The Role of the Saudi Government in the National Health Information Infrastructure NHII

1
The Role of the Saudi Government in the National
Health Information Infrastructure (NHII)

• Mohammed R. Alyemeni, DrPH
• King Saud University
• mohammed_at_alyemeni.com

2
What is the NHII?

• Its an effort (initiative) to improve the
  effectiveness, efficiency and overall quality of
  health and healthcare in the country
• A comprehensive knowledge-based network of
  interoperable systems of
• Clinical
• Public health
• Personal health information
• To improve decision-making by making health
  information available when and where it is needed

3
What is the NHII?

• Technologies
• Standards
• Applications
• Systems
• Values
• Laws
• Support all facets of individual health,
  healthcare, and public health
• Conceptually A collection of healthcare delivery
  providers that share patient-level information
  electronically

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Why Do We Need NHII?

• Breakthroughs in basic biomedical sciences,
  including
• Human genomics
• Stem cell biology
• Biomedical engineering
• Molecular biology
• Immunology
• Provided an unprecedented supply of information
  for improving human health

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Why Do We Need NHII?

• The explosion in biomedical knowledge is
  accelerating
• At the current rate of publication, a person who
  finishes school knowing everything, and reads two
  articles every night, becomes 1,225 years behind
  at the end of the first year
• Scientific approach to the effective use of
  information in biomedical and health disciplines

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Why Do We Need NHII?

• Decisions based on evidence from the literature
• IT training and use are important for doctors and
  other healthcare professionals as, increasingly,
  evidence-based medicine is being practiced from
  information obtained from the Internet
• NHII would allow all patients, healthcare
  providers, and those interested in population
  health to have access to comprehensive electronic
  health records

7
An Idea Whose Time Has Come

• Significant improvements in the quality and
  efficiency of healthcare are achievable if
  physicians and other providers are supported with
  readily accessible information about their
  patients and the most current medical knowledge
  through the NHII

8
An Idea Whose Time Has Come

• The availability of information alone is not
  sufficient it must be in a form that allows
  clinicians to interact with it easily and
  efficiently in their day-to-day practice

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An Idea Whose Time Has Come

• While the NHII concept is not novel, recent
  developments in IT and successful demonstrations
  of community-wide health information exchange
  clearly indicate that it is now both feasible and
  realistic
• The continued improvement in the
  price/performance ratio of computer systems

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An Idea Whose Time Has Come

• The transition of the Internet from a largely
  academic communications network to a nearly
  ubiquitous utility used daily by millions
• The growing sophistication of clinical
  information systems have all helped to transform
  NHII from an appealing but far-distant prospect
  to a near-term achievable goal

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The Status Quo

• Development of IT solutions involves a
  substantial investment of resources
• Regrettably, the entire healthcare industry
  continues to invest significantly less in IT than
  any other information intensive industry
• Healthcare agencies in Saudi Arabia are no
  exception

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The Status Quo

• Since progress in developing IT solutions is
  likely to improve system efficiency and patient
  outcomes
• By reducing medical error rates
• More rapidly displaying critical information
• Offering clinicians evidence-based decision
  support
• It is imperative to provide financial incentives
  to invest in such technology

13
The Status Quo

• The potential application and benefits of a more
  connected global community via IT
• WTO and SA how will healthcare be structured in
  5 to 10 years?
• IT and communication via the Internet is a
  fundamental commodity inherent in the delivery of
  healthcare now and in the future

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The Role of SA Government

• The Saudi government should play a more active
  leadership role in educating the medical
  community and in coordinating and encouraging a
  more rapid and effective implementation of
  clinically relevant applications of wide-area
  networking

15
Critical Areas for SA Government to Play a Vital
Role

• Developing standards
• Providing funding for research and development
• Ensuring the equitable distribution of resources,
  particularly to places and people considered by
  private sector to provide low opportunities for
  profit
• Protecting rights of privacy, intellectual
  property, and security

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Standards

• Standards ensure consistency, integration, and
  accuracy, yet standards for data entry, database
  management, and other processes vary among care
  providers, health insurers, and other members of
  the health sector
• Standardization in other industries has
  facilitated vast savings through process
  improvement, and IT has been an integral part of
  this transformation

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Standards

• This same revolution has yet to happen in
  healthcare, and the lack of strong interfaces and
  unified systems significantly complicates
  research and clinical decision support
• information systems with very different user
  interfaces may exchange information with each
  other if they capture data with the same
  terminology i.e., standards are the middle ground

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Standards

• It is therefore, imperative to develop national
  Saudi standards, and it is the proposal of this
  researcher to develop a National Health
  Information Infrastructure to coordinate and
  integrate systems, technologies, and tools on a
  national level to support the best possible
  health decision making

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Standards

• Under the Saudi government leadership, this
  infrastructure would be supported by
  telecommunications technology that allows
  different information systems to interact via the
  Internet

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Standards

• It is easier to grasp the scope of the NHII if it
  is seen in terms of building blocks layered over
  time
• The early building blocks can leverage current
  technology and know-how later ones will require
  advances in basic computer science and
  informatics research

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Standards

• The pragmatic steps, which can be taken
  immediately to accelerate the building of the
  NHII, deal with policy and governance issues as
  well as standardization and data interchange
  approaches
• Standards are an important building block for
  achieving the required comprehensive and
  integrated health information infrastructure

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Standards

• One of the priority areas for national action is
  accelerating standards development
• For many years, in the experience of other
  countries, the absence of universal and efficient
  standards for managing and exchanging health
  information has been identified as a key barrier
  in developing the national health information
  infrastructure

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Standards

• This vision should facilitate the capture and
  exchange of standardized health data, as well as
  its translation into information, knowledge and
  wisdom

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Standards

• Incompatibilities amongst data, communications
  and technology structures abound
• Data collected at different times, by different
  practitioners or organizations, are frequently
  difficult to interpret, compare and exchange

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Standards

• At the same time, the development of new
  information systems is a costly and risky
  activity
• Although new technologies offer many promises,
  the rapid evolution of information technology
  increases the risks associated with their adoption

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Standards

• The application of information technology to
  healthcare is still in its youth
• Although much has been learned over the years,
  there are still many lessons to be learned about
  how and when a computer-based intervention is
  most likely to be successful
• The scope of harms and benefits to be anticipated
  when information technology is implemented has
  not been well catalogued

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Standards

• Many of these issues can be reduced or resolved
  through the implementation of consensus standards
• As in other industries, health informatics
  standards have the potential to increase the
  quality and lower the costs and risks of
  developing, purchasing and managing health
  information and information technology

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Standards

• To date, standards development efforts have
  focused on messaging standards and terminologies
• Messaging standards provide a standard format for
  exchange of a transaction, such as an order,
  among systems
• Terminology standards provide a standard
  vocabulary for representing a concept, such as a
  specific orderable item, for use across systems

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Standards

• To meet the objectives of the proposed NHII,
  Saudi Arabia will need additional standards,
  including ones dealing with authentication and
  security, healthcare delivery processes,
  representations of medical knowledge that are
  interpretable by a computer, and interfaces to
  software components

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Standards

• Spreading a technology before the standards are
  established could lead to advances that do not
  achieve the full benefits for society that might
  otherwise be attained
• Waiting is equally unacceptable

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Standards

• A transformation of healthcare can occur if the
  country establishes minimum standards for the
  generation, capture, manipulation, and exchange
  of health-related information and the governance
  and informatics tools to support their evolution

32
NHII Prospective

• Properly executed, such a comprehensive,
  knowledge-based network could be the key to
  engaging patients in their care, providing care
  when and where needed, supporting processes that
  avoid error, and reducing administrative cost

33
NHII Prospective

• A National Health Information Infrastructure, in
  practice, will serve more as an enabler that
  facilitates the convergence of information with
  security and privacy, rather than an information
  system in itself, or even a federation of
  information systems

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Conclusion

• Saudi Arabia is at a decisive point in its
  investment in healthcare delivery and the
  nation's health. The scientific revolutions in
  biology, chemistry, and physics during the past
  century, combined with the more recent
  substantial increase in national budget and the
  movement toward privatization, now combine to set
  the stage for a dramatic alleviation of human
  suffering from disease

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Conclusion

• The goal, an improved healthcare system resting
  on an information and communication
  infrastructure, is achievable
• Saudi Arabia will not reach this goal by
  maintaining the status quo
• Action is necessary at all levels, by MOH and all
  other agencies that fund healthcare delivery

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Conclusion

• The complexity of the task of implementing
  infrastructure increases as the scope changes
  from organization, to region, to country
• Accordingly, approaches that work in one
  organization are unlikely to work for the country
  as a whole

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Conclusion

• The NHII (initiative) should focus on a few
  critical items, such as establishing key
  standards and healthcare policies, which must be
  done on a national scale to make it easier to
  exchange information among regions and
  organizations
• In parallel, regional- and organization-based
  efforts to share information across the care
  continuum need to begin seriously

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Conclusion

• Best practices and successes need to be
  reproduced
• If successful organizational and regional
  undertakings are aligned with national strategy,
  the collective efforts will incrementally build
  toward an effective healthcare information and
  communication infrastructure

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Closing

• The NHII has the potential to transform
  healthcare in Saudi Arabia improving healthcare
  quality, reducing healthcare costs, preventing
  medical errors, improving administrative
  efficiencies, reducing paperwork, and increasing
  access to affordable healthcare

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Closing

• The same infrastructure that facilitates
  improved patient care can also be used to provide
  the information needed for earlier detection of
  bioterrorism and other adverse health events
  e.g., SARS and Avian Influenza

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Closing

• The current practice of medicine . . .depends
  upon the decision-making capacity and reliability
  of autonomous individual practitioners, for
  classes of problems that routinely exceed the
  bounds of unaided human cognition.
• -Daniel R. Masys