An Overview of the National Health Information Infrastructure

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An Overview of the National Health Information
Infrastructure A Call to Action!

• Helga E. Rippen, MD, PhD, MPH
• NHII/ASPE/DHHS
• Washington Area Health Tech Net
• May 14, 2004

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Our 21st century health care system uses a 19th
century paperwork system
-- President George W. Bush April 27, 2004
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Overview

• The case for an National Health Information
  Infrastructure (NHII)
• NHII requirements implementation strategy
• Accelerating NHII progress
• Synopsis of the NCR-LHII activities
• Your role

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An NHII is Needed to Address 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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The NHII Enables Anywhere, Anytime Health Care
Delivery

• NOT a central database of medical records
• 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

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The NHII in More Than IT

• 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

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Four Domains of NHII
NHII
Personal/ Consumer
Clinical
Public Health/ Community
Research/ Policy
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The NHII Will Improve the Health Care System

• 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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Overview

• The case for an NHII
• NHII requirements implementation strategy
• Accelerating NHII progress
• Synopsis of the NCR-LHII activities
• Your role

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Core Requirements are Needed

• 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

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An Implementation Strategy that Overcomes
Potential Issues

• 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

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The Overall NHII Net National Savings is 131
Billion a Year
TOTAL 121.04
TOTAL 131
Source Center for Information Technology Leadersh
ip, Partners Health Care, Harvard (2004)
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An Inpatient EHR Provides Some Savings
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• Benefits go to hospital
• Larger hospitals are investing
• Capital is obstacle for small rural
  institutions

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Incentives are Needed to Ensure Outpatient EHR
Savings

• Benefits go to payer
• No business case for physicians (especially
  small practices)
• Payer incentives needed (e.g. Maine)

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Most of the Savings Come from Community Health
Information Exchange

• Substantial benefits to all
• First mover disadvantage
• Seed funding needed
• Focus of current Federal initiatives

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There are Many Advantages of an LHII Approach

• 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

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Overview

• The case for an NHII
• NHII requirements implementation strategy
• Accelerating NHII progress
• Synopsis of the NCR-LHII activities
• Your role

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Accelerating NHII Progress Through a Six Point
Strategy

• Inform
• Disseminate NHII vision
• Catalog NHII activities
• Disseminate lessons learned
• 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

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Accelerating NHII Progress

• Standardize
• 20 standards adopted by CHI e.g., HL7, DICOM,
  IEEE 1073, NCPDP SCRIPT
• SNOMED, LOINC
• HL7 EHR functions interchange standard coming
  next
• 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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The Presidents Goal Establishing EHRs for Most
Americans in 10 Years

• President Bushs Executive Order April 27, 2004
• HHS report on options for providing incentives
  in the HHS programs promoting adoption of
  interoperable HIT
• Director of OPM options to provide incentives
  in the Federal Employee Health Benefit Program
  promoting interoperable HIT
• VA and DoD approaches to working with private
  sector to make their HIT systems available as an
  affordable option

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Executive Order Reinforces the NHII

• Establish the position of National Health
  Information Technology Coordinator
• Work to be consistent with a vision of developing
  a nationwide interoperable health information
  technology infrastructure
• Ensure appropriate information to guide medical
  decisions is available at the time and place of
  care
• Improves health care...
• Promote an effective marketplace...
• Improves coordination of care and information
  among providers...
• Ensure patients individually identifiable health
  information is secure and protected

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Secretary Thompsons May 6 Summit Meeting

• Dr. Brailer named
• Additional standards adopted
• CHI HL7-demographics, units of measure,
  immunization, clinical encounters, and clinical
  document architecture standard for text based
  reports
• SNOMED CT lab result contents, non-lab
  interventions and procedures, anatomy, diagnosis
  and problems, nursing
• HIPAA transaction and code sets for billing or
  admin
• Medications FDAs names and codes, RxNORM for
  clinical drugs, VAs National Drug File Reference
  Terminology 9NDF-RT)
• Human Gene Nomenclature
• EPAs Substance Registry systems for
  non-medicinal chemicals
• SNOMED-CT

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A Call to Action and Three Tasks Directed by
Secretary Thompson

• Call to action to accelerate progress
• Tasks
• Adopt standards
• Wide adoption of e-prescribing and electronic
  health records
• Development of local health information exchanges

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Overview

• The case for an NHII
• Accelerating NHII progress
• NHII requirements implementation strategy
• Synopsis of the NCR-LHII activities
• Your role

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The National Capital Region LHII Initiative is
Moving Forward

• Not a Federal project HHS is playing a
  facilitating role
• First stakeholder meeting April 26, 2004 at the
  Council of Governments
• Agreement to move forward
• Volunteers for core group to move the process
  forward (20 people)
• Council of Governments to provide support for
  developing the business plan

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Overview

• The case for an NHII
• NHII requirements implementation strategy
• Accelerating NHII progress
• Synopsis of the NCR-LHII activities
• Your role

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How can you help with the NHII?

• Volunteer to participate in the NCR-LHII
• Developers should incorporate standards in
  systems to promote interoperability
• Attend the July 20-23 meeting
• Cost-benefit data needed
• Good data hard to find
• Consider making your internal studies available
• Keep informed on these issues
• Ask for periodic reports
• Make your views known

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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)
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Questions?
Mark Your Calendar NHII 04 Meeting July 20-23,
2004 Washington, DC
For more information about NHII http//aspe.hhs.go
v/sp/nhii
Helga E. Rippen, MD, PhD, MPH Helga.rippen_at_hhs.gov
202/205-8678