Transcript Communications Initiatives Annual Update July 2002

Health Informatics:
Challenges and Opportunities for
Health Policy
Judy Ozbolt, PhD, RN
FAAN, FACMI, FAIMBE
Scholar
Institute of Medicine
[email protected]
INSTITUTE OF MEDICINE
Advising the Nation.
Improving Health.
“As an independent scientific adviser, the
Institute of Medicine strives to provide
advice that is unbiased, based on
evidence and grounded in science.
The mission of the Institute of Medicine
embraces the health of people
everywhere.”
Health Informatics
The application of information science, knowledge
management, computing, and telecommunications
to
• The health and health care of individuals and
families;
• The health monitoring and health services afforded
to populations;
• The advancement of biomedical research;
• The education and work processes of health
professionals and scientists;
• The education and health practices of the public
Biomedical Research
Health of
Individuals
& Families
Information Science
And Technology
Health of
Populations
Education, Work Processes,
And Health Practices
Health Informatics
A Critical Infrastructure for the Nation’s Health
• The Computer-based Patient Record (IOM, 1991,
1997)
• For the Record (NRC, 1997)
• Networking Health (NRC, 2000)
• To Err is Human (IOM, 2000)
• Crossing the Quality Chasm (IOM, 2001)
• Health Professions Education (IOM, 2003)
• Mathematics and 21st Century Biology (NRC, 2005)
• Building a Better Delivery System (NAE, 2005)
Health Care Should Be . . .
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Safe
Effective
Patient-centered
Timely
Efficient
Equitable
IOM, Crossing the Quality Chasm, 2001
Health Informatics In Support
of Aims of Health Care
• Electronic health records (EHR) for providers, with
continuous access to patient information,
knowledge resources, and decision support.
• Personal health records (PHR) for everyone, with
continuous access to own information, knowledge
resources, and care providers.
• Regional and national health information
infrastructure for health services, consumer health,
quality, accountability, research, and education.
Electronic Health Records:
Foundation for the Infrastructure
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Health Information and data
Test results management
Order entry / management
Decision support
Electronic communication and connectivity
Patient support
Administrative support and reporting
Population health management (IOM, 2003)
Personal Health Records:
Tools for Self-Management
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Access to own EHR (read-only)
Opportunity to record information into PHR
Secure email communication with providers
Access to reliable health knowledge and
information (e.g., Medline Plus, Gateway)
• Access to monitored listserves and chat rooms for
health concerns
• Decision support, alerts, and reminders
IOM, A Focus on Communities, 2004
Health Information Networks:
Vehicles for Information Exchange
• Secure access of authorized users to
information across providers, settings, times
• Critical information for patient care
• Reporting for regulation, payment, public
health
• Appropriate, secure access for research
IOM, A Focus on Communities, 2004
Bioinformatics
Foundation for Life Sciences Research
• Mathematical research / new computational
methods
• Research on genomics, genetics, molecular
biology / dissemination and use of findings
• Education of biologists for 21st Century
science
--NRC, 2003, 2004, 2005
Informatics Challenges and
Opportunities
• Security of health information
• Appropriate uses of the Internet for health
information
• Reliability of hardware and software
• Adaptation of emerging technologies for
health care, management, and science
• Work redesign
NRC, 1997, 2000, 2004; NAE/IOM 2005
Current Initiatives
• Secretary of DHHS has created and chairs the
American Health Information Community.
• Office of National Coordinator for Health
Information Technology has issued RFPs for
– Process to harmonize standards
– Process to specify functional requirements for health IT
products and certify compliance
– Models and prototypes for national health information
exchange
– Process to address variations in privacy and security
practices
Current Initiatives (2)
• Centers for Medicare and Medicaid Services
will make VHA VistA record system available
at no charge.
• More than 100 initiatives in 45 states are
working to exchange health information
across providers.
• AHRQ is funding some of these for
development and evaluation.
Current Initiatives (3)
• CDC is working with others to share
information for monitoring, surveillance,
data mining.
• HRSA is supporting telemedicine projects.
• Other significant HIT activities are
underway at Department of Defense, Office
of Personnel Management, NIH, and the VA.
Response to Hurricanes
• Creation of prescription drug database from
combined commercial pharmacy databases
• In the works . . .
– Support for implementing EHRs
– Support for acquiring and using PHRs
– Requiring compliance with standards to receive
support
– Support for regional health information networks
Work Yet To Be Done
• Use evolving computer science knowledge
to create solutions to problems in health
care and science.
• Continue development of standards and
methods to share information and maintain
privacy and security.
• Develop decision-support and knowledgemanagement systems for vulnerable
populations such as children, the mentally
ill, and the underserved.
Work Yet To Be Done (2)
• Develop and use systems engineering and
change management knowledge to improve
integration of informatics into health care
and science.
• Address ethical, social, and economic issues
in the development, communication, and
use of genomic and genetic knowledge and
information.
• Educate health professionals, scientists, and
the public on the uses of health informatics.
Policy Issues
• The IOM and other units of The National
Academies have taken a number of
positions in their reports on the uses of
informatics to improve health care and
health sciences.
• The CCST may wish to consider some of
these in formulating its policy agenda.
Improving Health Care:
The Role of Informatics
• Health care has safety and quality problems
because it relies on outmoded systems of work.
• Poor designs set the workforce up to fail,
regardless of how hard they try.
• If we want safer, higher-quality care, we will need
to have redesigned systems of care, including the
use of information technology to support clinical
and administrative processes.
IOM, Crossing the Quality Chasm, 2001
Improving Health Care:
The Role of Informatics (2)
• Information technology must play a central role in
the redesign of the healthcare system if a
substantial improvement in quality is to be
achieved over the coming decade.
• Automation of clinical, financial, and administrative
transactions is essential to
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improving quality,
preventing errors,
enhancing consumer confidence in the health system, and
improving efficiency.
IOM, Crossing the Quality Chasm, 2001
National Health Information
Infrastructure (NHII)
• A national health information infrastructure
is needed
– To provide immediate access to complete patient
information and decision-support tools for
clinicians and their patients, and
– To capture patient safety information as a
byproduct of care and use this information to
design even safer delivery systems
NRC, Patient Safety, 2004
Barriers and Risks
to Adopting EHRs and RHIOs
• Concerns about privacy and confidentiality
• Lack of national standards
• Varied and complex transactions requiring elegant
but not simple solutions
• Sizable capital investment and multiyear
commitment required to build systems
• Behavioral adaptations required for patients,
clinicians, and organizations
IOM, Crossing the Quality Chasm, 2001
Strategies to Support
Adoption of EHRs and RHIOs
• Promulgate national data standards
• Set rules and regulations for functionality of EHRs
• Increase consumer awareness of the importance of
these tools
• Finance EHRs: Develop the business case
• Create a public utility to hold health data at the
local level (See County of Santa Cruz, CA)
IOM, A Focus on Communities, 2004
Informatics and Life Sciences
• Progress in biology depends on quantitative
methods and understanding.
• A top priority of science policy should be the
creation and maintenance of a robust interface
between biology and mathematics.
• Biologists require knowledge of math and
computing to communicate with systems engineers
who design software for modeling biological
processes.
NRC, Mathematics & 21st Century Biology, 2005; NRC,
Catalyzing Inquiry at the Interface of Computing and Biology,
2005
Questions for CCST
• Which of these or other policy issues is
important to California now?
• Which of these or other policy issues is
opportune for action now?
• How can CCST best use its expertise and
prestige to influence the development of
policy in the priority areas?
Thank you!
Questions and Discussion