Health Care Information Technology Ramesh Rao California Institute for Telecommunication and Information technology University of California, San Diego

Role of Cyberinfrastructure

Taxonomy of Cyberinfrastructure

Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions William W. Stead and Herbert S. Lin, Editors Committee on Engaging the Computer Science Research Community in Health Care Informatics Computer Science and Telecommunications Board National Research Council of the National Academies

Recommendations for the Federal Government Incentivize clinical performance gains rather than acquisition of IT per se. Encourage initiatives to empower iterative process improvement and small-scale optimization. Encourage development of standards and measures of health care IT performance related to cognitive support for health professionals and patients, adaptability to support iterative process improvement, and effective use to improve quality.

Recommendations for the Federal Government Encourage interdisciplinary research in three critical areas: (a) organizational systems-level research into the design of health care systems processes and workflow; (b) computable knowledge structures and models for medicine needed to make sense of available patient data including preferences, health behaviors, and so on; and (c) human- computer interaction in a clinical context. Encourage (or at least do not impede) efforts by health care institutions and communities to aggregate data about health care people, processes, and outcomes from all sources subject to appropriate protection of privacy and confidentiality. Support additional education and training efforts at the intersection of health care, computer science, and health/biomedical informatics. Current programs of the National Library of Medicine and other institutes of the National Institutes of Health are exemplars of such support.

Health Care Institutions Organize incentives, roles, workflow, processes, and supporting infrastructure to encourage, support, and respond to opportunities for clinical performance gains. Balance the institutions IT portfolio among automation, connectivity, decision support, and data-mining capabilities. Develop the necessary data infrastructure for health care improvement by aggregating data regarding people, processes, and outcomes from all sources. Insist that vendors supply IT that permits the separation of data from applications and facilitates data transfers to and from other non-vendor applications in sharable and generally useful formats. Seek IT solutions that yield incremental gains from incremental efforts.

Computer Science Community Engage as co-equal intellectual partners and collaborators with health care practitioners and experts in health/biomedical informatics and other relevant disciplines, such as industrial and process engineering and design, in an ongoing relationship to understand and solve problems of importance to health care. Develop institutional mechanisms within academia for rewarding work at the health care/computer science interface. Support educational and retraining efforts for computer science researchers who want to explore research opportunities in health care.

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14 CALIFORNIA TELEHEALTH NETWORK Proposition 1D $200 million in new bond funding for five UC medical schools to leverage telemedicine technology, help support major new initiatives in telemedicine and grow medical student class size With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California. - Governor Arnold Schwarzenegger

15 PALMS Physical Activity Location Measurement System An integrated suite of hardware and software to enable continuous capture and subsequent analysis of data on physical activity, spatial location and other sensor data important to understanding physical activity--environment exposure PALMS will support gathering data from multiple participants within studies and aggregating and comparing data between and among multiple researchers across studies Funded through the NIH Gene, Environment and Health Initiative Exposure Biology Program Copyright, Regents of the University of California and Santech, Inc, 2008

16 Visualize – Heart Rate Red and orange indicate higher heart rates Copyright, Regents of the University of California and Santech, Inc, 2008

17 Mapping / GIS Heart rate shown in ESRI ArcGIS against land use Copyright, Regents of the University of California and Santech, Inc, 2008

Suggestions, Comments

Backup

What is HIT infrastructure? RAND (2005) Electronic Medical Records Decision Support Systems Computerized Physician Order Entry for medications

Components of Health Information Exchange: AHRQ Data-Sharing Agreements Data Pipes Interface Engines Data Models Record Locator Service Master Patient Index Data Repository Standards Interoperability

23 CALIFORNIA TELEHEALTH NETWORK FCC Rural Health Care Pilot Program Announced Fall 2006: Up to $417 million available over three years Purpose: to facilitate the creation of a nationwide broadband network dedicated to health care, connecting public and private non-profit health care providers in rural and urban locations Pays 85% of telecommunication-related expenses Capital Connection Installation Network Consulting/Design Encourages regional broadband health care networks with connections to national backbones, e.g., National Lambda Rail (NLR), Internet2 (I2)

24 CALIFORNIA TELEHEALTH NETWORK Californias Proposal - Goals Create statewide broadband network dedicated to health care Link the California Telehealth Network (CTN) to a national backbone Leverage and build upon recent investments in telehealth Utilize the CTN for ongoing disaster preparedness training Report back to the FCC on the pilot program and suggested revisions to the FCCs current rural health rules

25 CALIFORNIA TELEHEALTH NETWORK CTN - Strategic Purposes Create a highly reliable, interoperable, ubiquitous broadband network, encompassing the majority of rural areas Create a highly reliable, interoperable, ubiquitous broadband network, encompassing the majority of rural areas Integrate current and emerging regional, statewide and national networks, forming a network-of-networks supporting peer-to-peer communications Integrate current and emerging regional, statewide and national networks, forming a network-of-networks supporting peer-to-peer communications Facilitate telehealth services over the network, showing participants how to leverage the network to improve patient care Facilitate telehealth services over the network, showing participants how to leverage the network to improve patient care

26 CALIFORNIA TELEHEALTH NETWORK Californias Proposal - Details Proposed creation of a statewide, peer-to-peer network over three years, connecting over 300 California health care sites, the majority of which are located in Health Professional Shortage Areas (HPSAs) Preliminary list of sites included: 256 Rural Urban Commuting Area (RUCA) sites 154 primary care clinics 22 tribal clinics 81 rural hospitals 26 teaching hospitals One psychology clinic Proposed also using the statewide network for: ongoing disaster preparedness training, outbreak surveillance, and communication during emergencies/disasters continuing education for health professionals

27 CALIFORNIA TELEHEALTH NETWORK

28 CALIFORNIA TELEHEALTH NETWORK

29 CALIFORNIA TELEHEALTH NETWORK CTN - Proposed Sites

30 CALIFORNIA TELEHEALTH NETWORK Californias Proposal to the FCC Background Fall 2006: Consortium formed by Governors Office Fall 2006: Consortium formed by Governors Office May 2007: Single California proposal submitted May 2007: Single California proposal submitted University of California Office of the President and UC Davis Health System selected as managing partners University of California Office of the President and UC Davis Health System selected as managing partners November 2007: FCC awards California up to $22.1 million to create the California Telehealth Network November 2007: FCC awards California up to $22.1 million to create the California Telehealth Network Winter 2007: Matching funds granted by California Emerging Technology Fund, and UnitedHealth/PacifiCare Winter 2007: Matching funds granted by California Emerging Technology Fund, and UnitedHealth/PacifiCare

31 CALIFORNIA TELEHEALTH NETWORK California Telehealth Network (CTN) Consortium Members California Business, Transportation and Housing Agency (BTH) California Department of Managed Health Care (DMHC) California Emerging Technology Fund (CETF) California Health & Human Services Agency (CHHSA) California Health Foundation and Trust (CHFT) California Hospital Association (CHA) California Institute for Telecommunications and Information Technology (Cal IT2) California Office of Emergency Services (OES) California Office of Emergency Services (OES) California Primary Care Association (CPCA) California Public Utilities Commission (CPUC) California Rural Telehealth Networks (various) California State Rural Health Association (CSRHA) California Telemedicine & eHealth Center (CTEC) Corporation for Education Network Initiatives in California (CENIC) Office of Statewide Health Planning and Development (OSHPD) Office of the Governor University of California Davis Health System University of California Office of the President University of California System

32 CALIFORNIA TELEHEALTH NETWORK Recent California Broadband, Technology, and Telemedicine Initiatives California Telemedicine & eHealth Center (CTEC): regional eHealth networks Governors Health Information Technology (HIT) Executive Order (S ): $240 million for health information exchange Governors Broadband Task Force Executive Order (S-23-06) California Emerging Technology Fund: $60 million from SBC-AT&T, and Verizon-MCI mergers, for ubiquitous broadband access and emerging technologies California Teleconnect Fund (CPUC): 50% discount to eligible hospitals and clinics Indian Health Service: Growth in Telemedicine Blue Cross of California Telemedicine Network

33 So we now have the opportunity to explore interrelationships between and among health behaviors, ecological factors, and physiological processes Physiological factors Interpersonal & psychosocial factors Ecological factors Medical & Exercise Sciences Psychological & Social Sciences Environment & Policy Science