Federal Health Information Federal Health Information Technology Initiatives Technology Initiatives

May 5, 2006May 5, 2006

Jodi G. Daniel, JD, MPHJodi G. Daniel, JD, MPHDirector, Office of Policy and ResearchDirector, Office of Policy and ResearchOffice of the National Coordinator for Health ITOffice of the National Coordinator for Health IT

"The health of people is "The health of people is really the foundation upon really the foundation upon which all their happiness which all their happiness and all their powers as a and all their powers as a state depend.”state depend.” Benjamin Disraeli

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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.

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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.

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.

“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, Quality Chasm Report, 2001

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Medical Errors from Lack of Information

• The lack of immediate access to patient healthcare information is the source of one-fifth 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, misfiled or missing charts, and inadequate reminder systems2.

1Health Research Institute & GlobalTechnology Center. Reactive to Adaptive:Transforming 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.

““In attempting to arrive at In attempting to arrive at the truth, I have applied the truth, I have applied

everywhere for everywhere for information, information,

but in scarcely an instance but in scarcely an instance have I been able to obtain have I been able to obtain hospital records fit for any hospital records fit for any purpose of comparison. If purpose of comparison. If they could be obtained, they could be obtained, they would enable us to they would enable us to

decide many other decide many other questions besides the one questions besides the one

alluded to. They would alluded to. They would show subscribers how their show subscribers how their

money was being spent, money was being spent, what amount of good was what amount of good was really being done with it, really being done with it,

or whether the money was or whether the money was not doing mischief rather not doing mischief rather

than good.”than good.”

Florence Nightingale, 1873

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The Rising Costs

Source: Ending the Document Game: Connecting and Transforming Your Healthcare Through Information Technology

www.EndingTheDocumentGame.gov

The U.S. leads the world in healthcare spending per capita, The U.S. leads the world in healthcare spending per capita, yet our technology lags behind other nations.yet our technology lags behind other nations.

““Americans are spending Americans are spending $1.7 trillion on health care $1.7 trillion on health care every year, accounting for every year, accounting for 15.3 percent of our gross 15.3 percent of our gross domestic product, at an domestic product, at an average cost of $5,670 per average cost of $5,670 per person. Our lagging health person. Our lagging health IT infrastructure compounds IT infrastructure compounds the problem, contributing to the problem, contributing to fragmentation, waste, and fragmentation, waste, and

inefficiencyinefficiency.”.”

Statement by Senate MajorityStatement by Senate MajorityLeader Bill Frist andLeader Bill Frist andSenator Hillary Rodham ClintonSenator Hillary Rodham Clinton

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The Rising Costs

Health care costs are rising faster than inflation:• An aging population:

– 2000, 35 million Americans were 65 or older, – 2050, that number will likely increase to 82 million.

• 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

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Industry and Commercial Support

• Health IT Leadership Panel convened by the Lewin Group– 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. economy • consumer buy-in is key to success• stakeholder incentives must be aligned

• NHIN Request For Information– Over 500 respondents have fed into the process.

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Consumers Want Health IT

Source: Connecting for Health Collaborative. The Personal Health Working Group: Final Report. Markle Foundation. July 1, 2003.

75 Percent Say They Would

Email Their Doctor

63 Percent Would Track

Immunizations

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

69 Percent Would Monitor Their Record for Mistakes

65 Percent Would Transfer Information to New Doctors

63 Percent Would Look Up and Track Their

Own Test Results

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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).

Percent of patients who said…

69%… coordination among their various

health providers is a problem

32%

…they had to wait/reschedule their appointment because the provider did not have all their medical information

48%…their health care provider did not

have all of their medical information

Consumers Need Health IT

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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 health

– 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

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Federal Government’s Leadership

Office of the National Coordinator for Health IT

• Established by Executive Order 13335 (April 27, 2004)• Responsible for realizing the President’s vision of

Health IT:– Widespread adoption of interoperable

EHR within 10 years– Medical information follows the consumer– Clinicians have complete, computerized patient information– Quality initiatives measure performance and drive

quality-based competition– Public health and bioterrorism surveillance are seamlessly

integrated into care

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Office of the National Coordinator Structure

Immediate Office of theNational Coordinator

David Brailer

Immediate Office of theNational Coordinator

David Brailer

Office of Health Information

Technology Adoption

Office of Health Information

Technology AdoptionOffice of Programsand Coordination

Office of Programsand Coordination

Office of Interoperabilityand Standards

Office of Interoperabilityand Standards

Office of Policyand Research

Office of Policyand Research

OperationsOperations

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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

StrategicStrategic

FrameworkFrameworkGoal 2: InterconnectClinicians•Foster Regional Collaboration•Develop a Nationwide Health Information Network (NHIN)•Coordinate Federal Health Information Systems

Goal 3: Personalize Care•Use of Personal Health Records,Enhancement of Informed ConsumerChoice, and Promotion of Telehealth Systems

Goal 4: Improve Population Health•Unify PH surveillance architectures, streamline quality and health status monitoring, and accelerate research and dissemination of evidence into practice

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The Administration:Leadership for Health IT Adoption

• Lead by example:– Leverage the buying power of the many federal health care

programs to jump start health IT adoption

• Serve as Convener: – Help the health care industry build sustainable public/private

collaborations by bringing together:• Providers• Payers• Consumers• Employers• Health IT vendors• Standards Development Organizations (SDOs)• Regional Health Information Organizations (RHIOs)• State/Territory governments• Federal government• Etc.

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ONC Major Initiatives

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

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 initiatives:

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The American Health Information Community

• Federal Advisory Committee appointed and chaired by Secretary Leavitt

• Nine public sector and eight private sector appointees

• 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 architecture

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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 (HITSP).

• 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.

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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 proposed.• Standards• Functionality• Security

• Certification will begin summer 2006.

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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

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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

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Health Information Technology and Health Care Anti-Fraud

• Examine how automated coding software and a nationwide interoperable health information technology infrastructure can address healthcare fraud.

• The project was conducted through a contract with the Foundation of Research and Education (FORE) of the American Health Information Management Association (AHIMA).

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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.

23Consumer Value

Standards Harmonization

ComplianceCertification

NHIN

Privacy / Security

Health ITAdoption

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Biosurveillance Consumer Empowerment

Chronic Care Electronic HealthRecords

Breakthroughs

Health Care Industry

Coordination of Policies, Resources, and Priorities

Office of the National Coordinator -Health IT Policy Council

-Federal Health Arch.

The Community-Workgroups

Health Information Technology Deployment Coordination

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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 awardees)

– Transforming Health Care Quality Through Health IT (100+ grants awarded in 38 states)

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Other HHS Health IT Initiatives

• Centers for Medicare and Medicaid Services (CMS)

– Doctor's Office Quality - Information Technology (DOQ-IT)

• Promotes adoption of EHR systems and IT in small-to-medium sized physician offices

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Other HHS Health IT Initiatives

• Health Resources and Services Administration (HRSA)– Healthy Communities Access Program (HCAP)

• Develop/strengthen health care safety net delivery systems through providing an infrastructure to coordinate health care for uninsured.

• Development of information systems to support coordination of efforts that increase access to care.

– Office for the Advancement of Telehealth grants (OAT)

• Support community-based activities in informatics, electronic medical records, and telemedicine.

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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 sharing.

– 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.

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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.

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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

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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, 1834By way of Dr. Jeremy Nobel Harvard School of Public Health

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For More Information Visit…

www.hhs.gov/healthitwww.hhs.gov/healthit

“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