Health Information Conference Tbilisi, Georgia May 27

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Health Information ConferenceTbilisi,
GeorgiaMay 27 28 2003

• Introduction and Standards
• Layton Engwer

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Health Reform and Information
Health Reform
Evidence Based Decisions
Quality Information
Service statistics costs
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Objectives of discussions

• To understand the need for quality information
• To understand the benefits of quality information
  
• To understand the basic building blocks to
  quality information
• Coordinate the work towards a unique identifier
• Standards
• Confidentiality

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Visions for Information

• The right information to the right person at the
  right time in a secure manner
• Vision enablers
• Standards
• Unique identifier
• Confidentiality and privacy

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What is the need for Quality information?

• Means of documenting accreditation or
  credentialing
• Fiscal responsibility/utilization of resources
• Means of documenting progress in health reform
• Better individual health
• Improve health status of the population

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Guiding principles

• Collect information once - use many times
• Dont collect information for the sake of
  collecting it- just too expensive to collect and
  store the info
• Collect the information as close to the source as
  possible (a by product of normal service
  delivery)
• Try not to develop a standard- use someone elses
• Treat the data as if someone was looking at your
  health information

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Data vs. information

• Data
• 040303
• Information
• April 3rd 2003

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Standards Enabler

• Can evidence based decisions be made without
  standards?

Not likely without a lot of associated notes
describing the limitations of the data. Somewhat
dysfunctional
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Data vs. information

• Data
• 040303
• Information
• 04/03/2003 OR April/3rd/2003
• 4 March/2003 OR 2003/ 04/03
• Standards are the stepping stone to information.
• (Date standard yyyy/mm/dd)

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Standards current status?

• Limited use of standards
• Primarily within a given institution
• Some misuse of standards due to processes
• ZAGS
• Reliability questionable
• Difficulty
• Cross institutional/regional information
• Cross government department differences

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Standards are not

• Forms or records of reporting
• A one off description of anything
• Necessarily SCHIP wide, all the time
• Exciting
• Quickly and easily implemented

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Standards need

• To be published to solicit input and reflect
  consensus
• To be accepted by those that use them
• To be tested for viability and eventually,
  compliance
• A governance process
• To support organizational goals
• To evolve (adequately documented)
• Standards are a necessary evil

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Standards Questions

• Do we have the need to share data?
• How does it get designed? Communication/consensus/
  publishing
• Who can authorize standards?
• What are our immediate needs?

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To set and enforce standards

• Governance process has to be established
• Who needs to be represented on the standing(?)
  decision committee?
• How will the committee be empowered?
• Who can act as subject matter experts to the
  decision committee?
• What structure will work best? Working groups,
  focus groups?

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Typical process
Needs
Needs
Preparation
Consensus
Approval/Implement
Monitor/Evaluate
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Typical Process identify need (why)

• Identify benefits of standards
• Improve communication
• Eliminate confusion
• Facilitate policy development/measures
• Key to program delivery and monitoring for best
  practices
• Fiscal responsibility

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Typical process Preparation(how)

• Define scope of standard
• Local/national/international?
• Are processed involved?
• Are service delivery components involved?
• Establish working group(s)
• Research for possible existing standards (subject
  matter experts)
• Draft proposal

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Typical process Consensus(acceptance)

• Publish as draft standard for consideration
  comment by the field
• Seek specific comments
• Working group to finalize draft

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Typical process Approval and implementation (the
hard part)

• Due authorization of standard
• Publication will include
• Training implications (ongoing education)
• Integration of standards in day-to-day activities
  (communication strategy)
• Compliancy process
• Time frames, incentives, etc for compliance
• Time frame for next review

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Typical process Monitor/evaluate

• Enforcement
• Avoid inconsistencies
• Are benefits being achieved?
• Is it being used for what it was designed for?

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Typical process Helpful hints

• Determine when a standard can be local or
  temporary and let them manage it
• Create a library of these local standards
• others may seek a similar standard
• this may evolve to a wide area standard through
  acceptance and consensus
• Assign responsibility
• Always try to see if the proposed standard exists

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Working groups Standards

• What standards currently exist and what is the
  acceptance?
• Based on that experience, what governance would
  you put in place to replicate a positive
  experience or repair a poor experience?
• What would you see as the first priorities for
  the governance.