Strategies for Increased Interoperability Standards Adoption

1. Strategies for Increased Interoperability Standards Adoption Marc R. Wine, M.H.A Program Analyst, Health IT GSA Office of Intergovernmental Solutions December 8, 2005

2. Strategies for Increased Interoperability Standards Adoption ~ A presentation for the Health Information Management Systems Society, RHIO Federation – sharing knowledge, fostering collaboration environments and building communities. Two suggested guiding lights: “Federal leadership and nationwide private sector initiatives are important – and they must be coordinated with efforts at the state and local governmental levels.” “RHIOs will work closely with state and local governments in supporting health information exchange. They will play a crucial role in fostering the creation of regional data exchange networks, support the deployment of appropriate infrastructure, stimulate the involvement of local leadership, and provide leadership in local efforts.”

3. Five Learning Objectives 1. Strategies for interoperability in implementing public-private collaborative health IT projects 2. Challenges facing large healthcare systems when implementing EHRs 3. Importance of Incremental System Development 4. Leading-edge approaches to interoperability standards for high-performance health IT systems 5. Examples of transforming healthcare through innovative technologies

4. “Placing a Face on Interoperability Standards” Two Proposed Major Questions: 1.How can a number of provider organizations as well as other healthcare organizations come together to trust, connect and share patient data at the regional level? 2.How can organizations standardize on and provide for an environment that enables all healthcare providers to connect seamlessly to an interoperable environment?

5. Can we Tell Where the Pandemic Will Strike? • November 1, 2005 President Bush announced at NIH that a pandemic bird flu needs to be prepared for. • Supporting a $7.1 Billion initiative to track and counter this serious health issue. “…at some point we are likely to face another pandemic…” - President George W. Bush

6. Katrina, Rita and Wilma Left Citizens at Certain High-Risks • Prescriptions were left, doctor contacts and healthcare indentification were destroyed or missing. • These recent natural and human tragedies focus on the need for an electronic health record available nationwide for citizens.

7. The Challenge to Achieve EHRs Only about 10-15% of the market is using electronic health records which are often stored across disparate systems and are constantly needed by physicians, in remote medical offices, ERs, labs and hospitals. The majority of the time, a clinician lacks a complete medical record of the patient

8. For Patients Behind the Driving Force: “With an interoperable system in place, you can refer to your physician’s information network and find information you need to make a doctor’s appointment go more efficiently or reduce the number of follow-up visits you might have to make.” -- Ending the Document Game, Commission on Systemic Interoperability October 25, 2005

9. Citizens Trust for Achieving the Goals of Adopting Interoperable Standards “Technology must fit seamlessly into the existing ‘psychology of trust’ found in the healthcare world. The trust a patient holds on a healthcare provider helps build trust in new elements added to the healthcare system, leading to an attitude of… If my doctor trusts this new system, then I do too.” “Each element of an interoperable system must be fully known to the public, its function clearly understood, and its mechanisms available for inspection. Explanation to the public must use straightforward language to create confidence and must acknowledge – not dismiss – doubt.” -- Ending the Document Game, Commission on Systemic Interoperability October 25, 2005

10. “Health IT in Government – Transforming Health Care and Empowering Citizens” - A case book of examples of leading-edge projects and future directions, meant to help raise awareness of some of the early successes in adopting interoperable standards-based health IT systems and applications. *Product of the Intergovernmental Advisory Board, American Council for Technology - in Cooperation with the GSA Office of Intergovernmental Solutions

11. A Sample of Leading-edge Projects from “Health IT in Government – Transforming Health Care and Empowering Citizens” Federal: The Centers for Medicare and Medicaid Services (CMS) is aligning its Medicaid Information Technology Architecture (MITA) with the goals of the Nationwide Health Information Infrastructure. MITA is intended to foster integrated business and information technology transformation across the Medicaid enterprise to improve the administration of the $300 billion Medicaid program.

12. A Sample of Leading-edge Projects from “Health IT in Government – Transforming Health Care and Empowering Citizens,” cont. Federal, Cont. Medicaid, MITA Key Features MITA’s common business and technology vision emphasizes: • Medicaid client-centric view not constrained by traditional organizational barriers • Common standards with, but not limited to, Medicare • Interoperability between State organizations that provide services to Medicaid clients within and across States, as well as with other agencies involved in healthcare delivery • Web-based access and integration • Software reusability • Use of Commercial-off-the-Shelf (COTS) software • Integration of pubic health and clinical data

13. A Sample of Leading-edge Projects from “Health IT in Government – Transforming Health Care and Empowering Citizens,” cont. State: Projects in North Carolina are providing lessons learned related to Immunization Registry and Hospital Emergency Surveillance Systems, and plans call for Medications Management, Electronic Lab and Radiology Order and Report, and EHRs Some Key Lessons from NC: • Include such top champions as the Secretary of the NC State Dept. of Health and Human Services • Plan for phased-implementation of complex systems • Collaborate with a broad range of state-based organizations to ensure appropriate statewide leadership and consensus for change

14. A Sample of Leading-edge Projects from “Health IT in Government – Transforming Health Care and Empowering Citizens,” cont. Local county: Los Angeles County, CA - Public Health Information Network – Developing the Operational Data Store (ODS), an architecture based upon the Public Health Information Network (PHIN) initiative published by CDC. This aligns the county public health system with federal directives and national initiative on surveillance for bioterrorism, control of disease outbreaks and the tracking of epidemiological information.

15. A Sample of Leading-edge Projects from “Health IT in Government – Transforming Health Care and Empowering Citizens,” cont. Local county, cont. Benefits of L.A. County Public Health Information Network, ODS: • Web-based system architecture capable of supporting electronic data exchange from public health partners using HL7 based integration hub • Management tools and applications to assist public health response • Unifying system to further improve access to laboratory data and response protocols • Enhanced capability to train public health staff and a uniform data exchange standard for exchanging data between the public health partners. • Real-time collection of data from heterogeneous healthcare systems • Dissemination of critical public-interest information to the community in general.

16. A Sample of Leading-edge Projects from “Health IT in Government – Transforming Health Care and Empowering Citizens,” cont. Predictions on Future Advances in Health IT Systems from Interoperable Standards: • Genomic information systems will be a standard component of a person’s medical record. • Nano-medicine and health IT systems will create solutions to revolutionize health care. • Increased usage of solar power across all sectors of the economy will result in hybrid solar powered health care facilities and computer systems. • Wearable computers for physicians will allow them to treat patients and complete their rounds while connected via wireless networks to computerized

17. Some Suggested Strategies for Federal, State and Local Governments 1.How can a number of provider organizations as well as other healthcare organizations come together to trust, connect and share patient data at the regional level? 2.How can organizations standardize on and provide for an environment that enables all healthcare providers to connect seamlessly to an interoperable environment? • Seek authorization to implement financial, and other incentives for participation in a standards-based healthcare information network. • Revise regulations that prevent healthcare entities, networks, hospitals and clinicians from working together to create and adopt interoperable healthcare information systems, including competition and maintaining protections against kickbacks.

18. Some Suggested Strategies for Consideration by Federal, State and Local Governments, cont. Continue to support approaches to precise interoperability standards, including: • Consolidated Health Informatics (CHI) – Federal agencies endorsement if 20 sets of standards that enable information to be shared across agencies • SNOMED – HHS, VA & DoD signed an agreement in 2003 to license the standardized medical vocabulary developed by the College of American Pathologists • Electronic Medical Records using Health Level 7 (HL-7) – standard that define the set of functions needed in an electronic medical record. • Standardize data at point of creation including drugs, devices, and tests kits – enabling standardized identifiers and vocabulary labels and packaging, and data outputs.

19. Some Suggested Strategies for Consideration by Federal, State and Local Governments, cont. • Ensure that the benefits of health IT are equally available to all the nation’s citizens, and explore public and private sector policies to address gaps in interoperable health IT services. • Identify deficiencies in the healthcare workforce that must be addressed in order to secure the most benefit from health IT. • Develop and implement public awareness campaigns, for consumers, providers and organizations on the benefits of using interoperable health IT. • Provide Web-based personal patient records with release for use of specific providers and provider organizations. • Provide State and Local server farms that will support an EHR funded by the State and licensed to all providers in a given area that could support statewide initiatives and RHIO development.

20. Strategies for Increased Interoperability Standards Adoption Discussion and Q&A Marc R. Wine, M.H.A. GSA Office of Intergovernmental Solutions Email: marc.wine@gsa.govThank you for participating !