national health information infrastructure - ncvhs home page
TRANSCRIPT
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The National Health Infor m ation 1
NATIONAL HEALTH INFORMATION INFRASTRUCTURE
NATIONAL HEALTH INFORMATION INFRASTRUCTURE
! John R. Lumpkin, MD, MPH! Jeffey S. Blair, MBA!Daniel Friedman, Ph.D.!Richard K. Harding, MD!Clement J. McDonald, MD!Barbara Starfield, MD, MPH!Kepa Zubeldia, MD
! Mary Jo Deering, Ph.D.!Mike Carleton!Betsy D’Jamoos!Theresa Krol!Dena Puskin, Sc.D.!Steve Steindel, Ph.D.
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The National Health Infor m ation 2
The Challenge that we faceThe Challenge that we face! “THE MANAGED-CARE-BASED HEALTH SYSTEM IS
FAILING. MEDICAL INFLATION IS BACK. CONSUMER DISTRUST, PROVIDER HOSTILITY, COSTLY NEW TECHNOLOGIES AND POLITICAL OPPORTUNISM WILL NO LONGER ALLOW COSTS AND QUALITY TO BE CONTROLLED BY MOST EXISTING MANAGED CARE ARRANGEMENTS”
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The National Health Infor m ation 3
The Challenge that we faceThe Challenge that we face!“OVERALL, QUALITY HAS NOT BEEN
DELETERIOUSLY AFFECTED BY MANAGED CARE, BUT MANAGED CARE HAS NOT SUBSTANTIALLY REDUCED UNSAFE PRACTICES, OVERUSE, UNDERUSE AND MISUSE OF HEALTH CARE” - PAUL ELLWOOD
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The National Health Infor m ation 4
HEALTHHEALTH!WHO
!HEALTH IS A STATE OF COMPLETE PHYSICAL, MENTAL AND SOCIAL WELL-BEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY
!HEALTH IS A STATE OF WELL-BEING AND THE CAPABILITY TO FUNCTION IN THE FACE OF CHANGING CIRCUMSTANCES
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The National Health Infor m ation 5
HEALTHHEALTH!SHARED RESPONSIBILITY
!HEALTH CARE!PUBLIC HEALTH!OTHER
!-IOM 1997 IMPROVING HEALTH IN THE COMMUNITY-A ROLE FOR PERFORMANCE MONITORING
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The National Health Infor m ation 6
HIPPOCRATESHIPPOCRATES!NOTED THAT IF YOU WANTED TO KNOW ABOUT
THE HEALTH OF A PEOPLES NOTE!THE WINDS AND THE CHARACTER OF THE AIR!THE WATER AND THAT THEY DRINK!THE LAY OF THE LAND!THE HABITS OF THE PEOPLE
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The National Health Infor m ation 7
Social EnvironmentIndividual
ResponseBehaviorBiology
PhysicalEnvironment
Genetic Endowment
Health &Function Disease Health
Care
Well-being Prosperity
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The National Health Infor m ation 8
PERCIVAL POTTS, MDPERCIVAL POTTS, MD!IDENTIFIED LINK BETWEEN !OCCUPATION AND CANCER!RECOMMENDATIONS FOLLOWED?
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The National Health Infor m ation 9
SNOW ON CHOLERASNOW ON CHOLERA!DATABASE ANALYSIS!GIS SYSTEM
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The National Health Infor m ation 10
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The National Health Infor m ation 11
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The National Health Infor m ation 12
The Business of HealthThe Business of Health!Helping people stay healthy!Helping people get better when they are ill!Helping people live with illness when their illness
is chronic!Helping people manage a changing lifestyle when
their illness impairs their functioning!based upon work by the Foundation for Accountability
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The National Health Infor m ation 13
Vision of the NHIIVision of the NHII
! The set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health.
! NOT a centralized database.! Connects distributed health information in the
framework of a secure network with strict confidentiality protections.
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The National Health Infor m ation 14
NHIINHII!DATA MODEL!DATA STANDARDS!CONNECTIVITY STANDARDS
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The National Health Infor m ation 15
Australian Data ModelAustralian Data Model
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AMERICAN APPROACHAMERICAN APPROACH!RESPECT INDIVIDUAL PRIVACY!ASSURE CONFIDENTIALITY!ENGINEERED FOR SECURITY
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NHIINHII!DATA STANDARDS
!HIPAA!X12!HL7!NCPDP!NPI!OTHER STANDARDS
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NHIINHII!EDI!INTERNET!INTRANET!OTHER CONNECTIVITY STANDARDS
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The National Health Infor m ation 19
NHIINHII
!STANDARDS ARE NOT ENOUGH
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The National Health Infor m ation 20
NHIINHII!THE GOAL IS TO PUSH KNOWLEDGE TO THE
POINT OF SERVICE (CONTACT)!EXPERT SYSTEMS!DECISION SUPPORT!PRACTICE GUIDELINES
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NHIINHII
Universe of Health Data
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NHIINHII
Universe of Health Data
PROVIDER DATA
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NHIINHII
Universe of Health Data
ADMINISTRATIVE DATA
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NHIINHII
Universe of Health Data
PERSONAL DATA
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NHIINHII
Universe of Health Data
COMMUNITYBASED DATA
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NHIINHII
Universe of Health Data
QUALITY DATA
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NHIINHII
COMMUNITY
CAREGIVERPERSONAL
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Personal Health DimensionPersonal Health Dimension! Supports the management of individual wellness
and health care decision-making! Includes a personal health record, created and
controlled by the individual or family! Includes non-clinical information such as self-
care trackers, health materials, local public health and health care services
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The National Health Infor m ation 29
Personal Health DimensionPersonal Health Dimension! Personal health record component could be
stored in a variety of repositories--smart card, home computer, third party information guardian service, health plan/provider server, etceteras
! Individual authorizes access to specific categories of information in their PHD by specific people, organizations, or categories of users
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PHD Core DataPHD Core Data!Patient identification information!Lifetime health history!Treatment plans and instructions!Health risk factor profile!Self-care trackers!Personal library of quality health information
resources!Healthcare proxies and living wills
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!The vision of the Caregiver Dimension was generally described in the Institute of Medicine’s study entitled “Computer-Based Patient Record: An Essential Technology for Health Care”.
!Information systems will assist the caregiver by reviewing the data within the encounter record and providing appropriate warnings, alerts and reminders.
Health Care Provider DimensionHealth Care Provider Dimension
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Health Care Provider DimensionHealth Care Provider Dimension! Encompasses information to enhance the quality
and efficiency of health services for individual! Includes information captured during patient
care process! Integrates clinical guidelines and protocols,
specific information from PHD, as authorized, and from Community Health Dimension
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Health Care Provider DimensionHealth Care Provider Dimension! Primary record of care is under the control of the
provider who captures original information! May be stored on site or on server of a third-
party health information guardian! Confidentiality protections include technologies
for authorization, authentication, encryption and electronic signatures; restricted access by class, role, or location of user
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Community Health DimensionCommunity Health Dimension! Supports the identification of health threats,
assessment of population health status, focussing programs and services, research and evaluation
!Encompasses population-based health data and resources, statutorily authorized data in public health systems and the Health Care Provider Dimension, and other anonymous data
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Community Health DimensionCommunity Health Dimension! No single database of public health information! Improved vertical and horizontal integration of
federal, state, and local systems through electronic data exchange standards
! Data aggregated by geographic area, demographic element, health event, etceteras
! Access defined along a continuum with strict protocols and monitoring
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The National Health Infor m ation 36
CHD Core DataCHD Core Data1 Health of community members
!health status, behaviors and outcomes!social, economic, and demographic characteristics
2 Health care of community members3 Community attributes affecting health4 Community health resources5 Community health
!receipt of preventive care!disease rates!morbidity burden rates
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CHD Access ContinuumCHD Access ContinuumIndividually identifiable
data by authorized public health workers
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CHD Access ContinuumCHD Access Continuum
Deidentified data for population health research, with IRB approval
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CHD Access ContinuumCHD Access Continuum
Public access to anonymized and aggregated data
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The National Health Infor m ation 40
Privacy, Confidentiality, and SecurityPrivacy, Confidentiality, and Security
Legal and policy framework to maximize confidentiality, security and appropriate use
Issues requiring resolution! Anonymized linkage variable! Access continuum! Decision rules
!cell size suppression!IRB approval of research uses and linkages
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RequirementsRequirements! “It’s not just the technology”! Privacy protections! Standards ! Business models! Attitudes and practices! Equity
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The National Health Infor m ation 42
NHII next stepsNHII next steps!Validation of the vision!Identification of the barriers
!Privacy Protection!Standards!Technology
!Development of recommendations!Commitment to implementation