How We Got There'

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How We Got There.

• POLICY 1980-2000
• Don E. Detmer

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Policy Perspective of Period 1980-1990s

• American Medicine is the best in the world by
  far.
• Potomac Elsewhere in USA
• Happy Stupid
• View of Informatics Enthusiasts
• Computers improve medical care research.
• View of Medical Establishment
• Modern medicine is wonderful
• Our clinicians are the best in the world.
• Quality measurement was in its infancy.

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AAMC Study 1986

• Medical Education in the Information Age Proc.
  Symposium on Medical Informatics. Washington, DC
• Take home message
• Informatics is good good for you.

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Institute of Medicine-1986 - 1991

• NIH / IOM June 86 Program Development Workshop
  Recommends Study
• Queta Bond, then Exec. Dir., IOM, seeks funds
• First internally funded IOM policy study
• IOM Committee formed in 1989
• Improving the Medical (Patient) Record in
  Response to Increasing Functional Requirements
  and Technological Advances

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Heavy ACMI Representation

• CPR Committee Members
• Marion Ball Octo Barnett Don Berwick Morris
  Colleen Nick Davies Don Detmer (C) Ruth Garry
  Tom Morris John Norris Ted Shortliffe Henry
  Krakauer Don Lindberg, plus many, many more
  involved
• Subcommittees
• Users and Uses (Berwick Margolis)
• Technical Requirements (Collen Ball)
• Policy Implementation (Shortliffe Tang)
• Staff
• Richard Dick, Elaine Steen, Kathy Lohr et al

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An Essential Technology for Health Care
1st edition 1987-1991 2nd edition 1997
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The Computer-based Patient Record An Essential
Technology for Health Care

• The 1991 1997 Reports
• (Tang / Hammond / van Bemmel / van Ginneken / van
  der Lei)
• A newly conceived record, not a digital version
  of traditional medical record
• Computer-based -- Put the focus on the record,
  not the computer
• Data entry by relevant responsible person

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Twelve Attributes of the Computer-based Patient
Record

• The CPR has a problem list with status of each
  problem
• The CPR encourages health status functional
  level measurement to promote outcomes assessment
• The CPR documents clinical rationale

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Twelve Attributes of the Computer-based Patient
Record

• The CPR can link to other clinical records over
  time
• The CPR system protects confidentiality
  comprehensively
• The CPR is accessible on a timely basis to
  authorized individuals

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Twelve Attributes of the Computer-based Patient
Record

• The CPR system allows selective retrieval and
  formatting
• The CPR system links to local remote knowledge,
  literature, data-bases, systems to aid decision
  making
• The CPR assists guides clinical problem solving

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Twelve Attributes of the Computer-based Patient
Record

• The CPR supports data collection storage with a
  defined vocabulary
• The CPR helps manage quality cost of care
• The CPR is flexible expandable to meet needs
  over time

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The Computer-based Patient Record An Essential
Technology For Health Care

• Rec. 1 CPRs become the standard for medical ---
  all other records relating to patient care.
• Rec. 2 CPR Institute
• Rec. 3 R D Support Public Private
• Rec. 4 Standards
• Rec. 5 Model Legislation
• Rec. 6 Shared Costs
• Rec. 7 Informatics Education

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The Economist Magazine 1997

• The CPR Report of the Institute of Medicine
  changed the electronic medical record from the
  realm of off-beat visionaries to an
  establishment-endorsed probability.

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The Computer-based Patient Record An Essential
Technology For Health Care

• Set goal of 10 years for widespread
  implementation, e.g., 2001
• CPR Institute founded
• Security Guidelines, etc.
• Nicholas Davies Awards

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Other Relevant IOM / NRC Studies

• The Computer-based Patient Record 1991 1997
• Health Data in the Information Age 1994
• Telemedicine 1995
• For the Record 1997
• Trust in Cyberspace 1999
• Networking Health 2000
• Key Capabilities of an Electronic Health
• Record System 2003
• Patient Safety Achieving a New Standard
• for Care 2004

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IOM / NAS Reports 1991-2000
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AMIA NHI Strategy Policy 97

• Universal Access to Web Health Resources
• Telemedicine Tele-education
• CHRs
• Hospital Primary Care
• Personal Health Records
• Population Health Records
• Decision Support Systems
• Standards Development
• Confidentiality Security
• Research, Education, Development
• International Collaboration

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Notable Federal Activity 90s

• Health Insurance Portability Accountability Act
  of 1997
• Administrative Simplification for Standards incl.
  Privacy Security
• VA DOD develop system-wide CPRs using IOM
  Report as future planning template
• NCVHS reorganizes as the Governments Health
  Information Policy Advisory Committee
• NHII Working Group formed

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PERSONAL Record Consumer e-health records
Infostructure Knowledge IT
First-class Health Care
PATIENT Record Clinic Hospital Records
PUBLIC HEALTH/ POPULATION Record Community
Records Data Banks Repositories
Interlocking computer-based health records
(C3PRs) supported by knowledge IT
infrastructure The EHR
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And, so ends the Second Millennium.

• Pushing Policy for Health IT
• End of Part I
• (Simborg Detmer)

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