Health Informatics: Challenges and Opportunities for Health Policy

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Health InformaticsChallenges and Opportunities
for Health Policy

• Judy Ozbolt, PhD, RN
• FAAN, FACMI, FAIMBE
• Scholar
• Institute of Medicine
• jozbolt_at_nas.edu

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• INSTITUTE OF MEDICINE

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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.
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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

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Biomedical Research
Health of Individuals Families
Information Science And Technology
Health of Populations
Education, Work Processes, And Health Practices
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Health InformaticsA Critical Infrastructure for
the Nations 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)

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Health Care Should Be . . .

• Safe
• Effective
• Patient-centered
• Timely
• Efficient
• Equitable
• IOM, Crossing the Quality Chasm, 2001

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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.

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Electronic Health Records Foundation for the
Infrastructure

• 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)

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Personal Health RecordsTools for Self-Management

• 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

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Health Information NetworksVehicles 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

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BioinformaticsFoundation 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

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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

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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

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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.

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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.

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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

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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 knowledge-management
  systems for vulnerable populations such as
  children, the mentally ill, and the underserved.

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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.

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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.

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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

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Improving Health CareThe 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
• improving quality,
• preventing errors,
• enhancing consumer confidence in the health
  system, and
• improving efficiency.
• IOM, Crossing the Quality Chasm, 2001

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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

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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

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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

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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

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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?

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Thank you!

• Questions and Discussion