Transcript The Decade of Health Information Technology Begins:

Federal Health Information
Technology Initiatives
May 5, 2006
Jodi G. Daniel, JD, MPH
Director, Office of Policy and Research
Office of the National Coordinator for Health IT
"The health of people is
really the foundation upon
which all their happiness
and all their powers as a
state depend.”
Benjamin Disraeli
Basis for Priority on Health IT
• High rate of medical errors and rising health care
costs necessitate it.
• The health care industry and commercial leaders
support it.
• Consumers need and want it.
• The Federal Government is providing leadership
to achieve it.
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Medical Errors
• In 2000, the Institute of Medicine estimated that between
44,000 and 98,000 Americans die each year from
preventable medical errors1.
• Subsequent studies have estimated
that the number may be twice as high2.
“If we want safer, higherquality care, we will need to
have redesigned systems of
care, including the use of
information technology to
support clinical and
administrative processes.”
IOM, Quality Chasm Report, 2001
• Medical errors are killing more people per year, in the U.S.,
than breast cancer, AIDS, or motor vehicle accidents3.
1Kohn,
L., J. Corrigan, and M. Donaldson. To Err Is Human: Building a Safer Health System. Committee of Health Care in America, Institute of Medicine.
2000.
2HealthGrades. In-Hospital Deaths from Medical Errors at 195,000 perYear, HealthGrades Study Finds. July 27, 2004.
3Institute of Medicine and Centers for Disease Control and Prevention. National Center for Health Statistics: Preliminary Data for 1998 and 1999. 2000.
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Medical Errors from Lack of Information
“In attempting to arrive at the
truth, I have applied
everywhere for information,
but in scarcely an instance
have I been able to obtain
hospital records fit for any
purpose of comparison. If they
could be obtained, they would
enable us to decide many
other questions besides the
one alluded to. They would
show subscribers how their
money was being spent, what
amount of good was really
being done with it, or whether
the money was not doing
mischief rather than good.”
• The lack of immediate access to patient healthcare
information is the source of one-fifth of these
errors1.
• 80 percent of errors were initiated by
miscommunication, including missed
communication between physicians,
misinformation in medical records, mishandling of
patient requests and messages, inaccessible
records, mislabeled specimens, misfiled or missing
charts, and inadequate reminder systems2.
Florence Nightingale, 1873
1Health
2
Research Institute & GlobalTechnology Center. Reactive to Adaptive:Transforming Hospitals with DigitalTechnology, PriceWaterhouseCoopers. 2005.
Smith, Peter, et. al. “Missing Clinical Information During Primary Care Visits,” The Journal of the American Medical Association. February 2005.
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The Rising Costs
The U.S. leads the world in healthcare spending per capita,
yet our technology lags behind other nations.
“Americans are spending
$1.7 trillion on health care
every year, accounting for
15.3 percent of our gross
domestic product, at an
average cost of $5,670 per
person. Our lagging health
IT infrastructure compounds
the problem, contributing to
fragmentation, waste, and
inefficiency.”
Source: Ending the
Document Game:
Connecting and
Transforming Your
Healthcare Through
Information
Technology
Statement by Senate Majority
Leader Bill Frist and
Senator Hillary Rodham Clinton
www.EndingTheDoc
umentGame.gov
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The Rising Costs
Health care costs are rising faster than inflation:
Source: US
Department of
Census: Fast
Facts; April 29,
2005
•
An aging population:
–
–
•
2000, 35 million Americans were 65 or older,
2050, that number will likely increase to 82 million.
Chronic Care expenditures:
–
–
–
23% of Medicare beneficiaries have 5 or more chronic conditions
68% total Medicare expenditures.
On average:
• 13 different doctors
• 50 prescriptions.
Savings from health IT and corresponding changes in care:
•
•
7.5 percent of health care costs (Johnston et al., 2003; Pan et al, 2004)
30 percent of health care costs (Wennberg et al., 2002; Wennberg et al.,
2004; Fisher et al., 2003; Fisher et al., 2003).
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Industry and Commercial Support
• Health IT Leadership Panel convened by the
Lewin Group
– Asked how IT has transformed other industries,
• Banking, credit, retail, etc.
– Concluded that investment in interoperable health IT is urgent
and vital to the broader U.S. economy
• consumer buy-in is key to success
• stakeholder incentives must be aligned
• NHIN Request For Information
– Over 500 respondents have fed into the process.
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Consumers Want Health IT
Americans who know about connected, interoperable health care systems
recognize their benefits.
•
Roughly 70% report that they would use one or more features of a PHR.
63 Percent
Would Track
Immunizations
Source: Connecting
for Health
Collaborative. The
Personal Health
Working Group:
Final Report.
Markle Foundation.
July 1, 2003.
65 Percent
Would Transfer
Information to
New Doctors
63 Percent
Would Look Up
and Track Their
Own Test
Results
69 Percent
Would Monitor
Their Record
for Mistakes
75 Percent
Say They Would
Email Their Doctor
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Consumers Need Health IT
Percent of patients who said…
…they had to wait/reschedule their
appointment because the provider did
not have all their medical information
…their health care provider did not
have all of their medical information
Source: Kaiser
Family Foundation /
Agency for
Healthcare
Research and
Quality / Harvard
School of Public
Health National
Survey on
Consumers’
Experiences with
Patient Safety and
Quality Information,
November 2004
(Conducted July 7 –
September 5, 2004).
… coordination among their various
health providers is a problem
32%
48%
69%
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Health IT Activities Over the Years
•
Selected activities to drive interoperability and standardization of
health information technology:
–
1996 – The Health Insurance Portability and Accountability Act (HIPAA) enacted
–
1998 – The National Committee on Vital and Health Statistics (NCVHS)
espoused a national health information infrastructure to promote American
health
–
2002 – Markle Foundation forms the Connecting For Health initiative that
assembled public/private leadership in healthcare to promote common electronic
standards
–
2003 – The Federal Health Architecture (FHA) is established in the HHS Office
of the Chief Information Officer and is tasked with defining a framework and
methodology for establishing the target architecture and standards for
interoperability and communication throughout the federal health community
–
2003 – President Bush signs the Medicare Prescription Drug Improvement and
Modernization Act (MMA) allowing CMS to establish key infrastructure for health
information technology such as e-prescribing
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Federal Government’s Leadership
Office of the National Coordinator for Health IT
• Established by Executive Order 13335 (April 27, 2004)
• Responsible for realizing the President’s vision of
Health IT:
– Widespread adoption of interoperable
EHR within 10 years
– Medical information follows the consumer
– Clinicians have complete, computerized patient information
– Quality initiatives measure performance and drive
quality-based competition
– Public health and bioterrorism surveillance are seamlessly
integrated into care
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Office of the National Coordinator Structure
Operations
Office of
Health Information
Technology Adoption
Immediate Office of the
National Coordinator
David Brailer
Office of
Interoperability
and Standards
Office of Programs
and Coordination
Office of Policy
and Research
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Publication of a Strategic Framework:
July 2004
Goal 1: Inform
Clinical Practice
Goal 3:
Personalize Care
•Incentivize EHR Adoption
•Reduce Risk of EHR Investment
•Promote EHR Diffusion in
Rural and Underserved
Areas
•Use of Personal Health
Records,Enhancement of
Informed Consumer
Choice, and Promotion of
Telehealth Systems
Strategic
Framework
Goal 2: Interconnect
Clinicians
Goal 4: Improve
Population Health
•Foster Regional Collaboration
•Develop a Nationwide Health
Information Network (NHIN)
•Coordinate Federal Health
Information Systems
•Unify PH surveillance
architectures, streamline
quality and health status
monitoring, and accelerate
research and dissemination
of evidence into practice
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The Administration:
Leadership for Health IT Adoption
• Lead by example:
– Leverage the buying power of the many federal health care programs
to jump start health IT adoption
• Serve as Convener:
– Help the health care industry build sustainable public/private
collaborations by bringing together:
• Providers
• Payers
• Consumers
• Employers
• Health IT vendors
• Standards Development Organizations (SDOs)
• Regional Health Information Organizations (RHIOs)
• State/Territory governments
• Federal government
• Etc.
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ONC Major Initiatives
In 2004, President Bush called for the widespread use of electronic health
records (EHRs) within 10 years. Despite the demonstrated benefits to care
delivery, studies have found use of EHRs remains low among physicians,
hospitals and other health care providers. The Office of the National
Coordinator for Health Information Technology (ONC) has set the foundation
for adoption of interoperable EHRs through the following major initiatives:
 American Health
Information Community
 Standards
Harmonization Process
 Compliance Certification
Process
 Privacy and Security
Solutions
 Nationwide Health
Information Network
 Health IT and
Health Care Anti-Fraud
 Health IT Adoption
 Proposed Changes to
Self-Referral and
Anti-Kickback Rules
 Digital Health Recovery
for the Gulf Coast
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The American Health Information
Community
• Federal Advisory Committee appointed and chaired by
Secretary Leavitt
• Nine public sector and eight private sector appointees
• Initial recommendations:
– Prioritize Health IT initiatives
– Identify breakthrough opportunities including:
• Biosurveillance
• Consumer empowerment
• Electronic health records
• Chronic care monitoring
– Ensure privacy and security protections
– Harmonize industry-wide health IT standards
– Create an internet-based nationwide health IT architecture
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Standards Harmonization Process
• HHS awarded a contract to the American
National Standards Institute, a non-profit
organization that administers and coordinates the
U.S. voluntary standardization activities, to
convene the Health Information Technology
Standards Panel (HITSP).
• The HITSP will develop, prototype, and evaluate
a harmonization process for achieving a widely
accepted and useful set of health IT standards
that will support interoperability among health
care software applications, particularly EHRs.
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Compliance Certification Process
• HHS awarded a contract to the Certification Commission for
Health Information Technology (CCHIT) to develop criteria
and evaluation processes for certifying EHRs and the
infrastructure or network components through which they
interoperate.
• First set of certification criteria have been proposed.
•
•
•
Standards
Functionality
Security
• Certification will begin summer 2006.
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Nationwide Health Information Network
(NHIN)
• Contracts have been awarded by HHS to four
consortia of health care and health information
technology organizations to develop prototypes
for the Nationwide Health Information Network
(NHIN) architecture.
–
–
–
–
Accenture
Computer Sciences Corporation
IBM
Northrop Grumman
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Privacy and Security Solutions
• HHS awarded a contract to RTI International to lead the
Health Information Security and Privacy Collaboration
(HISPC)
– HISPC - A collaboration that includes the National Governors
Association (NGA), up to 40 state and territorial governments, and a
multi-disciplinary team of experts.
• 18-month period
• RTI will subcontract with up to 40 states to:
– Identify within the state business practices and state laws that affect
electronic health information exchange
– Propose solutions and implementation plans
– Collaborate on regional and national meetings to develop solutions
with broader application
• Provide final report on overall project outcomes and
recommendations
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Health Information Technology and
Health Care Anti-Fraud
• Examine how automated coding software and a
nationwide interoperable health information
technology infrastructure can address healthcare
fraud.
• The project was conducted through a contract
with the Foundation of Research and Education
(FORE) of the American Health Information
Management Association (AHIMA).
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Proposed Changes to Self-Referral
and Anti-Kickback Rules
• HHS announced proposed rules that would ease
self-referral and anti-kickback restrictions.
• The proposed rules would provide a Stark
exception and an Anti-kickback safe harbor to
allow hospitals and other entities to provide
physicians with e-prescribing and electronic
health record software and related training.
• Proposals published in the Fed. Reg. 10/5/2005.
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Health Information Technology
Deployment Coordination
Health Care Industry
Breakthroughs
Chronic Care
Electronic Health
Records
Compliance
Certification
NHIN
Privacy / Security
Coordination of Policies,
Resources, and Priorities
Office of the National Coordinator
-Health IT Policy Council
-Federal Health Arch.
The Community
-Workgroups
Health IT
Adoption
Consumer Value
Industry Transformation
Consumer
Empowerment
Standards
Harmonization
Infrastructure
Technology Industry
Biosurveillance
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Other HHS Health IT Initiatives
• Agency for Healthcare Research and
Quality (AHRQ)
– Health IT Grants and Contracts
• 2005: 16 grantees were awarded a total of $22.3
million to continue projects to improve the quality
and safety of health care through IT
• 2004: $139 million in contracts & grants to promote
use of health IT
– State and Regional Demonstrations in Health IT
(5 awardees)
– Transforming Health Care Quality Through
Health IT (100+ grants awarded in 38 states)
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Other HHS Health IT Initiatives
• Centers for Medicare and Medicaid
Services (CMS)
– Doctor's Office Quality - Information Technology (DOQIT)
• Promotes adoption of EHR systems and IT in smallto-medium sized physician offices
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Other HHS Health IT Initiatives
• Health Resources and Services
Administration (HRSA)
– Healthy Communities Access Program (HCAP)
• Develop/strengthen health care safety net delivery
systems through providing an infrastructure to
coordinate health care for uninsured.
• Development of information systems to support
coordination of efforts that increase access to care.
– Office for the Advancement of Telehealth grants (OAT)
• Support community-based activities in informatics,
electronic medical records, and telemedicine.
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Regional Health Information
Organizations (RHIOs)
• What is a RHIO?
– Non-governmental, multi-stakeholder organizations
– Provide oversight, coordination, and operational management for
health information exchange.
– Guide day-to-day operations on data access and data protection
rules, support EHR implementation, clinical improvement programs,
and sustainable financing for health information sharing.
– Covers a defined and contiguous geographic area
• Why RHIOs?
– Clinical care is largely shaped by local referral patterns, and public
health is organized locally within states, including corresponding
surveillance and reporting activities.
– Reimbursement structures, both through private insurers and
Medicaid, reinforce the state and regional context of health delivery.
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State level Regional Health
Information Organizations (RHIOs)
• States have a unique opportunity to either coordinate
ongoing regional activities or create the public-private
governance and policy and technical framework needed for
successful health information exchange.
• States can address the policy/legal barriers, consider
funding mechanisms, ensure coordination with State level
programs i.e., public health/biosurveillance and Medicaid.
• Governors and organizations representing states (NGA,
NCSL, etc) can lead change at a state level.
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What can you do?
• Connect with federal efforts…
– American Health Information Community
– Grant/contract opportunities
– Standards/certification processes
• Participate in State/Local Efforts
– RHIO/e-health efforts
– Policy efforts to reduce barriers
to health IT
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Our Challenge is not new…
•
“That it will ever come into general use,
notwithstanding its value, is extremely doubtful
because its beneficial application requires
much time and gives a good bit of trouble, both
to the patient and to the practitioner because
its hue and character are foreign and opposed
to all our habits and associations.”
The London Times, 1834
By way of Dr. Jeremy Nobel
Harvard School of Public Health
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For More Information Visit…
www.hhs.gov/healthit
“Health IT can enable transformation of
healthcare by allowing a better way to care —
consumer by consumer, physician by physician,
disease by disease, and region by region.”
David Brailer, M.D., Ph.D.,
National Coordinator for Health Information Technology
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