The National Health Information Infrastructure NHII

1
The National Health Information Infrastructure
(NHII)

• Pete Palmer Parkweb Associates LLC
• HIMSS NHII Task Force Member
• Electronic Authentication Partnership Meeting
  June 22, 2004

2
Outline

• Healthcare Industry Sector Overview
• NHII Vision and Architecture
• Role of HIMSS in the NHII
• NHII and the EAP

3
Healthcare Industry Size

• 2002
• 1/7th of the economy
• 2.4 Trillion
• 13.2 GDP
• 2011
• 17 GDP expected
• 9,216 per person, twice per capita of 2000
• Expected to swell at rate exceeding overall
  economic growth

4
Healthcare Industry - Demographics

• Aging population (1/3 born 46-61) 100 million
• Oldest boomers are 43-58 in 2004
• Sweet spot for needing medical attention
• 90 of healthcare needs are just starting
• 10 used up to age 50 (not including pregnancy)

5
Healthcare Industry Information

• Lots of Information
• Claims, payments, insurance eligibility
• Electronic medical record
• Office Visit (Encounters)
• Lab results
• Referrals
• Medication history
• Implantable device data
• Radiology

6
Healthcare Industry Information Infrastructure

• Unlike other industry sectors, an infrastructure
  for healthcare information exchange is virtually
  non-existent
• Healthcare encounters usually between you, your
  provider, and your insurance company

7
NHII Challenge

• November 15, 2001, the National Committee on
  Vital and Health Statistics (NCVHS) issued the
  challenge
•  
• We as a Nation have a timely opportunity and
  an urgent need to build a 21st-century health
  support system.

8
NHII Vision

• Anywhere, anytime health care information and
  decision support
• Dr. William Yasnoff, Senior Advisor,
  National Health Information Infrastructure, HHS

9
Who Needs the NHII?

• Patients
• Hospitals and Clinics
• Insurance companies
• Disease state management companies
• Device biotech companies
• Public health agencies
• Researchers

10
NHII Goals

• Real-time consolidated patient medical record
  availability to healthcare providers
• On-demand decision support information for
  healthcare providers
• Reporting capabilities to support public health
  and research
• Common set of tools to support healthcare
  delivery applications (such as electronic
  prescribing)
• Access control mechanisms for information privacy
  enforcement

11
NHII Architecture

• System of interoperable Local Health Information
  Infrastructures (LHII)
• Common data formats
• Common information vocabularies
• Standardized mechanism for security and identity
  management

12
NHII Federation of Domains

• Personal/Consumer
• Clinical
• Public Health/Community
• Research/Policy

13
HIMSS

• Health Information Management and Systems Society
• 14,000 Members
• 200 Corporate members
• 40 Local Chapters

14
HIMSS and the NHII

• HIMSS recognizes that a properly maintained and
  funded information infrastructure is key to
  meeting the healthcare industry's current and
  future needs
• Launches the HIMSS NHII Task Force in October
  2002

15
HIMSS NHII Task Force

• Chaired by Dr. C. Martin Harris, MD, CIO
  Cleveland Clinic
• Membership includes representatives from provider
  organizations, supplier and consulting firms,
  NCVHS, CDC, DoD, HHS, and the VA

16
HIMSS North East Ohio LHII -Healthcare Providers

• Cleveland Clinic
• Metro Health Hospital
• Kaiser Permanente HMO
• Cleveland Area Veterans Affairs Hospital
• LHII Observer San Diego - Scripps Health Network

17
HIMSS North East Ohio LHII Infrastructure

• NHII Services
• Authentication Infrastructure General Services
  Administration (GSA)
• Electronic Prescribing Engine RxHub LLC
• Management - HIMSS

18
North East Ohio LHII/NHII Demonstration
ePrescribing

• Provides secure access to pharmacy benefits
  information
• Delivers detailed medication history
• Enhances electronic prescription writing
• Demonstrates a NHII working model

19
NE Ohio LHII/NHII ePrescribing
Insurance Info, Medication History, Routing info
- RxHub
E-Authentication (GSA)
NHII
CSP
Internet
Pharmacy or Home Delivery
NE Ohio LHII
20
NHII and the Issuing of Electronic Credentials

• Organizations issue user-ids and passwords
• Organizations issue badges
• Organizations issue smart cards
• Challenges
• No common rule book for issuing these credentials
• No auditing mechanism for evaluating practices

21
NHII and the Validation of Electronic Credentials

• Organizations validate credentials locally
• Organizations validate only those credentials
  they themselves issue
• Challenges
• No authentication infrastructure
• No federation interoperability

22
NHII and Assurance Levels

• Healthcare applications and data have various
  sensitivity levels
• HIPAA privacy and security regulations
• FDA 21CFR Part 11 clinical trial reporting
  regulations
• Challenges
• Industry has no standard, well defined set of
  assurance levels

23
NHII and ID Management Governance

• LHIIs require cooperation
• Without LHIIs, local competition restricts
  interoperability
• LHIIs well-suited for federated identity
  management
• Challenges
• No cooperative LHII/NHII identity management
  support

24
Summary

• Federated LHIIs and the NHII need
• Re-usable credentials
• Standardized and well understood assurance levels
• Real-time credential validation services
• Identity management governance framework
• NHII cannot exist without these solutions
• Healthcare Industry looking to EAP for leadership

25
Contact Information

• Pete Palmer
• HIMSS NHII Task Force
• Parkweb Associates LLC
• ppalmer_at_parkweb.com
• [phone]