Health and Human Services: NHII-MEDINFO9-8-2004

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Developing National HealthInformation Infrastructure

(NHII) in the U.S.

William A. Yasnoff, MD, PhD, FACMI

Senior Advisor National Health Information Infrastructure

Department of Health and Human Services

MEDINFO 2004

September 8, 2004



Overview

I. Organization of U.S. health care“system”

II. History of NHII

III. What is NHII?IV. NHII Challenges

V. Accelerating NHII

VI. Presidential Attention







III. What is NHII?

s Comprehensive knowledge-basednetwork of interoperable systems

s

Capable of providing information for sound decisions about health when andwhere needed

s “Anywhere, anytime health care

information and decision support”s NOT a central database of medical

records





NHII Requirements: Functionss Overall: “Anytime, anywhere health care

information and decision support”s Immediate availability of complete

medical record (compiled from allsources) to any point-of-care

s Enable up-to-date decision support atany point of care

s Enable selective reporting (e.g. for public health)

s Enable use of tools to facilitate deliveryof care (e.g. e-prescribing)

s Allow patients to control access to their information



NHII Requirements:Implementation Strategys

No national database or identifier s Alignment of incentivess Allow each care facility to maintain its

own datas Minimize cost & risks Use proven implementation strategies

(where possible), e.g. incremental

approachq Each implementation step benefits all

participantsq Implementation scope coincides with

benefits scope



IV. NHII Challengess

Health care information is very complex

ITsystems more expensive and difficult to builds Health care is highly fragmenteds Organizational and change management

issues from IT systems are difficult to managein clinical environmentq Physicians are independent contractorsq

Reimbursement does not provide ROI for ITs Difficult to generate capital needed for IT

investmentq IT is regarded as an add-on cost, not an

investment for competitive advantage



0

V. Accelerating NHII progresss

Informq Disseminate NHII visionq Catalog NHII activitiesq Disseminate “lessons learned”

s Collaborate with Stakeholderss Convene

q NHII 03: 6/30-7/2/2003 –Develop a consensus agenda

q NHII 04: 7/21-23/2004 in D.C. –Release strategic framework

–More stakeholder feedback



1

NHII 03Final Recommendations

I. Management

1) Governance

2) Education

3) SharedResources

4) Metrics

II. Enablers

1) FinancialIncentives*

2) Standards*

3) Legal Issues

I. ImplementationStrategy

1) Demonstration

Projects2) Architecture*

3) Identifiers

II. Targeted Domains

1) Consumer Health*

2) Research*

*original breakout track

Views expressed do not necessarily

represent U.S. Government policy



2

V. Accelerating NHII progress (2)

s Standardizeq

HL7, DICOM, IEEE 1073, NCPDP SCRIPTq SNOMED, LOINCq HL7 projects: EHR functions, EHR

interchange format

s Demonstrateq $50 million in FY 04 budget for NHII

demonstration projects (AHRQ)q President has requested additional $50

million for FY 05s Evaluate

q Rigorous assessment of NHII benefitsq Policy options for aligning financial

incentives



3 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

Info exch system

Records

Returned

Requests

for Records

community



4

Index of where patients

have records Temporary Aggregate

Patient History

Authorized

Inquiry

Hospital Record Laboratory Results Specialist Record

Patient data

delivered

Info exch system

Records

Returned

Requests

for Records

U.S.

another

Info Exch

System



5

Advantages of Local Approachs Existing HII systems are local

s Health care is local benefits are locals Facilitates high level of trust neededs Easier to align local incentivess

Local scope increases probability of successs Specific local needs can be addresseds Can develop a repeatable

implementation processs Parallel implementation more rapidprogress

s Use of standards allows connectivity

between local info exchanges NHII



6

VI. Presidential Attention

“Our 21st century health care

system uses a 19

th

centurypaperwork system”

-- President George W. Bush

April 27, 2004



7

President’s Executive Order April 27, 2004

s Creates position of National Health ITCoordinator in HHSq David Brailer MD, PhD

q Reports to HHS Secretaryq New Office in HHS (ONCHIT)

s Responsible for q

Coordinating all Federal and privatesector efforts toward NHIIq Developing and monitoring

strategic plan



8

Strategic Framework (7/21/2004)

s EHR Adoption & Useq Incentives

s Interconnecting Cliniciansq

RHIOss Personalize Care

q Develop personal health recordss

Improve Population Healthq Use electronic health informationfor public health & research



9

Questions?

William A. Yasnoff, MD, [email protected]/690-7862

For more information about NHIIhttp://aspe.hhs.gov/sp/nhii

For more information about ONCHIT

http://www.hhs.gov/onchit/index.html

http://aspe.hhs.gov/sp/nhii





Documents

Health and Human Services: NHII-MEDINFO9-8-2004