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The Decade of Health Information Technology Begins:


Office of the National Coordinator for Health IT ' ... High rate of medical errors and rising health care costs necessitate it. ... – PowerPoint PPT presentation

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Title: The Decade of Health Information Technology Begins:

Federal Health Information Technology Initiatives
May 5, 2006 Jodi G. Daniel, JD, MPH Director,
Office of Policy and Research Office of the
National Coordinator for Health IT
"The health of people is really the foundation
upon which all their happiness and all their
powers as a state depend. Benjamin Disraeli
Basis for Priority on Health IT
  • High rate of medical errors and rising health
    care costs necessitate it.
  • The health care industry and commercial leaders
    support it.
  • Consumers need and want it.
  • The Federal Government is providing leadership to
    achieve it.

Medical Errors
  • In 2000, the Institute of Medicine estimated that
    between 44,000 and 98,000 Americans die each year
    from preventable medical errors1.
  • Subsequent studies have estimated
  • that the number may be twice as high2.
  • Medical errors are killing more people per year,
    in the U.S., than breast cancer, AIDS, or motor
    vehicle accidents3.

If we want safer, higher-quality care, we will
need to have redesigned systems of care,
including the use of information technology to
support clinical and administrative
              IOM, Quality Chasm Report, 2001
1Kohn, L., J. Corrigan, and M. Donaldson. To Err
Is Human Building a Safer Health System.
Committee of Health Care in America, Institute of
Medicine. 2000. 2HealthGrades. In-Hospital
Deaths from Medical Errors at 195,000 perYear,
HealthGrades Study Finds. July 27, 2004.
3Institute of Medicine and Centers for Disease
Control and Prevention. National Center for
Health Statistics Preliminary Data for 1998 and
1999. 2000.
Medical Errors from Lack of Information
  • The lack of immediate access to patient
    healthcare information is the source of one-?fth
    of these errors1.
  • 80 percent of errors were initiated by
    miscommunication, including missed communication
    between physicians, misinformation in medical
    records, mishandling of patient requests and
    messages, inaccessible records, mislabeled
    specimens, mis?led or missing charts, and
    inadequate reminder systems2.

In attempting to arrive at the truth, I have
applied everywhere for information, but in
scarcely an instance have I been able to obtain
hospital records fit for any purpose of
comparison. If they could be obtained, they would
enable us to decide many other questions besides
the one alluded to. They would show subscribers
how their money was being spent, what amount of
good was really being done with it, or whether
the money was not doing mischief rather than
good. Florence Nightingale, 1873
1Health Research Institute GlobalTechnology
Center. Reactive to AdaptiveTransforming
Hospitals with DigitalTechnology,
PriceWaterhouseCoopers. 2005. 2 Smith, Peter, et.
al. Missing Clinical Information During Primary
Care Visits, The Journal of the American Medical
Association. February 2005.
The Rising Costs
The U.S. leads the world in healthcare spending
per capita, yet our technology lags behind other
Americans are spending 1.7 trillion on health
care every year, accounting for 15.3 percent of
our gross domestic product, at an average cost of
5,670 per person. Our lagging health IT
infrastructure compounds the problem,
contributing to fragmentation, waste, and
inefficiency. Statement by Senate
Majority Leader Bill Frist and Senator Hillary
Rodham Clinton
Source Ending the Document Game Connecting and
Transforming Your Healthcare Through Information
The Rising Costs
  • Health care costs are rising faster than
  • An aging population
  • 2000, 35 million Americans were 65 or older,
  • 2050, that number will likely increase to 82
  • Chronic Care expenditures
  • 23 of Medicare beneficiaries have 5 or more
    chronic conditions
  • 68 total Medicare expenditures.
  • On average
  • 13 different doctors
  • 50 prescriptions.
  • Savings from health IT and corresponding changes
    in care
  • 7.5 percent of health care costs (Johnston et
    al., 2003 Pan et al, 2004)
  • 30 percent of health care costs (Wennberg et al.,
    2002 Wennberg et al., 2004 Fisher et al., 2003
    Fisher et al., 2003).

Source US Department of Census Fast Facts
April 29, 2005
Industry and Commercial Support
  • Health IT Leadership Panel convened by the Lewin
  • Asked how IT has transformed other industries,
  • Banking, credit, retail, etc.
  • Concluded that investment in interoperable health
    IT is urgent and vital to the broader U.S.
  • consumer buy-in is key to success
  • stakeholder incentives must be aligned
  • NHIN Request For Information
  • Over 500 respondents have fed into the process.

Consumers Want Health IT
  • Americans who know about connected, interoperable
    health care systems recognize their benefits.
  • Roughly 70 report that they would use one or
    more features of a PHR.

63 Percent Would Track Immunizations
69 Percent Would Monitor Their Record for
63 Percent Would Look Up and Track Their Own
Test Results
65 Percent Would Transfer Information to New
75 Percent Say They Would Email Their Doctor
Source Connecting for Health Collaborative. The
Personal Health Working Group Final Report.
Markle Foundation. July 1, 2003.
Consumers Need Health IT
Percent of patients who said
Source Kaiser Family Foundation / Agency for
Healthcare Research and Quality / Harvard School
of Public Health National Survey on Consumers
Experiences with Patient Safety and Quality
Information, November 2004 (Conducted July 7
September 5, 2004).
Health IT Activities Over the Years
  • Selected activities to drive interoperability and
    standardization of health information technology
  • 1996 The Health Insurance Portability and
    Accountability Act (HIPAA) enacted
  • 1998 The National Committee on Vital and Health
    Statistics (NCVHS) espoused a national health
    information infrastructure to promote American
  • 2002 Markle Foundation forms the Connecting For
    Health initiative that assembled public/private
    leadership in healthcare to promote common
    electronic standards
  • 2003 The Federal Health Architecture (FHA) is
    established in the HHS Office of the Chief
    Information Officer and is tasked with defining a
    framework and methodology for establishing the
    target architecture and standards for
    interoperability and communication throughout the
    federal health community
  • 2003 President Bush signs the Medicare
    Prescription Drug Improvement and Modernization
    Act (MMA) allowing CMS to establish key
    infrastructure for health information technology
    such as e-prescribing

Federal Governments Leadership
  • Office of the National Coordinator for Health IT
  • Established by Executive Order 13335 (April 27,
  • Responsible for realizing the Presidents vision
    of Health IT
  • Widespread adoption of interoperable EHR within
    10 years
  • Medical information follows the consumer
  • Clinicians have complete, computerized patient
  • Quality initiatives measure performance and drive
    quality-based competition
  • Public health and bioterrorism surveillance are
    seamlessly integrated into care

Office of the National Coordinator Structure
Immediate Office of the National
Coordinator David Brailer
Office of Health Information Technology Adoption
Office of Programs and Coordination
Office of Interoperability and Standards
Office of Policy and Research
Publication of a Strategic Framework July 2004
  • Goal 1 Inform Clinical Practice
  • Incentivize EHR Adoption
  • Reduce Risk of EHR Investment
  • Promote EHR Diffusion in
  • Rural and Underserved Areas

Strategic Framework
  • Goal 2 Interconnect
  • Clinicians
  • Foster Regional Collaboration
  • Develop a Nationwide Health
  • Information Network (NHIN)
  • Coordinate Federal Health
  • Information Systems

The AdministrationLeadership for Health IT
  • Lead by example
  • Leverage the buying power of the many federal
    health care programs to jump start health IT
  • Serve as Convener
  • Help the health care industry build sustainable
    public/private collaborations by bringing
  • Providers
  • Payers
  • Consumers
  • Employers
  • Health IT vendors
  • Standards Development Organizations (SDOs)
  • Regional Health Information Organizations (RHIOs)
  • State/Territory governments
  • Federal government
  • Etc.

ONC Major Initiatives
In 2004, President Bush called for the widespread
use of electronic health records (EHRs) within 10
years. Despite the demonstrated benefits to care
delivery, studies have found use of EHRs remains
low among physicians, hospitals and other health
care providers. The Office of the National
Coordinator for Health Information Technology
(ONC) has set the foundation for adoption of
interoperable EHRs through the following major
  • American Health Information Community
  • Standards Harmonization Process
  • Compliance Certification Process
  • Privacy and Security Solutions
  • Nationwide Health Information Network
  • Health IT and Health Care Anti-Fraud
  • Health IT Adoption
  • Proposed Changes to Self-Referral and
    Anti-Kickback Rules
  • Digital Health Recovery for the Gulf Coast

The American Health Information Community
  • Federal Advisory Committee appointed and chaired
    by Secretary Leavitt
  • Nine public sector and eight private sector
  • Initial recommendations
  • Prioritize Health IT initiatives
  • Identify breakthrough opportunities including
  • Biosurveillance
  • Consumer empowerment
  • Electronic health records
  • Chronic care monitoring
  • Ensure privacy and security protections
  • Harmonize industry-wide health IT standards
  • Create an internet-based nationwide health IT

Standards Harmonization Process
  • HHS awarded a contract to the American National
    Standards Institute, a non-profit organization
    that administers and coordinates the U.S.
    voluntary standardization activities, to convene
    the Health Information Technology Standards Panel
  • The HITSP will develop, prototype, and evaluate a
    harmonization process for achieving a widely
    accepted and useful set of health IT standards
    that will support interoperability among health
    care software applications, particularly EHRs.

Compliance Certification Process
  • HHS awarded a contract to the Certification
    Commission for Health Information Technology
    (CCHIT) to develop criteria and evaluation
    processes for certifying EHRs and the
    infrastructure or network components through
    which they interoperate.
  • First set of certification criteria have been
  • Standards
  • Functionality
  • Security
  • Certification will begin summer 2006.

Nationwide Health Information Network (NHIN)
  • Contracts have been awarded by HHS to four
    consortia of health care and health information
    technology organizations to develop prototypes
    for the Nationwide Health Information Network
    (NHIN) architecture.
  • Accenture
  • Computer Sciences Corporation
  • IBM
  • Northrop Grumman

Privacy and Security Solutions
  • HHS awarded a contract to RTI International to
    lead the Health Information Security and Privacy
    Collaboration (HISPC)
  • HISPC - A collaboration that includes the
    National Governors Association (NGA), up to 40
    state and territorial governments, and a
    multi-disciplinary team of experts. 
  • 18-month period
  • RTI will subcontract with up to 40 states to
  • Identify within the state business practices and
    state laws that affect electronic health
    information exchange
  • Propose solutions and implementation plans
  • Collaborate on regional and national meetings to
    develop solutions with broader application
  • Provide final report on overall project outcomes
    and recommendations

Health Information Technology and Health Care
  • Examine how automated coding software and a
    nationwide interoperable health information
    technology infrastructure can address healthcare
  • The project was conducted through a contract with
    the Foundation of Research and Education (FORE)
    of the American Health Information Management
    Association (AHIMA).

Proposed Changes to Self-Referral and
Anti-Kickback Rules
  • HHS announced proposed rules that would ease
    self-referral and anti-kickback restrictions.
  • The proposed rules would provide a Stark
    exception and an Anti-kickback safe harbor to
    allow hospitals and other entities to provide
    physicians with e-prescribing and electronic
    health record software and related training.
  • Proposals published in the Fed. Reg. 10/5/2005.

Health Information Technology Deployment
Health Care Industry
Technology Industry
Other HHS Health IT Initiatives
  • Agency for Healthcare Research and Quality (AHRQ)
  • Health IT Grants and Contracts
  • 2005 16 grantees were awarded a total of 22.3
    million to continue projects to improve the
    quality and safety of health care through IT
  • 2004 139 million in contracts grants to
    promote use of health IT
  • State and Regional Demonstrations in Health IT (5
  • Transforming Health Care Quality Through Health
    IT (100 grants awarded in 38 states)

Other HHS Health IT Initiatives
  • Centers for Medicare and Medicaid Services (CMS)
  • Doctor's Office Quality - Information Technology
  • Promotes adoption of EHR systems and IT in
    small-to-medium sized physician offices

Other HHS Health IT Initiatives
  • Health Resources and Services Administration
  • Healthy Communities Access Program (HCAP)
  • Develop/strengthen health care safety net
    delivery systems through providing an
    infrastructure to coordinate health care for
  • Development of information systems to support
    coordination of efforts that increase access to
  • Office for the Advancement of Telehealth grants
  • Support community-based activities in
    informatics, electronic medical records, and

Regional Health Information Organizations (RHIOs)
  • What is a RHIO?
  • Non-governmental, multi-stakeholder organizations
  • Provide oversight, coordination, and operational
    management for health information exchange.
  • Guide day-to-day operations on data access and
    data protection rules, support EHR
    implementation, clinical improvement programs,
    and sustainable financing for health information
  • Covers a defined and contiguous geographic area
  • Why RHIOs?
  • Clinical care is largely shaped by local referral
    patterns, and public health is organized locally
    within states, including corresponding
    surveillance and reporting activities.
  • Reimbursement structures, both through private
    insurers and Medicaid, reinforce the state and
    regional context of health delivery.

State level Regional Health Information
Organizations (RHIOs)
  • States have a unique opportunity to either
    coordinate ongoing regional activities or create
    the public-private governance and policy and
    technical framework needed for successful health
    information exchange.
  • States can address the policy/legal barriers,
    consider funding mechanisms, ensure coordination
    with State level programs i.e., public
    health/biosurveillance and Medicaid.
  • Governors and organizations representing states
    (NGA, NCSL, etc) can lead change at a state level.

What can you do?
  • Connect with federal efforts
  • American Health Information Community
  • Grant/contract opportunities
  • Standards/certification processes
  • Participate in State/Local Efforts
  • RHIO/e-health efforts
  • Policy efforts to reduce barriers
  • to health IT

Our Challenge is not new
  • That it will ever come into general use,
    notwithstanding its value, is extremely doubtful
    because its beneficial application requires much
    time and gives a good bit of trouble, both to the
    patient and to the practitioner because its hue
    and character are foreign and opposed to all our
    habits and associations.

The London Times, 1834 By way of Dr. Jeremy Nobel
Harvard School of Public Health
For More Information Visit
Health IT can enable transformation of
healthcare by allowing a better way to care
consumer by consumer, physician by physician,
disease by disease, and region by region. David
Brailer, M.D., Ph.D., National Coordinator for
Health Information Technology