# Presentation: 534975

## Developing National Health Information Infrastructure (NHII) in the U.S.

**William A. Yasnoff, MD, PhD, FACMI**
**Senior Advisor**
**National Health Information Infrastructure**
**Department of Health and Human Services**

**MEDINFO 2004**
**September 8, 2004**

## Overview

**Organization of U.S. health care “system”**
**History of NHII**
**What is NHII?**
**NHII Challenges**
**Accelerating NHII**
**Presidential Attention**

## I. Organization of U.S. Health Care “System”

**Employer-based coverage**
**Limited consumer choice of plans**
**Diversity of pricing/covered services**
**Multiple competing systems**
**Hospitals**
**Health plans**
**Government is major payer (~50%)**
**Medicare**
**Medicaid (shared with states)**
**Minimal centralized control**

## II. History of NHII: Reports

| IOM
 | 19911997 | Computer-Based Patient Record |
| --- | --- | --- |
| IOM
 | 2000 | To Err is Human |
| NRC/
CSTB | 2001 | Networking Health: Prescriptions for the Internet |
| IOM | 2001 | Crossing the Quality Chasm
 |
| PITAC | 2001 | Transforming Health Care Through Information Technology |
| NCVHS | 2001 |  NHII
 |

## III. What is NHII?

**Comprehensive knowledge-based network of interoperable systems**
**Capable of providing information for sound decisions about health when and where needed**
**“****Anywhere, anytime health care information and decision support”**
**NOT a central database of medical records**

## What is NHII? (continued)

**Includes technologies, practices, relationships, laws, standards, and applications, e.g.**
**Communication networks**
**Message & content standards**
**Computer applications**
**Confidentiality protections**
**Individual provider Electronic Health Record (EHR) systems are only the building blocks, not NHII**

## NHII Requirements: Functions

**Overall: “Anytime, anywhere health care information and decision support”**
**Immediate availability of complete medical record (compiled from all sources) to any point-of-care**
**Enable up-to-date decision support at any point of care**
**Enable selective reporting (e.g. for public health)**
**Enable use of tools to facilitate delivery of care (e.g. e-prescribing)**
**Allow patients to control access to their information**

## NHII Requirements: Implementation Strategy

**No national database or identifier**
**Alignment of incentives**
**Allow each care facility to maintain its own data**
**Minimize cost & risk **
**Use proven implementation strategies (where possible), e.g. incremental approach**
**Each implementation step benefits all participants**
**Implementation scope coincides with benefits scope**

## IV. NHII Challenges

**Health care information is very complex ******** IT systems more expensive and difficult to build**
**Health care is highly fragmented**
**Organizational and change management issues from IT systems are difficult to manage in clinical environment**
**Physicians are independent contractors**
**Reimbursement does not provide ROI for IT**
**Difficult to generate capital needed for IT investment**
**IT is regarded as an add-on cost, not an investment for competitive advantage**

## V. Accelerating NHII progress

**Inform**
**Disseminate NHII vision**
**Catalog NHII activities**
**Disseminate “lessons learned”**
**Collaborate with Stakeholders**
**Convene**
**NHII 03: 6/30-7/2/2003 **
**Develop a consensus agenda**
**NHII 04: 7/21-23/2004 in D.C.**
**Release strategic framework**
**More stakeholder feedback**

## NHII 03Final Recommendations

_**Management**_
**Governance**
**Education**
**Shared Resources**
**Metrics**
_**Enablers**_
**Financial Incentives***
**Standards***
**Legal Issues**

_**Implementation Strategy**_
**Demonstration Projects**
**Architecture***
**Identifiers**
_**Targeted Domains**_
**Consumer Health***
**Research***

***original breakout track**

**Views expressed do not necessarily**
** ****represent U.S. Government policy**

## V. Accelerating NHII progress (2)

**Standardize**
**HL7, DICOM, IEEE 1073, NCPDP SCRIPT**
**SNOMED, LOINC**
**HL7 projects: EHR functions, EHR interchange format**
**Demonstrate**
**$50 million in FY 04 budget for NHII demonstration projects (AHRQ)**
**President has requested additional $50 million for FY 05**
**Evaluate**
**Rigorous assessment of NHII benefits**
**Policy options for aligning financial incentives**

## Slide 13

## Slide 14

## Advantages of Local Approach

**Existing HII systems are local**
**Health care is local ******** benefits are local**
**Facilitates high level of trust needed**
**Easier to align local incentives **
**Local scope increases probability of success**
**Specific local needs can be addressed**
**Can develop a repeatable implementation process**
**Parallel implementation ******** more rapid progress**
**Use of standards allows connectivity between local info exchanges ******** NHII**

## VI. Presidential Attention

- “**Our 21****st**** century health care**
**system uses a 19****th**** century**
**paperwork system”**

**-- President George W. Bush**
**April 27, 2004**

## President’s Executive Order               April 27, 2004

**Creates position of National Health IT Coordinator in HHS**
**David Brailer MD, PhD**
**Reports to HHS Secretary**
**New Office in HHS (ONCHIT)**
**Responsible for**
**Coordinating all Federal and private sector efforts toward NHII**
**Developing and monitoring strategic plan**

## Strategic Framework (7/21/2004)

**EHR Adoption & Use**
**Incentives**
**Interconnecting Clinicians**
**RHIOs**
**Personalize Care**
**Develop personal health records**
**Improve Population Health**
**Use electronic health information for public health & research**

## Questions?

**William A. Yasnoff, MD, PhD**
**william.yasnoff@hhs.gov**
**202/690-7862**

- _For more information about NHII_
- _[http://aspe.hhs.gov/sp/](http://aspe.hhs.gov/sp/nhii)__[nhii](http://aspe.hhs.gov/sp/nhii)_
_**For more information about **__**ONCHIT**_
- _[http://www.hhs.gov/onchit/index.html](http://www.hhs.gov/onchit/index.html)_**	**