Beyond the EMR – Exchanging Beyond the EMR – Exchanging Health Information Outside of Your Health Information Outside of Your OrganizationOrganization

John W. Loonsk, MD, FACMIJohn W. Loonsk, MD, FACMI

Office of the National CoordinatorOffice of the National Coordinatorfor Health Information Technologyfor Health Information Technology

Some Critical Health Needs

• Avoidance of medical errors– Up to 98,000 avoidable annual deaths due to medical errors

• Improvement of resource utilization– Up to $300B spent annually on treatments with no health yield

• Acceleration of knowledge diffusion– 17 years for evidence to be integrated into practice

• Reduction of variability in healthcare delivery and access– Access to specialty care highly dependent on geography

• Empowerment of the consumer– Capitalize on growing consumer trend of active health management

• Strengthening of data privacy and protection– HIPAA becomes reality

• Promotion of public health and preparedness– Surveillance is fragmented, and importance to homeland security brings heightened

awareness

State and Local Public Health Departments Centers For

Disease Control and Prevention

(CDC)

State/Local Response

Team

Other Federal Response

Team

Contractor Response

Team

FBI

Contaminated Bldg.

Regular Lab (non-

LRN)

02.10

Person

010

02N0

0 3 0

04N0

04.110

04P0 04.120

04.1r0

05006N006P0

06.10

04.130

04.20

06.110

06.120

06.20

06.130

0 0 – specimen 0

02P0

Other Federal

Agencies

070

080

01000110

0120

0130

0100

0160

016001700170

0150

0150

0150

0140

0140

Affected Community

LRN Labs (may be separate or

combined A/B/C)

0200

0180

0190

Local Responders (police, fire,

etc.)0220

0230

Clinical Site

Hospital Clinic

0240 0250

0260

0270

0270

CDC Response Team

0300

0320

0330

04.30

02.20

04.40

04.1q0

0350

080

080

080090

0370

0390

02800360

04.50

0400

0410

0430

0440

0450

0380

0380

0420

Treatment/Intervention Center

0210

0460

0470

0480

0490

0500

0510

0140

0150 0310

02900140

080

Information Exchange Needs During Anthrax Attacks

25

20

15

10

5

0

4.4%

20.8%

Size of Practice

Physicians*

Per

cent

age

11 or more in practice

1 or 2 in practice

Current State EHR Adoption: US Physicians (2005)

25

20

15

10

5

0

25%

10%

Level of Function

Physicians*

Per

cent

age

Using some functions

With (1) electronic note keeping,(2) lab order, (3) med orders, & (4) ability to obtain lab results

*3 times more prevalent in metropolitan areas

The National Health IT Agenda

Priorities• American Health Information

Community• Business needs and priorities• Use Cases

Priorities• American Health Information

Community• Business needs and priorities• Use Cases

Standards• Healthcare Information

Technology Standards Panel

• Recognized standards

Standards• Healthcare Information

Technology Standards Panel

• Recognized standards

Networking• NHIN - network of

networks• Architecture

specifications

Networking• NHIN - network of

networks• Architecture

specifications

Policies• State laws and regulations –

State Alliance• Health Information Security and

Policy Collaboration

Policies• State laws and regulations –

State Alliance• Health Information Security and

Policy Collaboration

Certification• Certification Commission For

Healthcare Information Technology• Criteria development• Testing

Certification• Certification Commission For

Healthcare Information Technology• Criteria development• Testing

Business Deployment• Sustainable business models• Software• State / regional partnerships• Evaluation

Business Deployment• Sustainable business models• Software• State / regional partnerships• Evaluation

Agenda

AHIC Priorities and Use Case Roadmap

2006 2007 Use Cases

Consumer Empowerment

Use Case

· Registration· Medication

History

AHIC Priorities and Use Case Roadmap

Consumer Access to Clinical

Information

· Access to Clinical Data

· Provider Permissions

· PHR Transfer

Medication Management

· Medication Reconciliation

· Ambulatory Prescriptions

· Contra-indications

EHR Use Case

· Laboratory Result Reporting

Emergency Responder

EHR

· On-Site Care· Emergency Care· Definitive Care· Provider

Authentication and Authorization

Patient – Provider Secure

Messaging

· Structured email

· Reminders

· Referrals· Problem Lists· Transfer of Care

Personalized Healthcare

· Laboratory Genetic / Genomic Data

· Family Medical History

2008 Use Cases

Quality

· Hospital Measurement and Reporting

· Clinician Measurement and Reporting

· Feedback to Clinicians

BiosurveillanceUse Case

· Visit· Utilization· Clinical Data· Lab and

Radiology

Public HealthCase Reporting

· Case Reporting· Bidirectional

Communication· Labs· Adverse Events

Immunizations & Response

Management

· Resource Identification

· Vaccine· EHR Data

RemoteMonitoring

· Remote Monitoring of Vital Signs and Labs (Glucose)

2009 Use Case Work

Medical Home:Co-Morbidity

Maternal and Child Health:Pediatric-focused

Prior Auth & Sched for TPO:Prior Authorization

Long Term Care Assessments

Consumer AE Reporting

Consultations and Transfers of

Care

General Laboratory Orders

Medication Gaps

Common Device Connectivity

Order Sets

Consumer Preferences

Common Data Transport

Clinical Encounter Note Details

Newborn Screening

Medical Home:Registries

Maternal and Child Health:Adult-focused

Prior Auth & Sched for TPO:Scheduling

Standards in the National HIT Agenda

American Health

Information Community

Priorities(AHIC)

Healthcare Information Technology Standards

Panel(HITSP)

Nationwide Health Information Network (NHIN)

Certification Commission for Healthcare Information

Technology (CCHIT)

Stark and Anti-kickbackUse

Cases

Interoperability

Specifications Federal Systems and Healthcare Contracts

(Executive Order 13410)

Secretary and recognition• January, 2008 - 52 standards• January 2009 - 60 standards

The Nationwide Health Information Network

Labs

Pharmacies

Community Health Centers

State and Local Gov

HealthBank

CDCGeo HIE

RHIO

DoD

SSA

CMS

VA

PCHR SupportOrganization

Common “dial tone” and “chain of trust”

PHRHIE

FedHIE

HIE

IDSHIE

FDA

1. Provider has a patient but not their record

2. Updating health data where it is needed

3. Patient wants / doesn’t want information to be electronically released

4. Providing the best care and protecting the population

Common Network “Dial Tone”

Functions and specifications:

1. Patient look-up and information retrieval

2. Information routing and delivery

3. The exchange of consumer preferences

4. Support for population data uses

Enabling Information Exchange

Trust Issues– Tacit “ownership”– HIPAA and other legal angst– Propriety business needs– Patient confidentiality issues

Enablers– Value of exchanging data– Patient choice x 2– Support trusted users– High level access controls– Minimize identifying information

The Nationwide Health Information Network

Labs

Pharmacies

Community Health Centers

State and Local Gov

HealthBank

CDCGeo HIE

RHIO

DoD

SSA

CMS

VA

PCHR SupportOrganization

Common “dial tone” and “chain of trust”

PHRHIE

FedHIE

HIE

IDSHIE

FDA