
IV.
3
Why does health care need NHII?
What is NHII?
How will the NHII Influence
Standards?
Moving the NHII Forward with
Standardization
I. Health Care System Challenges







4
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
Solution: Information
Technology (IT) for Health Care





5
20% of labs and x-rays done because
prior results unavailable
1 in 7 hospitalizations occur because
information about patient not available
“NHII is required to make patient safety
a standard of care” – IOM, 2003
Ambulatory CPOE could save $44 B/yr
Potential net efficiency gain from use of
information technology in health care:
> $87 Billion/yr
II. What is NHII?


6
“Anywhere, anytime health care
information and decision support”
 Comprehensive knowledge-based
network of interoperable systems
 Capable of providing information for
sound decisions about health when
and where needed
NOT a central database of medical
records
What is NHII? (continued)


7
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 NHII
NHII
8
Personal/
Consumer
Clinical
Public
Health/
Community
Research/
Policy
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
9
NHII Requirements:
Implementation Strategy





10
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
NHII Net National Savings
TOTAL
TOTAL
$121.04
$87
8.57
~6
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~55
$ Billions
11
~25
34.4
Source:
Center for
Information
Technology
Leadership,
Partners
Health
Care,
Harvard
(2004)
Inpatient EHR
• Benefits go to
hospital
~6
8.57
• Larger
hospitals are
investing
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~55
$ Billions
12
~25
34.4
• Capital is
obstacle for
small & rural
institutions
Outpatient EHR
• Benefits go to
payer
8.57
~6
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~55
$ Billions
13
~25
34.4
• No business
case for
physicians
(especially small
practices)
• Payer
incentives
needed (e.g.
Maine)
Community Health Information
Exchange
• Substantial
benefits to all
8.57
~6
• First mover
disadvantage
Inpt
EHR
Community
Health
Information
Exchange
Outpatient
EHR
78.07
~55
$ Billions
14
~25
34.4
• Seed funding
needed
• Focus of
current Federal
initiatives
community
Hospital Record
Laboratory Results
Specialist Record
Records
Returned
Requests
for Records
Patient
Authorized
Inquiry
Index of where patients
have records
Temporary Aggregate
Patient History
LHII system
15
Clinical Encounter
Patient data
delivered to
Physician
U.S.
Hospital Record
Laboratory Results
Specialist Record
Records
Returned
Requests
for Records
Authorized
Inquiry
from LHII
another
LHII
16
Index of where patients
have records
Temporary Aggregate
Patient History
LHII system
Patient data
delivered to
other LHII
Advantages of LHII Approach









17
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
What will NHII Enable?
1. Linkage between medical care & public
health (e.g. for bioterrorism detection)
2. Test results and x-rays always available
 eliminate repeat studies
3. Complete medical record always
available
4. Decision support always available:
guidelines & research results
5. Quality & payment information derived
from record of care – not separate
reporting systems
6. Consumers have access to their own
records
18
Elements of NHII (1 of 3)



19
Standards: Messaging & Content
 Foundation for remainder of NHII
Electronic Health Record (EHR) Systems
 Hospital
 Outpatient
 Post acute and long-term care
Consumer Health Information Systems
 Personal health record
 Electronic patient-provider communication
 Support groups
 Authoritative information
Elements of NHII (2 of 3)


20
Ancillary health care systems
 Pharmacy
 Laboratory
 Physical therapy
 Post-acute care
 Public health reporting
Communication/networking systems
 Information moves with patient
 Integrated information from all
types of providers
 Electronic consultation
(telemedicine)
Elements of NHII (3 of 3)


21
Decision Support & Education
 Professional
 Consumer
Confidentiality protections
 Information available on need-to-know
basis
 Authentication of all users
 Encryption of data in transit
 Audit trails of all usage
 Penalties for violations
Benefits of NHII






22
Monitor and Protect Public Health
(e.g. rapid disease detection)
Improve Patient Safety
 IOM: 44,000-98,000 preventable
deaths/year (more than motor vehicle
accidents, breast cancer, or AIDS)
Improve Quality of Care
Effectively Share Decision Support
Understand Health Care Costs
Better-informed Health Care Consumers
III. How will the NHII Influence
Standards?
NHII
Personal/
Consumer
Clinical
Public
Health/
Community
Research/
Policy
Wide reach requires
standards that are
complementary and
integrated
23
Health Information is
Complex
Public Health
Research
Lifestyle
Health events
Clinical encounters
Birth
Family
Health
24
Etc....
Environmental events
Death
Health Information is
Complex
Public Health
Consumer
25
Decision Support
Research
Healthcare
Some Standard Requirements





26
Common vocabulary
Messaging standard
Security and authentification standards
Coding standards for decision support
Standards for health record portability
Messaging Standards



27
What information is requested
Where is the information in the
message
Example: “phone number” message
 Pick up phone
 Listen for dial tone
 Dial number
– If first digit is 1, then long
distance, otherwise local
Content Standards



28
A common, agreed-upon, detailed
vocabulary for all medical terminology
Without a standard:
 “high blood pressure”
 “elevated blood pressure”
 “hypertension”
With a standard
 C487231, hypertension
 Unambiguous meaning for both
sender and receiver
IV: Moving the NHII Forward
with Standardization


29
Adoption of standards across
government agencies (PHIN/CHI/FHA)
 HL7, DICOM, IEEE 1073, NCPDP
SCRIPT
 SNOMED, LOINC
Facilitating standards development
by HL7
 EHR functions
 EHR interchange standard
Questions?
For more information about
NHII
http://aspe.hhs.gov/sp/nhii
Helga E. Rippen, MD, PhD, MPH
[email protected]
202/205-8678
30