Strategic Directions in Health IT at the National Level

Strategic Directions in Health IT at the National Level

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Author: Kelly Cronin (Fellow) | Visits: 1923 | Page Views: 1925
Domain:  Medicine Category: Practice Mngmnt Subcategory: Digital Health 
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Office of the National Coordinator for Health Information Technology
Kelly Cronin Director, Office of Programs and Coordination

Visit our website at:

� ONC overview � ONC Major Initiatives � Opportunities for Clinical Research


Office of the National Coordinator (ONC) � Established in response to Executive Order 13335, April 27, 2004 � Responsible for realizing the President's vision of consumer centered, information rich healthcare:
� 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

Office of the National Coordinator (ONC) � Strategic Framework for Action in 2004 � set initial goals, objectives and strategies for achieving widespread adoption of interoperable HIT
� � � � Inform Clinicians Interconnect Clinical Care Personalize Health Care Improve Population Health � Streamline clinical research

� First phase of implementation of the Strategic Framework has been focused on interoperability


Office of the National Coordinator for Health IT: Where We Are Today � This has been a year of listening and doing...
� � � � � � Consulted with federal agencies Met with organizations, vendors, and individuals Reached out to states and regions through site visits and town hall meetings Met with HIT delegations from countries like Great Britain, Canada, Netherlands, Australia, and France Structuring the Office of the National Coordinator to best serve the needs of the public And, awarded important contracts to establish the foundation for widespread adoption of interoperable HIT


Office of the National Coordinator Structure

Operations Operations

Immediate Office of the Immediate Office of the National Coordinator National Coordinator

David Brailer David Brailer

Office of Office of Health Information Health Information Technology Adoption Technology Adoption

Office of Office of Interoperability Interoperability and Standards and Standards

Office of Programs Office of Programs and Coordination and Coordination

Office of Policy Office of Policy and Research and Research


ONC Major Initiatives
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:

American Health Information Community Standards Harmonization Process Compliance Certification Process Privacy and Security Solutions Nationwide Health Information Network Prototypes

Health Information Technology and Health Care Anti-Fraud Health IT Adoption Initiative Proposed Changes to Self-Referral and Anti-Kickback Rules


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.


Nationwide Health Information Network
� Based on public input, the NHIN should:
� Be a nation-wide utility that allows secure and seamless health information exchange � Be a decentralized architecture built using the Internet, linked by uniform communications and a software framework of open standards and policies. � Reflect the interests of all stakeholders and be a joint public/private effort � Be governed by public and private stakeholders who could oversee the determination of standards and policies � Provide sufficient safeguards to protect the privacy of personal health information � Be enabled by existing technologies, federal leadership, prototype localized or regional exchange efforts, and certification of EHRs

Nationwide Health Information Network - Prototypes and Timing
� NHIN Prototypes under development
� � � � � 3 Use cases validated by AHIC Operational Plan due in August Revenue and cost models due October Complete technical design and Architecture due in November Demonstrated health information exchange within and across 12 markets by December 31st

Expanded development and scalable, production quality demonstrations in 2007 Certification of NHIN by CCHIT in 2008


Proposed Changes to Self-Referral and Anti-Kickback Rules
� HHS is finalizing two regulations that would ease selfreferral and anti-kickback restrictions, which many providers say impede adoption of health IT The two proposed rules would change how CMS and the Office of the Inspector General enforce the Stark and Anti-kickback laws, which prohibits hospitals from giving physicians access to hardware, software or related training


Certification of EHRs
� 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. CCHIT has completed ambulatory EHR certification criteria and an evaluation process for ambulatory health records
� � First round of certified ambulatory EHRs will be in July Criteria include the capabilities of EHRs to protect health information, standards by which EHRs can share health information and clinical features that improve patient outcomes. What's next?....Inpatient EHRs, NHIN, and PHRs?

Privacy and Security Solutions
� Health Information Security and Privacy Collaboration (HISPC) will assess and develop plans to address variations in organization-level business policies and state laws that affect privacy and security practices that may pose challenges to interoperable electronic health information exchange while maintaining privacy protections. Contracts awarded to 34 States in May Our end point: 2007... detailed set of consensus recommendations including solutions to variation

� �


The American Health Information Community (the Community)
� � Federal Advisory Committee appointed and chaired by Secretary Mike Leavitt Nine public sector and eight private sector appointees
� � � � � � � � � � � � � � � � Scott P. Serota, President and CEO, Blue Cross Blue Shield Association Douglas E. Henley, M.D., Executive Vice President, American Academy of Family Physicians Lillee Smith Gelinas, R.N., Chief Nursing Officer, VHA Inc. Charles N. Kahn III, President, Federation of American Hospitals Nancy Davenport-Ennis, CEO, National Patient Advocate Foundation Steven S Reinemund, CEO and Chairman, PepsiCo Kevin D. Hutchinson, CEO, SureScripts Craig R. Barrett, Ph.D., Chairman, Intel Corporation E. Mitchell Roob, Secretary, Indiana Family and Social Services Administration Mark B. McClellan, M.D., Administrator, Centers for Medicare and Medicaid Services Julie Louise Gerberding, M.D., Director, Centers for Disease Control and Prevention Jonathan B. Perlin, M.D., Under Secretary for Health, Department of Veterans Affairs William Winkenwerder Jr., M.D., Assistant Secretary of Defense, Department of Defense Mark J. Warshawsky, Ph.D., Assistant Secretary for Economic Policy, Department of Treasury Linda M. Springer, Director, Office of Personnel Management Michelle O'Neill, Acting Under Secretary for Technology, Department of Commerce


The American Health Information Community (the Community)
� Initial recommendations:
� Prioritized health IT initiatives that will bring significant value to the consumer in 1-3 years � Identify breakthrough opportunities including: � Biosurveillance � Consumer empowerment � Electronic health records � Chronic care monitoring

4 work groups for each breakthrough involving 70 experts and stakeholders
� Work Groups have made recommendations on the major policy, technical and social barriers to the breakthroughs

Community Breakthroughs - Biosurveillance
� Broad Charge for the Workgroup: Make recommendations to the Community to implement real-time nationwide public health event monitoring and support rapid response management across public health and care delivery communities and other authorized government agencies. Specific Charge for the Workgroup: Make recommendations to the Community so that within one year, essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems can be transmitted in standardized and anonymized format to authorized public health agencies within 24 hours.

Community Breakthroughs � Consumer Empowerment
� Broad Charge for the Workgroup: Make recommendations to the Community to gain wide spread adoption of a personal health record that is easy-to-use, portable, longitudinal, affordable, and consumer-centered. Specific Charge for the Workgroup: Make recommendations to the Community so that within one year, a pre-populated, consumer-directed and secure electronic registration summary is available to targeted populations. Make additional recommendations to the Community so that within one year, a widely available prepopulated medication history linked to the registration summary is deployed.


Community Breakthroughs � Electronic Health Records
� Broad Charge for the Workgroup: Make recommendations to the Community on ways to achieve widespread adoption of certified EHRs, minimizing gaps in adoption among providers. Specific Charge for the Workgroup: Make recommendations to the Community so that within one year, standardized, widely available and secure solutions for accessing current and historical laboratory results and interpretations is deployed for clinical care by authorized parties.


Community Breakthroughs � Chronic Care
� Broad Charge for the Workgroup: Make recommendations to the Community to deploy widely available, secure technologies solutions for remote monitoring and assessment of patients and for communication between clinicians about patients. Specific Charge for the Workgroup: Make recommendations to the Community so that within one year, widespread use of secure messaging, as appropriate, is fostered as a means of communication between clinicians and patients about care deliver


Health Information Technology Deployment Coordination
Health Care Industry Breakthroughs


Consumer Empowerment

Chronic Care

Electronic Health Records

Technology Industry

Standards Harmonization


Compliance Certification NHIN

Coordination of Policies, Resources, and Priorities Office of the National Coordinator -Health IT Policy Council -Federal Health Arch. The Community -Workgroups

Privacy / Security

Health IT Adoption

Consumer Value

Industry Transformation

Why are Regional Health Information Organizations (RHIOs) a good first step to interoperability?
� Non-governmental, multi-stakeholder organization providing framework for health information exchange that builds trust among its users RHIOs will cover large geographic areas for financial and technical scalability while meeting the needs of local populations RHIOs bring to the forefront a business model for interoperable health information exchange They are accountable to the users of the RHIOs

� �


Progress with RHIOs
� � 30 States have introduced or passed legislation for Statewide health IT efforts 40 States have one or more community based health IT projects
� AHRQ funding � HRSA funding

� �

Over 60 RHIOs either have some degree of health information exchange among multiple, non affiliated entities or have significant planning infrastructure Most States have formal efforts underway developing one or multiple RHIOs to achieve interoperable EHR adoption BUT....


State level Regional Health Information Organizations (RHIOs)
� � � What can they do to ensure effectiveness in the various health care markets across the nation? How should they best relate to government's health information technology efforts? States can 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, and ensure coordination with State level programs including Medicaid Governors and organizations representing states (NGA, NCSL, etc) have the interest and capacity to lead change at a state level 23

Principles for Regional Health Information Organizations (RHIOs)
� � At least one RHIO in each state For the states that do have more than one RHIO, an overarching state level RHIO should coordinate RHIOs across the state and set a state level framework for health information exchange Each state level RHIO should meet a minimum set of best practices for governance, financing, operations, policies and transparency RHIOs should follow goals and recommendations from the American Health Information Community as recognized by the Secretary


Next Steps in Supporting RHIOs
� Research existing state-level RHIOs to understand their goals, current policies and practices including governance, financing, technology, financing, and policies Develop consensus around a model for state-level RHIOs and RHIO best practices at the state level Disseminate best practices, encourage conformance and coordination among state-level RHIOs, and to encourage participation in ONC/HHS initiatives informed by AHIC Monitor progress and encourage collaborative approaches to developing business models including sound policies on secondary uses of data

� �


Secondary Uses of Data � Barriers and Solutions
� � HIPAA solved some problems but some are concerned about the perception of barriers to the sharing of health data for research In light of efforts to share data expertise and research resources, how do we reconcile the potential challenges and benefits of collaborative data sharing? What potential problems may develop as the use of technology enables widespread data sharing and commercialization? What issues might we confront regarding inappropriate use and/or exploitation of data sharing and how can we address them? What polices and procedures may be needed to address these issues? American Medical Informatics Association writing a white paper to address the issues related to secondary uses of data

� � � �

Opportunities for Clinical Research
� Coordinate standards development and use across industry, government and academia to accelerate EDC in clinical research NIH, FDA, and CDISC coordination with Health IT Standards Panel Public input into functional requirements for NHIN on June 28 and 29th Demonstrations involving the NHIN to ensure requirements are met overtime for clinical research


For More Information Visit...
"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