The Decade of Health Information Technology Begins:

1
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
2
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.

3
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.
• Medical errors are killing more people per year,
  in the U.S., than breast cancer, AIDS, or motor
  vehicle accidents3.

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, Quality Chasm Report, 2001
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.
4
Medical Errors from Lack of Information

• The lack of immediate access to patient
  healthcare information is the source of one-?fth
  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, mis?led or missing charts, and
  inadequate reminder systems2.

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. Florence Nightingale, 1873
1Health Research Institute GlobalTechnology
Center. Reactive to AdaptiveTransforming
Hospitals with DigitalTechnology,
PriceWaterhouseCoopers. 2005. 2 Smith, Peter, et.
al. Missing Clinical Information During Primary
Care Visits, The Journal of the American Medical
Association. February 2005.
5
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. Statement by Senate
Majority Leader Bill Frist and Senator Hillary
Rodham Clinton
Source Ending the Document Game Connecting and
Transforming Your Healthcare Through Information
Technology www.EndingTheDocumentGame.gov
6
The Rising Costs

• Health care costs are rising faster than
  inflation
• 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).

Source US Department of Census Fast Facts
April 29, 2005
7
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.

8
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
69 Percent Would Monitor Their Record for
Mistakes
63 Percent Would Look Up and Track Their Own
Test Results
65 Percent Would Transfer Information to New
Doctors
75 Percent Say They Would Email Their Doctor
Source Connecting for Health Collaborative. The
Personal Health Working Group Final Report.
Markle Foundation. July 1, 2003.
9
Consumers Need Health IT
Percent of patients who said
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).
10
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

11
Federal Governments Leadership

• Office of the National Coordinator for Health IT
• Established by Executive Order 13335 (April 27,
  2004)
• Responsible for realizing the Presidents 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

12
Office of the National Coordinator Structure
Immediate Office of the National
Coordinator David Brailer
Operations
Office of Health Information Technology Adoption
Office of Programs and Coordination
Office of Interoperability and Standards
Office of Policy and Research
13
Publication of a Strategic Framework July 2004

• Goal 1 Inform Clinical Practice
• Incentivize EHR Adoption
• Reduce Risk of EHR Investment
• Promote EHR Diffusion in
• Rural and Underserved Areas

Strategic Framework

• Goal 2 Interconnect
• Clinicians
• Foster Regional Collaboration
• Develop a Nationwide Health
• Information Network (NHIN)
• Coordinate Federal Health
• Information Systems

14
The AdministrationLeadership 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.

15
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

16
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

17
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.

18
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.

19
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

20
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

21
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).

22
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.

23
Health Information Technology Deployment
Coordination
Health Care Industry
Technology Industry
24
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)

25
Other HHS Health IT Initiatives

• Centers for Medicare and Medicaid Services (CMS)
• Doctor's Office Quality - Information Technology
  (DOQ-IT)
• Promotes adoption of EHR systems and IT in
  small-to-medium sized physician offices

26
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.

27
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.

28
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