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Health Informatics: Challenges and Opportunities for Health Policy


Adoption of EHRs and RHIOs. Promulgate national data standards. Set rules and regulations for functionality of EHRs ... Finance EHRs: Develop the business case ... – PowerPoint PPT presentation

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Title: Health Informatics: Challenges and Opportunities for Health Policy

Health InformaticsChallenges and Opportunities
for Health Policy
  • Judy Ozbolt, PhD, RN
  • Scholar
  • Institute of Medicine


Advising the Nation. Improving Health.
As an independent scientific adviser, the
Institute of Medicine strives to provide advice
that is unbiased, based on evidence and grounded
in science. The mission of the Institute of
Medicine embraces the health of people
Health Informatics
  • The application of information science, knowledge
    management, computing, and telecommunications to
  • The health and health care of individuals and
  • The health monitoring and health services
    afforded to populations
  • The advancement of biomedical research
  • The education and work processes of health
    professionals and scientists
  • The education and health practices of the public

Biomedical Research
Health of Individuals Families
Information Science And Technology
Health of Populations
Education, Work Processes, And Health Practices
Health InformaticsA Critical Infrastructure for
the Nations Health
  • The Computer-based Patient Record (IOM, 1991,
  • For the Record (NRC, 1997)
  • Networking Health (NRC, 2000)
  • To Err is Human (IOM, 2000)
  • Crossing the Quality Chasm (IOM, 2001)
  • Health Professions Education (IOM, 2003)
  • Mathematics and 21st Century Biology (NRC, 2005)
  • Building a Better Delivery System (NAE, 2005)

Health Care Should Be . . .
  • Safe
  • Effective
  • Patient-centered
  • Timely
  • Efficient
  • Equitable
  • IOM, Crossing the Quality Chasm, 2001

Health Informatics In Support of Aims of Health
  • Electronic health records (EHR) for providers,
    with continuous access to patient information,
    knowledge resources, and decision support.
  • Personal health records (PHR) for everyone, with
    continuous access to own information, knowledge
    resources, and care providers.
  • Regional and national health information
    infrastructure for health services, consumer
    health, quality, accountability, research, and

Electronic Health Records Foundation for the
  • Health Information and data
  • Test results management
  • Order entry / management
  • Decision support
  • Electronic communication and connectivity
  • Patient support
  • Administrative support and reporting
  • Population health management (IOM, 2003)

Personal Health RecordsTools for Self-Management
  • Access to own EHR (read-only)
  • Opportunity to record information into PHR
  • Secure email communication with providers
  • Access to reliable health knowledge and
    information (e.g., Medline Plus, Gateway)
  • Access to monitored listserves and chat rooms for
    health concerns
  • Decision support, alerts, and reminders
  • IOM, A Focus on Communities, 2004

Health Information NetworksVehicles for
Information Exchange
  • Secure access of authorized users to information
    across providers, settings, times
  • Critical information for patient care
  • Reporting for regulation, payment, public health
  • Appropriate, secure access for research
  • IOM, A Focus on Communities, 2004

BioinformaticsFoundation for Life Sciences
  • Mathematical research / new computational methods
  • Research on genomics, genetics, molecular biology
    / dissemination and use of findings
  • Education of biologists for 21st Century science
  • --NRC, 2003, 2004, 2005

Informatics Challenges and Opportunities
  • Security of health information
  • Appropriate uses of the Internet for health
  • Reliability of hardware and software
  • Adaptation of emerging technologies for health
    care, management, and science
  • Work redesign
  • NRC, 1997, 2000, 2004 NAE/IOM 2005

Current Initiatives
  • Secretary of DHHS has created and chairs the
    American Health Information Community.
  • Office of National Coordinator for Health
    Information Technology has issued RFPs for
  • Process to harmonize standards
  • Process to specify functional requirements for
    health IT products and certify compliance
  • Models and prototypes for national health
    information exchange
  • Process to address variations in privacy and
    security practices

Current Initiatives (2)
  • Centers for Medicare and Medicaid Services will
    make VHA VistA record system available at no
  • More than 100 initiatives in 45 states are
    working to exchange health information across
  • AHRQ is funding some of these for development and

Current Initiatives (3)
  • CDC is working with others to share information
    for monitoring, surveillance, data mining.
  • HRSA is supporting telemedicine projects.
  • Other significant HIT activities are underway at
    Department of Defense, Office of Personnel
    Management, NIH, and the VA.

Response to Hurricanes
  • Creation of prescription drug database from
    combined commercial pharmacy databases
  • In the works . . .
  • Support for implementing EHRs
  • Support for acquiring and using PHRs
  • Requiring compliance with standards to receive
  • Support for regional health information networks

Work Yet To Be Done
  • Use evolving computer science knowledge to create
    solutions to problems in health care and science.
  • Continue development of standards and methods to
    share information and maintain privacy and
  • Develop decision-support and knowledge-management
    systems for vulnerable populations such as
    children, the mentally ill, and the underserved.

Work Yet To Be Done (2)
  • Develop and use systems engineering and change
    management knowledge to improve integration of
    informatics into health care and science.
  • Address ethical, social, and economic issues in
    the development, communication, and use of
    genomic and genetic knowledge and information.
  • Educate health professionals, scientists, and the
    public on the uses of health informatics.

Policy Issues
  • The IOM and other units of The National Academies
    have taken a number of positions in their reports
    on the uses of informatics to improve health care
    and health sciences.
  • The CCST may wish to consider some of these in
    formulating its policy agenda.

Improving Health Care The Role of Informatics
  • Health care has safety and quality problems
    because it relies on outmoded systems of work.
  • Poor designs set the workforce up to fail,
    regardless of how hard they try.
  • 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 processes.
  • IOM, Crossing the Quality Chasm, 2001

Improving Health CareThe Role of Informatics (2)
  • Information technology must play a central role
    in the redesign of the healthcare system if a
    substantial improvement in quality is to be
    achieved over the coming decade.
  • Automation of clinical, financial, and
    administrative transactions is essential to
  • improving quality,
  • preventing errors,
  • enhancing consumer confidence in the health
    system, and
  • improving efficiency.
  • IOM, Crossing the Quality Chasm, 2001

National Health Information Infrastructure (NHII)
  • A national health information infrastructure is
  • To provide immediate access to complete patient
    information and decision-support tools for
    clinicians and their patients, and
  • To capture patient safety information as a
    byproduct of care and use this information to
    design even safer delivery systems
  • NRC, Patient Safety, 2004

Barriers and Risks to Adopting EHRs and RHIOs
  • Concerns about privacy and confidentiality
  • Lack of national standards
  • Varied and complex transactions requiring elegant
    but not simple solutions
  • Sizable capital investment and multiyear
    commitment required to build systems
  • Behavioral adaptations required for patients,
    clinicians, and organizations
  • IOM, Crossing the Quality Chasm, 2001

Strategies to Support Adoption of EHRs and RHIOs
  • Promulgate national data standards
  • Set rules and regulations for functionality of
  • Increase consumer awareness of the importance of
    these tools
  • Finance EHRs Develop the business case
  • Create a public utility to hold health data at
    the local level (See County of Santa Cruz, CA)
  • IOM, A Focus on Communities, 2004

Informatics and Life Sciences
  • Progress in biology depends on quantitative
    methods and understanding.
  • A top priority of science policy should be the
    creation and maintenance of a robust interface
    between biology and mathematics.
  • Biologists require knowledge of math and
    computing to communicate with systems engineers
    who design software for modeling biological
  • NRC, Mathematics 21st Century Biology, 2005
    NRC, Catalyzing Inquiry at the Interface of
    Computing and Biology, 2005

Questions for CCST
  • Which of these or other policy issues is
    important to California now?
  • Which of these or other policy issues is
    opportune for action now?
  • How can CCST best use its expertise and prestige
    to influence the development of policy in the
    priority areas?

Thank you!
  • Questions and Discussion