Leveraging Existing Healthcare IT to Support Public Health ...Progress Has Been Made YCDC’s Public...

Foundation for eHealth

Leveraging Existing Healthcare IT to Support Public Health and Bioterrorism Surveillance and

Response:The Opportunities and the Challenges

The Tension Between Healthcare Privacy and Security in a Dangerous World - HIPAA Summit West

Janet MarchibrodaCEO, eHealth Initiative - Executive Director, Connecting for Health

June 7, 2003

Foundation for eHealth 2

eHealth Initiative 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.


eHealth InitiativeVision

Consumers, health care providers and those responsible for population health will have ready access to timely, relevant, reliable and secure health care information through an interconnected, electronic health information infrastructure.


eHealth Initiative’s 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 clinicians and their organizations

Public health organizations

Research and academic institutions


eHI’s 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 incentives for better quality health care enabled by information technology


Homeland Security and Public Health Challenges

Global response to SARS underscores the vital significance of disease surveillance in protecting the public health from natural…and unnatural outbreaks

Also discloses serious gaps and weaknesses in international and U.S. health monitoring

General Accounting Office Report suggests that public health surveillance programs, especially those capable of detecting possible bioterrorism attacks, are “inadequate”



State and local public health authorities rely primarily on passive surveillance systems that are prone to chronic under-reporting and significant time lags between diagnosis and receipt of data by public health authorities

Initiatives underway by public health authorities to develop active electronic surveillance systems have largely focused on hospitals and emergency rooms where access to data has been challenging

Level of preparedness in states and cities is varied, and generally lacking in terms of regional planning



States and metropolitan areas are focused on their specific populations, but there is little coordination across regional areas or state lines

Since infectious diseases (either naturally occurring or deliberately spread) know no jurisdictional boundaries, the lack of national or regional surveillance coordination or capacity represents a significant gap


What is Public Health Surveillance?

Ongoing collection, analysis, and dissemination of public health data related to disease and injury

Crucial monitoring function for CDC and public health partners at state and local level

Help detect threats to the health of public

Without public health surveillance systems, cannot identify outbreaks or problems, cannot investigate problems, identify their causes, and implement control measures if not detected


How Do We Handle Public Health Surveillance Today?

Two Kinds of Surveillance:

Direct observation, diagnosis and reporting by astute clinicians or from lab results

Observation of community-wide patterns that indicate a possible disease outbreak

An effective disease surveillance system uses both strategies

Both strategies require establishing systems that enable flows of information and health data within and across communities to permit timely recognition of events


How Do We Handle Public Health Surveillance Today?

For most surveillance data, initial source of information is provided by health care professionals

Currently our surveillance systems use paper or facsimile reporting by health care providers to public health agencies. If something is unusual, the provider may call the health department immediately

For routine public health surveillance, this largely paper-based system is burdensome to both providers and health departments often resulting in reports that are not complete or timely


Who are the Actors?

Centers for Disease Control and Prevention: Has responsibility on behalf of HHS to provide national and international leadership to detect, diagnose, respond to, and prevent illnesses, including those that occur as a result of a deliberate release of biological agents

ASTHO: Association representing the state public health agencies

NACCHO: National organization representing the nation’s nearly 3,000 local public health agencies

CSTE: Council of State and Territorial Epidemiologists


Who are the Actors?

Department of Defense: DoD Global Emerging Infections Surveillance and Response System (DoD-GEIS)…inspired by the early work of the City of New York, primary thrust has been to counter threats to U.S. forces that need to operate in locations with infectious diseases that are not considered a major threat to citizens in the U.S.ESSENCE – the Electronic Surveillance System for the Early Notification of Community-Based Epidemics. …ESSENCE II, is a civil-military operational and research partnership …objective is to create for the National Capitol Region a more powerful tool for detecting and characterizing outbreaks as soonas possible

Department of Homeland Security


Where We Need to Go….

Build on CURRENT HEALTHCARE INFORMATION SYSTEMS - direct linkages to the health care delivery system

Integrated electronic surveillance information systems

Real-time transmission of standardized, electronic data from existing information systems within the health care system (laboratory systems, ADT systems, pharmacy systems, etc.) and other data sources

Collaborations among various levels of government (national, state and local) and the private sector are critical


Infrastructure Will Serve Many PurposesRising healthcare costs and looming healthcare crisis

Nursing shortage and clinicians leaving practice

Quality and safety issues

Access issues

Increasing complexity of practicing medicine

Slow translation of research to practice


Progress Has Been Made

CDC’s National Electronic Disease Surveillance System (NEDSS)

Ultimate goal: electronic, real-time of information for public health action

Integrates numerous surveillance systems using a standards-based approach…standards for data, information architecture, security and information technology…use of standards is key!!

Enables sharing of data in a secure fashion, which is critical for identifying problems across institutional and jurisdictional boundaries


Progress Has Been Made

CDC’s Public Health Information Network (PHIN)

Expands the NEDSS approach of standards-based systems integration and applies it to other functions of the public health information life cycle

Enables electronic real-time data flow, computer assisted analysis, decision support, professional collaboration, and rapid dissemination of information to public health, the clinical community, and the public through a common integrated and standards-based framework


Examples of Surveillance Projects

New York City: well-established surveillance system of non-traditional data sources of pre-diagnostic indicators for surveillance and event

Pennsylvania: early warning system (RODS), using symptom data from emergency departments as a way to detect unusual patterns of illness and automatically alert providers

National Bioterrorism Syndromic Surveillance Demonstration Program: Collaboration between CDC, AAHP, several health plans, and Harvard Pilgram Health Care…Goal: create a system of access to data maintained by health plans


Examples of Data Sharing Projects

Community Health Information Technology Alliance

Indiana Network for Patient Care: community-based electronic health record covering most of Indianapolis

Massachusetts Health Data Consortium

North Carolina Healthcare Information and Communications Alliance

Patient Safety Institute

Santa Barbara County Care Data Exchange


Healthcare Collaborative Network….a National Demonstration Project

Foundation for eHealth Initiative and Connecting for Health National Demonstration Project (“Healthcare Collaborative Network”):

Over 20 organizations launched a national demonstration project on June 5th

• Goal is to demonstrate the feasibility and value of an electronic, standards-based model of data interchange.

• Demonstrates that all stakeholders.. including hospitals, practicing clinicians, public health agencies, payers, researchers, and patients will benefit from the use of an electronic standards-based infrastructure.


Primary objective is to encourage and enable sharing of health information to improve health care

Clinical data

Treatment options

Physicians & Patients

Bio-threat Alerts

Practice Guidelines

Open Standards

Government Agencies – CDC, CMS, FDA, etc.Payers

Pharma & Research Institutions

Diseas

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Manag

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t

Targeted drugs

& treatments

Clinical

trials data

Claims

data

Providers

Fast

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Healthcare Collaborative Network: Data Elements

The data elements that will be included in the national demonstration project are a subset of those that:

• Are necessary to drive improvement of care for those with diabetes and cardiovascular disease

• Will assist with public health surveillance, detection and response; and

• Will drive improvement in quality and patient safety


CDC Disease Surveillance and Stroke Initiative

AnthraxLegionellaRespiratory Viral TestStroke Discharges

CMS Quality-of-Care from Seventh Scope of Work

Ace Inhibitor Prescribed for Myocardial Infarction patientsHemoglobin A1C for Diabetes patients

FDA Adverse Drug Events

Low platelet count in Felbamate recipientsPregnancy Test for Thalidomide recipients

National Demonstration Project - Data


Our Strategy is to Grow the Health Information Ecosystem

Bio-threat Alerts

Practice Guidelines

Open Standards


Providers

Impr

ove

Car

e

Out

com

esda

ta


Our Strategy is to Grow the Health Information Ecosystem

Clinical data

Treatment options

Physicians & Patients

Bio-threat Alerts

Practice Guidelines

Open Standards


Pharma & Research Institutions

Diseas

e

Manag

emen

t

Targeted drugs

& treatments

Clinical

trials data

Claims

data

Providers

Fast

erR

eim

burs

emen

t

Out

com

esda

ta


National Demonstration Project - Participants

Hospitals

Health Care IT Suppliers

Practicing Physician Groups

Public Health Agencies

Payers

Regulators

Researchers


Caregroup HealthCare System

Centers for Disease Control and Prevention

Centers for Medicare and Medicaid Services

Cerner Corporation

Cleveland Clinic

Department of Defense

Food and Drug Administration

GE Medical Systems

GHI

IBM Corporation

Marion County Public Health Department

NDC Health

New York Presbyterian Hospitals, the University Hospitals of Columbia and Cornell

Novant Health

Regenstrief Institute for Health Care

Siemens Corporation

University of Illinois Medical Center -Chicago

University of Pittsburgh Medical Center

Vanderbilt University Medical Center

Wishard Memorial Hospital

National Demonstration Project Participants


New Program to be Launched This SummerAccelerating an Interconnected, Electronic Health Information

Infrastructure: National and Regional Implementation and Demonstration Projects

$6 million committed (approximately $4 million government funding, approximately $2 million in-kind support from private sector and government)

Aligning various stakeholders, including practicing clinicians, hospitals, health plans, public health, health care IT suppliers, government agencies and patients around the need for and the actions related to an interconnected, electronic health information infrastructure


New Demonstration and Implementation Program

Provide funding and support to national, regional and local projects which demonstrated interconnected, electronic health information exchange, to accelerate and support goals related to the health care information needs of providers, patients, payers and public health.

Demonstrate and communicate the value of an electronic, standards-based model of data interchange to practicing clinicians, hospitals, payers, and government agencies

Demonstrate and communicate the technical feasibility and replicability of an electronic, standards-based model of data interchange


New Demonstration and Implementation Program

Provide a forum for national experts and implementers to share barriers, strategies and potential solutions related to creating an electronic, standards-based model of data interchange

Build national awareness amongst policy-makers, health care industry leaders, and other drivers of change, regarding the feasibility and value of electronic data interchange for multiple stakeholders and the policy changes and other barriers that need to be addressed to realize this vision.


Connecting for Health

eHealth Initiative’s Public-Private Sector Collaboration for Public Health was a launching pad

Over 100 executives from hospitals, medical societies, health plans, health care IT suppliers, manufacturers, and federal agencies have come together to take actions to drive an interoperable, electronic health care system – large overlap with eHealth Initiative leadership and membership…


Connecting for Health Goals

Catalyze actions on a national basis to create an interconnected, electronic health information infrastructure to improve health and health care:

Accelerate the adoption clinical data standards to facilitate interoperability

Identify practical strategies and solutions for the secure and private transmission of medical information

Actively working to understand what consumers will need and expect from an interconnected, electronic health information infrastructure


Relevant Connecting for Health OutcomesConsensus on a set of standards and definitions that are necessary to enable movement of data and knowledge within health care

Consensus on those standards that are “adoption-ready” (government later moved to adopt internally those same standards)

Overview of the “value proposition” for standards and an interoperable health care system

High-level migration strategy for getting to an interoperable health care system


Connecting for Health Outcomes

Launch of national demonstration project to demonstrate feasibility and value of an electronic, standards-based model of data interchange to support health and health care

Identification and communication of examples of privacy and security-related “exemplary practices” to support organizations across the health care system

A “call to action” from the Connecting for Health Steering Group regarding key steps related to moving towards an interoperable health care system


Connecting for Health Outcomes- Privacy and Security

The adoption of electronic health record can enable greater security and privacy than is possible for a paper record

Making privacy and security an upfront and integral part of adopting new IT has potential to decrease costs and increase likelihood of successful implementation

Organizations adopting new healthcare IT can achieve high levels of security and privacy

Coordination and commitment among internal and external stakeholders and agreement on common policies is critical


Public-Private Sector Collaboration for Public Health

Engaged CDC, public health agencies, providers and vendors to develop strategies to transmit standardized, electronic data for public health purposes

Data includes lab results, microbiology results, orders, and chief complaint data.

Goal was to lay the foundation for an interconnected, electronic health information infrastructure…pull strategy based on a key national need….

Implementation guides were released last month


Barriers to Information Infrastructure?

Lack of standards…interoperable healthcare information systems

Lack of funding

Lack of penetration of clinical information systems in provider environment…particularly small physician practices

Lack of coordination across public and private sectors…across various levels of government


What Have We Learned from Data Sharing Projects?

Data exchanges are few and far between

Technology is no longer the primary barrier

Key barriers include:

Bringing diverse stakeholders together towards a common goal

Issues around proprietary nature of data

Carefully addressing the need to protect privacy and security –policies, governance models, etc.

Building a sustainable model for ongoing funding, resources and commitment (alignment of incentives)


What Have We Learned from Data Sharing Projects?

Organizational leadership and commitment most important factor

Neutral, non-profit, trusted convener model worked best

Use of open, common standards critical


How Are These Barriers Being Addressed?

Legislation

Administration Actions

Private Sector Actions

Public-Private Sector Partnerships


Legislation

Patient Safety Improvement Act (H.R. 663) – passed House in March 2003 - directs HHS Secretary to develop or adopt voluntary, national standards for the interoperability of health care IT systems within 18 months after enactment

Patient Safety Improvement Act (S. 720) – introduced in March 2003


President Bush Now Demonstrating Support

Remarks at March 4th AMA Meeting:

“Patient safety also improves when doctors can have access to health records without delay. When a patient has a medical emergency far from home, the attending physician should have quick access to that person’s medical records. Yet the health care industry, while progressing in many areas, has lagged in information technology.

Right now, as you all know better than most, health care records are kept in different formats—believe it or not, a lot of times on paper. In files. That can get lost. In the budget for next year I propose an increase of 53% for funding to help hospitals use information technology to keep better records, to share that information with doctors so that we can continue to improve patient safety.”


Secretary Thompson’s Support

Town Hall Meeting – Friday, March 21

“Information technology is going to be the key driver of change for the 21st Century”

Endorsed first set of clinical data standards

Announced intent to focus on economic incentives for IT in health care

Emphasized importance of use of IT for public health and bioterror-related surveillance – ePocrates Pilot


Consolidated Health Informatics Standards

Standards for electronic exchange of clinical information to be adopted across Federal Government

HL7 Messaging Standards

NCPDP Script – Pharmacy Data - already covered by HIPAA

IEEE 1073 – Medical Devices

DICOM – Images

LOINC – Lab Results

More to Come…Aggressive Time Schedule


Centers for Medicare and Medicaid Services

Commitment to adoption of clinical data standards

Commitment to launching of demonstration projects to evaluate reimbursement alternatives

Commitment to supporting rapid acceleration of adoption of electronic health records in ambulatory environment

Participation in Connecting for Health/Foundation for eHealth Initiative’s Healthcare Collaborative Network


Food and Drug Administration

Through “21st Century Patient Safety Programs”, piloting the supplementing of the traditional approach to adverse event monitoring with new, automatic reporting and electronically-based risk communication with health care providers – e.g. electronic reporting of ADE information

Participation in Connecting for Health/Foundation for eHealth Initiative’s Healthcare Collaborative Network


Other Administration-Related Activities

Consolidated Health Informatics Initiative Playing a Critical Role

National Committee on Vital and Health Statistics Playing a Critical Leadership Role

AHRQ has $50 million in President’s FY 04 budget to work on patient safety-related demonstration projects

HHS has new position- Senior Advisor of the NHII, and President’s FY 04 budget has funds allocated to this position


Significant Private Sector Momentum

AHIMA

AMIA

CHIME

Connecting for Health

eHealth Initiative

HIMSS

HL7

NAHIT

WEDI


Summary

Public health--and healthcare in general--is in crisis

Information technology will play a critical role in helping us address our health care challenges

The key is to move towards leveraging those information systems and mobilizing data across institutions to meet a range of stakeholder needs, including those related to national security and public health

Change is needed….momentum is building but there is still a lot more work to do…

Leveraging Existing Healthcare IT to Support Public Health ...Progress Has Been Made YCDC’s Public...

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