EHM-520_WEEK (9)منيف.pdf

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 9 Prof. Bakheet Aldosari Presented by Dr. Muneef AlMokhlef 9/29/2022 1 Today Session # WEEK 9 Topic Reading Health Information Exchange MARGRET’S CH 19 Due in Class 2 Learning Objectives • Discuss the impetus for HIE in the U.S. and the elements r...

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 9 Prof. Bakheet Aldosari Presented by Dr. Muneef AlMokhlef 9/29/2022 1 Today Session # WEEK 9 Topic Reading Health Information Exchange MARGRET’S CH 19 Due in Class 2 Learning Objectives • Discuss the impetus for HIE in the U.S. and the elements required to promote such exchange • Define “value-driven health care” and its role in HIE • Describe the role the federal government has played in promoting HIE, and especially the strategic plans of ONC • Describe the status of HIO development, including their goals and governance • Distinguish between the major types of HIE architectures • Identify the basic services an HIE should provide and suggest additional, advanced services that may aid in supporting the business case for HIE Learning Objectives • Define “data stewardship,” distinguish it from record custodian, and describe the importance each plays in an HIE structure • Identify benefits and challenges of HIE and what might be considered hallmarks of HIE success • Describe the vision inherent in the description of the national health information infrastructure • Describe how the vision of the NHII has become the concept of the nationwide health information network (NHIN) • Identify public and private sector activities that are supporting creation of the NHIN and its core services HIE in the U.S. • The Department of Health and Human Services (HHS) Web site on Value-Driven Health Care (2008) states: – “The health care ‘system’ in America is not a system. It’s a disconnected collection of large and small medical businesses, health care professionals, treatment centers, hospitals, and all who provide support for them. Each player may have its own internal structure for gathering and sharing information, but nothing ties those isolated structures into an interoperable national system capable of making information easily shared and compared.” Need for Value-Driven Health Care • Value = quality of outcomes for level of spending • U.S. spends $6,714 per capita on health care, in comparison to Switzerland (next highest) at $4,311 • Yet, – 40 out of 193 countries have lower infant mortality rates than the U.S. – U.S. life expectancy is ranked 35th – There are dramatic variations among regions and racial or ethnic groups in the rates of death from preventable causes – Some improvements in total cholesterol, cigarette smoking, and aerobic activity have been offset by obesity, hypertension, diabetes, and number of individuals reporting fair or poor health Technology for Value-Driven Care • U.S. healthcare remains a cottage industry • Providers view themselves independent of other providers • Technology has contributed to information silos • Providers view health information as their property Consumer Message on Vision for HIT • In April 2004, President Bush revealed his vision for the future of healthcare in the U.S. The president’s plan involves a healthcare system that puts the needs of the patient first, is more efficient, is cost-effective, and is based on the following tenets: – Medical information will follow consumers so that they are at the center of their own care. – Consumers will be able to choose physicians and hospitals based on clinical performance results made available to them. – Clinicians will have a patient’s complete medical history, computerized ordering systems, and electronic reminders. – Quality initiatives will measure performance and drive quality-based competition in the industry. – Public health and bioterrorism surveillance will be seamlessly integrated into care. – Clinical research will be accelerated and post-marketing surveillance will be expanded. • These tenets will make healthcare more consumer-centric, and will improve both the quality and the efficiency of health care in the U.S. Office of the National Coordinator for Health Information Technology (ONC) • April 27, 2004: President Bush called for widespread adoption of interoperable EHRs within ten years • May 6, 2004, David J. Brailer, MD, PhD, appointed first coordinator and released “The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care: A Framework for Strategic Action” • Subsequent coordinators: – Rob Kolodner, MD interim (2006); coordinator 2007-2009 – David Blumenthal, MD 2009 – 2011 – Farzad Mostashari, MD 2011 - present Framework for Strategic Action Goal 1 Inform Clinical Practice • Incentivize EHR adoption • Reduce risk of EHR investment • Promote EHR diffusion in rural & underserved areas Goal 3 Personalize Care • Encourage use of PHR • Enhance informed consumer choice • Promote use of telehealth Strategic Framework Goal 4 Improve Population Health • Unify PH surveillance architectures • Streamline quality & health status monitoring • Accelerate research & dissemination of evidence Goal 2 Interconnect Clinicians • Foster regional collaborations • Develop NHIN • Coordinate federal health information systems Issued July 21, 2004 (www.hhs.gov/healthit/framework.html) Federal Health IT Strategic Plan Source: U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology. 2011. The Federal Health IT Strategic Plan: 2011-2015 HIE Terminology • From the National Alliance for Health Information Technology: • HIE Organizations (HIOs) are also called: – Local health information organizations – Connected communities • Health information service provider is a vendor that provides operational and technical HIE services HIO Status of Development Source: eHealth Initiative Survey, 2010 HIE Goals and Governance • Many different organizations have started HIEs, with many different purposes – Some started as a means to reduce clearinghouse costs – Some started as a means to share patient data in geographically tight location – Some started to provide HIT for physicians and rural hospitals in the region to improve exchange of lab results – Some started to enhance ability to exchange data with public health • Many HIEs received federal and state grants to start up, and are struggling now to be selfsustaining • Some HIEs have been very successful; a few have already closed down; many are expected to reach a turning point in the near future HIE Architectural Models Although the federated inconsistent database model is one many believe offers the best privacy and is most appealing to the public, others believe the federated consistent database model is more cost-effective, just as capable of providing privacy and more capable of providing security HIE Architectural Models, Con’t. HIO Functions HIE Services Directory PID RLS IdM Security Consent Mgt Data Exchange Copyright © Margret\A Consulting, LLC. Reprinted with permission • Registry and directory services • Person identification • Record locator service • Identity management = security services • Consent management – Opt-in: Data may not be exchanged by default unless the individual consents – Opt-out: Data may be exchanged by default unless restricted by the individual • Secure data transport NIST HIE Security Architecture Source: NISTIR 7497 Security Architecture Design Process for Health Information Exchanges, September 2010 http://csrc.nist.gov/publications/nistir/ir7497/nistir-7497.pdf Basic HIO Services • Sustainable HIOs are providing – Connectivity to EHRs – Alerts to providers – Consultations – Results delivery – Health summaries for continuity of care – Clinical documentation – E-prescribing Advanced HIO Services • • • • • • • • De-identification and data aggregation Data warehousing and analytics Billing and clearinghouse services Transcription Coding/revenue cycle management EHR hosting Public health surveillance Many others HIO Agreements • HIE data sharing agreement • HIO participation agreement • HITECH clarifies that HIOs are business associates Data Stewardship • The “five rights” for HIE might include: right user (person, entity, system, or patient/consumer), right location, right record, right authority, and right consent • Such “rights” constitute health data stewardship: – Stewardship, in general, is personal responsibility for taking care of something one does not own. – Data stewardship has become an important function in corporate America—where management of the corporation’s data assets is critical for competitive advantage. – Health data stewardship (American Medical Informatics Association, 2007) encompasses “the responsibilities and accountabilities associated with managing, collecting, viewing, storing, sharing, disclosing, or otherwise making use of personal health information.” • Health data stewardship extends beyond HIPAA’s protected health information to personal health information, which includes health information that may be held by individuals themselves or in commercial PHR systems not subject to HIPAA Benefits and Challenges of HIE • Benefits – Improved quality of care – Increased consumer satisfaction – Cost savings – Healthier populace – Improved cash flow for providers • Challenges – Accurately linking patient data – Defining value for users – Addressing government policy and mandates – Addressing privacy and confidentiality issues – Addressing technical aspects – Systems integration – Engaging purchasers – Managing growth – Addressing organization and governance issues – Addressing other legal issues – Engaging commercial labs Hallmarks of HIE Success • Governance by diverse stakeholders • Common set of principles • Technical infrastructure based on national standards • Model for sustainability that aligns costs with benefits • Measures performance in patient care, public health, provider value, and economic value Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information • Published December 15, 2008 by the Office of the National Coordinator for Health Information Technology • Principles: – – – – – – – – Individual access Correction Openness and transparency Individual choice Collection, use, and disclosure limitation Data quality and integrity Safeguards Accountability • Guidance for the Framework: The HIPAA Privacy Rule and Electronic Health Information Exchange in a Networked Environment, Office for Civil Rights (OCR), December 15, 2008 National Health Information Infrastructure • National Health Information Infrastructure (NHII) – a vision of bringing timely health information to, and aid communication among, those making health decisions for themselves, their families, their patients, and their communities: – Avoiding unnecessary care, cost, and anxiety through NHII – Enhancing continuity of care and public health outreach through NHII – Avoiding adverse events through NHII – Upgrading public health resources for the identification of bioterrorist threats through the NHII – Improving individuals’ ability to self-manage chronic conditions through NHII – Responding rapidly to individual emergencies and local public health threats through NHII Dimensions of NHII NCVHS 2001 Nationwide Health Information Network • A vision for a “network of networks” – Built upon the Internet linked by uniform communications and a software framework of open standards and policies – Reflect interest of all stakeholders – Patient-centric with safeguards to protect privacy of personal health information – Incentives to accelerate development and adoption • Key challenges: — Accurately matching patients – Standards — Addressing discordant laws – Privacy concerns – Paying for development NHIN Core Service and Capabilities NHIN Planning • Healthcare Information Technology Standards Panel (HITSP) • Certification Commission for Health Information Technology (CCHIT) • Health Information Security and Privacy Collaboration (HISPC) • American Health Information Community (AHIC) • NHIN Prototypes • NHIN Trial Implementations NHIN Exchange Other Projects • NHIN Direct (2010) – Complementary to the work of the Exchange, – Focus is simple, secure, scalable, standards-based way to send authenticated, encrypted health information to known, trusted recipients over the Internet • CONNECT – Open source software solution and community that enables HIE – Project initiated in 2007 by the Federal Health Architecture – Components: • Gateway • Enterprise Service Platform • Universal Client Framework Conclusion • What will the impact be of a new administration, new times, new economy? • Many believe these initiatives need to be sustained for a relatively long time to see true results • Federal HIT initiatives are advancing, but they, too, could be impacted by the shifting sands of time • “The challenges are not technical. They never are. . .” John Halamka, MD, HITSP For Next Session # Topic WEEK 10 # Project Presentations and Course Wrap up Topic WEEKS 11-12 Final Examinations Reading Due in Class Amatayakul Margret Ch. 1, 14, 15, 16,17, 18 and 19 34 9/29/2022 35