Moving the National Health Information Technology Agenda Forward

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Moving the National Health Information Technology
Agenda Forward Mayo Clinic Centennial Of
Informatics October 18, 2007 Robert M.
Kolodner, MD National Coordinator Office of the
National Coordinator for
Health Information Technology (ONC)
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Overview

• Not the Usual ONC Presentation
• 2 complementary constructs a range of ONC
  options
• Transforming Health Care
• Office of the National Coordinator for Health IT
• Health ITs Role
• Puzzle Pieces Necessary to Reach the Tipping
  Point
• Putting It All Together

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Transforming Health Care Moving from Treating
to Preventing to Predicting1
BIRTH
Injury and Acute Illness
Family History Genetics
Environmental Exposures
Death
Chronic Illness
Lifestyle
Prevent
Intervene
Predict
1. Adapted from Perlin, Dr. Jonathan B,
Healthcare 1015 beyond Some Thoughts on
Planning Ahead, p. 95
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Achieving Personalized Health Care
Heart Disease Diabetes Arthritis Cancer Control
. . .
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The Future of Health Care Personalized Medicine

• Leverage genetic information in research and
  routine practice
• Genetic/genomic tests are used in current
  clinical practice for over 1,100 diseases1
• Can be used for prediction, prevention, and
  appropriate treatment selection

• Link genetic information to Electronic Health
  Record
• EHRs can drive the uptake and adoption of new
  technologies such as pharmacogenetics

1. www.genetests.org
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Office of the National Coordinator (ONC)

• Executive Order, April 2004
• The President created the National Coordinator
  position
• To advance the vision of developing a nationwide
  interoperable health information technology
  infrastructure
• To achieve the Presidents goal of widespread
  adoption of interoperable electronic health
  records (EHR) by 2014
• Key Role for ONC
• Provide leadership for the development and
  nationwide implementation of an interoperable
  health information technology infrastructure to
  improve
• The quality and efficiency of health care and
• The ability of consumers to manage their health

• Key Role for ONC
• Provide leadership for the development and
  nationwide implementation of an interoperable
  health information technology infrastructure to
  improve
• The quality and efficiency of health care and
• The ability of consumers to manage their health

National Health IT Agenda
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Health Care Transformation Through Health IT

• Making health care information available
  electronically (reliably and securely) a
  necessary step to improve the health of
  individuals and the nation
• Perspective? Role? Other?

ActivatedIndividual
CommunityPH, Quality, RD
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Key Health IT Components to Enable Transformation
A Robust, Interoperable, Health IT Environment
that brings together

• Electronic Health Records (EHR)
• Personal Health Records (PHR)
• Population Health Information (Public
  Health, Quality Improvement, Research)

• Standards (Data, Technical and Security)
• Interoperable Health Information Exchange Network
• (Nationwide Health Information Network -
  NHIN)

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Moving Toward the Tipping Point How
Transformational Change Occurs
Health IT Tipping Point
2014
TIME
2004

• Executive Order
• Health IT Agenda Established

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Pieces of the Puzzle Necessary to Reachthe
Health IT Adoption Tipping Point
Governance
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Privacy Security Issues and Activities

• State Level
• Misinterpretation of HIPAA
• Additional legal impediments to appropriate
  information flow
• eSignature
• CLIA
• Liability Issues
• Licensure Issues
• Health Information Security Privacy
  Collaboration (HISPC)
• State Alliance for e-Health

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Privacy Security Issues and Activities (2)

• Federal Level
• HIPAA
• Additional privacy security challenges with
  robust exchange of electronic information health
• Federal Advisory Committees (AHIC, NCVHS)
• Confidentiality, Privacy Security Workgroup
  (AHIC)
• Developing a Privacy Security Framework
• Capabilities required for nationwide network
  participation

ActivatedIndividual
CommunityPH, Quality, RD
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Pieces of the Puzzle Necessary to Reachthe
Health IT Adoption Tipping Point
Governance
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Standards
Summary of the Cyclical Process

• Staffed the prioritization process (AHIC)
• Developed the Scenarios
• Established and funded public-private
  organizations
• To identify and recommend harmonized standards
• To create certification criteria

ActivatedIndividual
CommunityPH, Quality, RD
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Priorities and Scenario (Use Case) Roadmap
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Standards in HIT Products

• Drivers For Using Standards
• Recognition of standards by HHS Secretary
• Interoperability required
• Presidential Executive Order August 2006
• Federal Health Information Systems
• Contracts
• Stark Exception and Anti-Kickback Safe Harbor
• Certified deemed to be interoperable
• First cycle Spring 2006 ? Summer 2008
• 30 interoperability standards identified for use
  in health IT systems
• New priority areas increasing with each cycle 3
  ? 4 ? 6
• 92 ambulatory EHRs (40 of the market) certified

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Pieces of the Puzzle Necessary to Reachthe
Health IT Adoption Tipping Point
Governance
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Governance

• Inclusive of all stakeholders
• Otherwise the solutions are sub-optimized
• May replicate down to state, tribal, and local
  communities
• Barrier is lack of trust across the stakeholder
  sectors
• Manages prioritization and trade-offs
• To achieve nationwide health IT infrastructure
• Initial governance HHS Secretary Michael Leavitt
• Guided by recommendations from theAmerican
  Health Information Community (AHIC)
• A Federal Advisory Committee
• Transitioning to a public-private governance
  entity

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The AHIC Successor Why Change?

• Continuity of leadership is needed to sustain the
  momentum gained over the past 24 months
• Government transition occurs every four years
• Changes again 460 days from today
• Uncertainty under new leadership places momentum
  at risk
• Sustainable business model is needed to support
  perpetual operation
• Congressional appropriations are a cyclical model
• Decisive action is needed keep pace with large
  scale innovation and transformation
• Government is necessarily a deliberate process

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AHIC Successor (2.0) - Principles for Governance

• The entity should exist for the purpose of
  individual/ consumer benefit
• The entity should establish and enhance trust
  among stakeholders
• The entity should have broad participation across
  the health care industry stakeholders
• The governing bodies of the entity should have
  necessary authority to make decisions, but only
  the authority that is necessary to do this
• The entity should be feasible to establish and
  operate, and sustainable into the future
• The entity should be adaptable over time and
  across future circumstances

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AHIC 2.0 What It Will Do

• Provide continuity -- accelerate and coordinate
  current AHIC interoperability initiatives
• Provide strong leadership in
• determining priorities
• harmonizing interoperability standards
• certifying products and systems to those
  standards
• overseeing and facilitating the NHIN
• establishing criteria for assuring
  interoperability, privacy and security
• Construct and champion a balanced view
• that takes into account the needs of all
  stakeholder groups

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Governance of the Health IT Agenda

• Three Phases

1. Governance by HHS Secretary with AHIC
guidance. ONC funds the standards processes
2. AHIC 2.0 An early hybrid of a public,
private partnership. ONC continues to fund
standards processes
3. AHIC 2.0 Self-sustaining Public Private
Partnership. ONC continues to fund efforts
related to population issues
ActivatedIndividual
CommunityPH, Quality, RD
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Pieces of the Puzzle Necessary to Reachthe
Health IT Adoption Tipping Point
Governance
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Current State EHR Adoption US Physicians (2005)
3 times more prevalent in metropolitan areas
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Current State EHR Adoption Hospitals (2007)
Rate of hospital use does not represent
physician use only ¼ of implemented hospitals
report 50 MD use (or more)
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Adoption of Interoperable Health IT

• Barriers to adoption
• Misalignment of incentives
• Doubts remain about the quality benefits of EHRs
  in small practices
• Lack of interoperability
• Necessary workflow changes
• Lack of adequately skilled national workforce
• Product certification decreases perceived risk
• Stark Anti-Kickback for donations to small
  providers
• Decreased malpractice insurance being explored
• Pay for performance?

ActivatedIndividual
As a driver?
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Pieces of the Puzzle Necessary to Reachthe
Health IT Adoption Tipping Point
Governance
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NHIN Trial Implementations

• Awards to 9 state regional Health Information
  Exchanges (HIEs)
• Forming the NHIN Cooperative to implement, test,
  and demonstrate core services by September 2008
• Support of consumer access controls
• Lookup and retrieval of clinical information
• Exchange of patient summary records
• Test implementations of the first 7 priority
  scenarios
• Lab result reporting medication history
  exchange quality and public health, etc.
• Expanding to include other types of HIEs, such as
  
• Multi-community Integrated Delivery Systems
• Health plans
• Health data banks

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NHIN Awardees

• CareSpark
• Tricities region of Eastern Tennessee and
  Southwestern Virginia
• Delaware Health Information Network
• Delaware
• Indiana University
• Indianapolis metroplex
• Long Beach Network for Health
• Long Beach and Los Angeles, California
• Lovelace Clinic Foundation
• New Mexico
• MedVirginia
• Central Virginia
• New York eHealth Collaborative
• New York
• North Carolina Healthcare Information and
  Communications Alliance, Inc.
• North Carolina
• West Virginia Health Information Network
• West Virginia

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Bringing It All Together to Reachthe Health IT
Adoption Tipping Point
Governance
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Health IT Support for Transforming Health Care
and
Care

PRIVACY, SECURITY, and CONFIDENTIALITY
Health IT
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The Ultimate Reason for Health IT
Health IT is a key enabler for us ALL to get
The quality of health we want and deserve The
quality and value of health care services we
demand
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For More Information
www.hhs.gov/healthit