leveraging existing healthcare it to support public health ...progress has been made ycdc’s public...
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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
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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.
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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.
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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
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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
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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”
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Homeland Security and Public Health Challenges
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
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Homeland Security and Public Health Challenges
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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
e
Manag
emen
t
Targeted drugs
& treatments
Clinical
trials data
Claims
data
Providers
Fast
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eim
burs
emen
t
Out
com
esda
ta
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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
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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
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Our Strategy is to Grow the Health Information Ecosystem
Bio-threat Alerts
Practice Guidelines
Open Standards
Government Agencies – CDC, CMS, FDA, etc.Payers
Providers
Impr
ove
Car
e
Out
com
esda
ta
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Our Strategy is to Grow the Health Information Ecosystem
Clinical data
Treatment options
Physicians & Patients
Bio-threat Alerts
Practice Guidelines
Open Standards
Government Agencies – CDC, CMS, FDA, etc.Payers
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
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National Demonstration Project - Participants
Hospitals
Health Care IT Suppliers
Practicing Physician Groups
Public Health Agencies
Payers
Regulators
Researchers
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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
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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
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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
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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.
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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…
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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
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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
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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
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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
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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
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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
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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)
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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
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How Are These Barriers Being Addressed?
Legislation
Administration Actions
Private Sector Actions
Public-Private Sector Partnerships
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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
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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.”
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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
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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
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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
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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
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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
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Significant Private Sector Momentum
AHIMA
AMIA
CHIME
Connecting for Health
eHealth Initiative
HIMSS
HL7
NAHIT
WEDI
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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…