Office of the National Coordinator for Office of the National Coordinator for Health Information Technology – Health Information Technology – Overview of Initiatives Overview of Initiatives

February 10, 2006February 10, 2006

Jodi G. Daniel, JD, MPHJodi G. Daniel, JD, MPHDirector, Office of Policy and ResearchDirector, Office of Policy and Research

"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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Office of the National Coordinator (ONC)

• Established in response to Executive Order 13335, April 27, 2004

• Responsible for realizing the President’s vision of Healthcare 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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Current Health Care System

• In 2000, the Institute of Medicine estimated that between 44,000 and 98,000 Americans die each year from preventable medical errors.1

• Subsequent studies have estimated that the number may be twice as high.2

• Medical errors are killing more people per year, in the U.S., than breast cancer, AIDS, or motor vehicle accidents.3

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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Current Health Care System

• The lack of immediate access to patient healthcare information is the source of one-fifth of these errors.1

• 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 systems.2

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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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 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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• HHS awarded a contract valued at $3.3 million 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.

Standards Harmonization Process

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• HHS awarded a contract valued at $2.7 million 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 will be required to submit recommendations for ambulatory EHR certification criteria in December 2005, and to develop an evaluation process for ambulatory health records in January 2006.

• Criteria will include the capabilities of EHRs to protect health information, standards by which EHRs can share health information and clinical features that improve patient outcomes.

Compliance Certification Process

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• Contracts have been awarded by HHS totaling $18.6 million to four consortia of health care and health information technology organizations to develop prototypes for the Nationwide Health Information Network (NHIN) architecture.

• The contracts were awarded to: Accenture, Computer Sciences Corporation, IBM, and Northrop Grumman, along with their affiliated partners and health care market areas.

• The four consortia will move the nation toward the President’s goal of personal electronic health records by creating a uniform architecture for health care information that can follow consumers throughout their lives.

Nationwide Health Information Network (NHIN)

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Privacy and Security Solutions

• HHS awarded a contract to RTI International, a private, non-profit corporation, to lead the Health Information Security and Privacy Collaboration (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; $11.5 million

• 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 Security and Privacy Collaboration (HISPC)

• HISPC will be an organization that supports collaboration within and among states in order to foster participation of stakeholders

• RTI and the National Governors Association will support HISPC, which will have members from: state governments, the Federal government, and leaders from key non-governmental organizations

• The purpose will be to maximize knowledge exchange, and identify common solutions

• HISPC will seek consensus-based solutions and implementation plans through a public, community-based model

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Standards Harmonization

ComplianceCertification

NHIN

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Health Information Technology Deployment Coordination

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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

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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 information technology (IT)

• 2004: Awarded $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)

• 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

• Health Resources and Services Administration (HRSA)

– Healthy Communities Access Program (HCAP)– Office for the Advancement of Telehealth grants (OAT)

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Connect with federal efforts…

• HISPC – Privacy and Security Solutions

• American Health Information Community

What can states do?

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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