Panel on Standards Consortia and Integration Initiatives Presentation to IOM Committee on Patient Sa

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Panel on Standards Consortia and Integration
InitiativesPresentation to IOM Committee on
Patient Safety Data StandardsJanet M.
MarchibrodaeHealth Initiative and Foundation for
eHealthNovember 25, 2002
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Our Mission

• The missions of both the eHealth Initiative and
  its Foundation for eHealth are the same
• To drive improvement in the quality, safety, and
  cost-effectiveness of health care through
  information technology.

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Our Vision

• An interconnected, electronic health information
  infrastructure that benefits all stakeholders in
  the health care system
• Computerized patient records in every clinicians
  office.
• Interoperable health care systems with secure
  connectivity across providers, patients, payers,
  public health and others.
• Clinicians armed with the information they need
  to make the best clinical decisions at the right
  time.
• Consumers, patients and caregivers armed with the
  information they need to manage and address their
  own health care needs.

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eHealth Initiatives Members

• Health care information technology suppliers
• Health systems and hospitals
• Health plans
• Employers and purchasers
• Non-profit organizations and professional
  societies
• Pharmaceutical and medical device manufacturers
• Practicing clinician organizations
• Public health organizations
• Research and academic institutions

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eHealth Initiatives Strategic Priorities

• Increase awareness of the role of information
  technology in driving greater quality, safety,
  and cost-effectiveness in health care
• Lay the foundation for an interconnected,
  electronic health information infrastructure by
  promoting the adoption of clinical data standards
  and enhanced connectivity
• Build the case for public and private economic
  incentives for better quality health care enabled
  by information technology

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Scope of Our Standards Initiatives

• Promoting Acceleration of Standards Adoption
  through Various Levers
• Using a multi-stakeholder approach, developing
  and communicating strategies for transmitting
  electronic data of public health importance using
  operable standards, through eHI Foundations
  Public-Private Sector Collaboration for Public
  Health
• Providing significant staffing support to Markle
  Foundations Connecting for Health initiative,
  which is designed, among other things, to
  accelerate data standards adoption.

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Scope of Our Standards Initiatives

• Promoting Acceleration of Standards Adoption
  through Various Levers
• Launching broad-based multi-stakeholder
  initiative designed to accelerate adoption of
  computerized prescribing, using operable
  standards, by clinicians in the outpatient
  environment

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Scope of Our Standards Initiatives

• Educating Policy-Makers, Media and Industry
  Regarding the Need for an Interoperable,
  Electronic Information Infrastructure Enabled by
  Clinical Data Standards
• One-on-one Meetings
• Briefings on Capitol Hill
• Industry Conferences
• National Events e.g co-sponsored national event
  with Kanter Family Foundation, AHRQ, CDC, and the
  Office of the Assistant Secretary for Health,
  focused on raising awareness of the need for an
  interconnected, electronic health information
  infrastructure.

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Strategy for Developing, Promoting and
Implementing Data Standards

• Identify consensus standards that are
  adoption-ready
• Align adoption-ready standards with the data
  needs of critical stakeholders that have the
  ability to accelerate adoption (e.g. public
  health, payers, vendors, quality improvement and
  accrediting organizations, practicing clinician
  organizations)
• Build critical stakeholder understanding of the
  value of interoperability and the steps that
  are needed to drive adoption of data standards

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Strategy for Developing, Promoting and
Implementing Data Standards

• Highlight for policy-makers and media, currently
  operating community models for electronic,
  standards-based clinical data transmission and
  exchange and the benefits that have been realized
• Encourage government leadership of and funding
  for actions that will promote interoperability
  and standards adoption

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Strategy for Developing, Promoting and
Implementing Data Standards

• Convene private and public sector stakeholders to
  identify and articulate strategies and processes
  for driving transmission of data in standard,
  electronic formats (e.g. eHIs Public-Private
  Sector Collaboration for Public Health, eHIs eRX
  Initiative and eHIs support of Markle
  Foundations Connecting for Health initiative)
• Convert strategies and processes into
  implementation guides to facilitate compliance
  and adoption.

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Public-Private Sector Collaboration for Public
Health - Goals

• Develop and communicate strategies to efficiently
  and securely capture and transmit standardized
  electronic data of public health importance
• Leverage existing health care information systems
  and data sources to enhance public health
  surveillance

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Public-Private Sector Collaboration for Public
Health - Goals

• Focus on the following
• Lab results
• Microbiology results
• Orders
• Chief complaint data
• Lay the foundation for a national health
  information infrastructure

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Public Health Collaboration Participants

• Federal entities such as CDC, CMS, and NCVHS
• State and local public health agencies and
  partner organizations such as APHL, ASTHO, CSTE,
  NACCHO, NAHDO, NAPHSIS, PHDSC
• Health care technology suppliers (representing
  80 of nations health care systems) -- Cerner,
  EDS, IBM, McKesson, SAIC, Siemens and others
• Health care providers such as Cleveland Clinic,
  Duke, the Permanente Federation, MedStar Health,
  NY Presbyterian, and VHA Inc.

• Holders of large sources of health care data such
  as Advance PCS, Quest Diagnostics and Quintiles
• Academic/research institutions such as Columbia,
  RAND, Regenstrief Institute for Healthcare, and
  University of Pittsburgh Center for
  Bioinformatics
• Standards organizations such as HL7, SNOMED and
  LOINC
• Labs such as Quest Diagnostics and Labcor
• Non-profit associations such as ACEP, AHIMA,
  AMIA, and WEDI

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Critical Success Factors

• Public and private sectors working together
• Support of specific, well-defined, highly visible
  needs for data (e.g. public health)
• Focus on data that already exists in electronic
  forms (e.g. lab data)
• Align efforts with existing funding sources
• Leverage work of experts and those working in the
  trenches

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Critical Success Factors

• Involve key stakeholdersdata producers, data
  consumers, and data enablers
• Drive usage of standards and strategies through
  implementation and demonstration projects
• Align efforts with national initiatives, such as
  those related to NCVHS

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Starting Point was CDCs NEDSS

• Starting point for our work was CDCs National
  Electronic Disease Surveillance System (NEDSS)
• Element 2 Accept, route process electronic
  HL7 messages containing laboratory and clinical
  content
• Element 4 Develop active data translation and
  exchange (integration broker) functionality
• Our experience demonstrated that the NEDSS
  framework is rapidly extensible

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NEDSS is Rapidly Extensible

• In 8-12 weeks, our work groups were able to
  develop messaging specifications for
• Microbiology Results
• Orders
• Chief Complaint Data
• Lab Results
• State and local communities can rely on the NEDSS
  framework to support them in implementing
  electronic reporting for
• Adding new data types
• Implementing electronic reporting between health
  departments and healthcare providers

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Integration Broker Overview
are Clinical Settings (CSs)
Pharmacy
Emergency Department Chief Complaint
LIS
Billing
Clinical Documentation
Public Health NEDSS System
Collation, transformation and routing processes
PH Compliant HL7 Messages
Web page Data entry
HIS other systems
Veterinary / Zoo Labs
Web page Data entry
Reference Labs
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Integration Broker Detail
Transformation Functions (may be performed at
Public Health Department, Clinical Setting, or
an intermediary)
CS Feeder Systems
Public Health NEDSS System
PH compliant HL7 messages
Functions Required to convert CS Feeder System
output
to PH Compliant HL7 messages.
Public Health NEDSS System
PH compliant HL7 messages
Public Health NEDSS System
PH compliant HL7 messages
Web page Data entry
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Public-Private Sector Collaboration for Public
Health Next Steps

• Finalize and release implementation guides for
  lab results, microbiology results, orders, chief
  complaint data (this Winter)
• Promote widespread adoption through
  communication, education and other vehicles
  targeted to providers, labs, and public health
  organizations
• Encourage funding of implementation activities,
  including community-based clinical data exchange
  initiatives that assist public health with its
  mission
• Show-case success stories to maintain momentum

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Markle Foundation Connecting for Health

• Accelerating the rate of adoption of national
  clinical data standards across the nations
  health care system in order to facilitate
  interoperability.
• Identifying practical strategies and solutions
  for developing an interconnected, electronic
  health information infrastructure that will
  assure the secure and private transmission of
  medical information.
• Actively working to understand what consumers
  will need and expect from an interconnected
  health information system and identifying key
  steps for meeting their needs.

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Data Standards Specific to Patient Safety and
Quality Improvement

• Data Standards Specific to Patient Safety and
  Quality Improvement are the Same as Those
  Required for Public Health and Delivering Health
  Care
• Lab Results LOINC
• Clinical Messaging HL7
• Terminology SNOMED, MEDCIN
• Pharmacy NCPDP, RX Norm, MedDRA
• Administrative X12
• Imaging DICOM
• Diagnoses/Procedures ICD 9, ICD10, CPT 4

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Barriers that Impede Adoption

• Lack of clear consensus on the standards to adopt
  (it requires resources to transition to a
  standardthe various stakeholders need to know
  that the standard theyre moving to is the right
  one)
• Lack of understanding of the business case or
  value proposition for interoperability
• Costs (e.g. licensing fees) associated with
  implementing some of the standards

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Barriers that Impede Adoption

• The need for a widely and publicly available
  terminologies
• The need for capital or operating funds to make
  the transition
• Lack of understanding of a migration strategy
• Competing priorities

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Strategies to Overcome Barriers

• Federal leadership and broad-based consensus on
  what standards to adopt (incorporating views of
  both public and private sectors)
• Widespread awareness of the business case or
  value proposition for interoperability
• Alignment of the data reporting requirements of
  critical stakeholders that currently require
  transmission of data (e.g. public health, payers,
  regulators, accrediting organizations)

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Strategies to Overcome Barriers

• Incentives provided to those who submit data from
  those same critical stakeholders that need data
• Reduction of financial barriers to using
  standards and terminologies
• Funding to support migration strategies

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Business Case or Model to be Developed

• Align adoption-ready standards with the data
  needs of critical stakeholders that have the
  ability to accelerate adoption (e.g. public
  health, payers, vendors, quality improvement and
  accrediting organizations, practicing clinician
  organizations)
• Encourage such stakeholders to take the steps
  necessary to drive not only the electronic
  transmission of data, but also the transmission
  of such data using standards

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Business Case or Model to be Developed

• Articulate value to all health care
  constituenciesproviders, public health, payers,
  practicing clinicians, researchers, accrediting
  organizations, consumers
• In the aggregate, cost-savings and quality
  improvement will result! .However, it should be
  noted that we need to consider aligning the costs
  of migration with the benefits.