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

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

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

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

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”

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

Four Domains of NHII Personal/ Consumer Public Health/ Community NHII Research/ Policy Clinical

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

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

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

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

The Overall NHII Net National Savings is $131+ Billion a Year Source: Center for Information Technology Leadership, Partners Health Care, Harvard (2004) Community Health Information Exchange Outpatient EHR Inpt EHR TOTAL $ ~10 ~44 ~77 TOTAL $131+

An Inpatient EHR Provides Some Savings Benefits go to hospital Larger hospitals are investing Capital is obstacle for small & rural institutions Community Health Information Exchange Outpatient EHR Inpt EHR ~10 ~44 ~77

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) Community Health Information Exchange Outpatient EHR Inpt EHR ~10 ~44 ~77

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 Community Health Information Exchange Outpatient EHR Inpt EHR ~10 ~44 ~77

community Clinical Encounter Index of where patients have records Temporary Aggregate Patient History Patient Authorized Inquiry Hospital Record Laboratory Results Specialist Record Patient data delivered to Physician LHII system Records Returned Requests for Records

U.S. Index of where patients have records Temporary Aggregate Patient History Authorized Inquiry from LHII Hospital Record Laboratory Results Specialist Record Patient data delivered to other LHII LHII system Records Returned Requests for Records another LHII

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

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

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

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

The President’s Goal: Establishing EHRs for Most Americans in 10 Years President Bush’s 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

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 patient’s individually identifiable health information is secure and protected

Secretary Thompson’s 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 [FDA’s names and codes, RxNORM for clinical drugs, VA’s National Drug File Reference Terminology 9NDF- RT)] – Human Gene Nomenclature – EPA’s Substance Registry systems for non-medicinal chemicals SNOMED-CT

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

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

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

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

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 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

“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)

Questions? Helga E. Rippen, MD, PhD, MPH 202/ For more information about NHII Mark Your Calendar NHII 04 Meeting July 20-23, 2004 Washington, DC Mark Your Calendar NHII 04 Meeting July 20-23, 2004 Washington, DC