Health Informatics:Challenges and Opportunities

for Health Policy

Judy Ozbolt, PhD, RN FAAN, FACMI, FAIMBE

Scholar

Institute of Medicinejozbolt@nas.edu

INSTITUTE OF MEDICINE

Advising the Nation. Improving Health.

“As an independent scientific

adviser, the Institute of Medicine strives to provide advice that is unbiased, based on evidence and grounded in science.

The mission of the Institute of Medicine embraces the health of people everywhere.”

Health Informatics

The application of information science, knowledge management, computing, and telecommunications to

• The health and health care of individuals and families;

• The health monitoring and health services afforded to populations;

• The advancement of biomedical research;• The education and work processes of health

professionals and scientists;• The education and health practices of the

public

Information ScienceAnd Technology

Biomedical Research

Health ofIndividuals& Families

Health ofPopulations

Education, Work Processes,And Health Practices

Health InformaticsA Critical Infrastructure for the Nation’s

Health

• The Computer-based Patient Record (IOM, 1991, 1997)

• For the Record (NRC, 1997)• Networking Health (NRC, 2000)• To Err is Human (IOM, 2000)• Crossing the Quality Chasm (IOM, 2001)• Health Professions Education (IOM, 2003)• Mathematics and 21st Century Biology (NRC,

2005)• Building a Better Delivery System (NAE, 2005)

Health Care Should Be . . .

• Safe• Effective• Patient-centered• Timely• Efficient• Equitable

IOM, Crossing the Quality Chasm, 2001

Health Informatics In Support of Aims of Health

Care• Electronic health records (EHR) for providers,

with continuous access to patient information, knowledge resources, and decision support.

• Personal health records (PHR) for everyone, with continuous access to own information, knowledge resources, and care providers.

• Regional and national health information infrastructure for health services, consumer health, quality, accountability, research, and education.

Electronic Health Records: Foundation for the Infrastructure

• Health Information and data• Test results management• Order entry / management• Decision support• Electronic communication and connectivity• Patient support• Administrative support and reporting• Population health management (IOM, 2003)

Personal Health Records:Tools for Self-Management

• Access to own EHR (read-only)• Opportunity to record information into PHR• Secure email communication with providers• Access to reliable health knowledge and

information (e.g., Medline Plus, Gateway)• Access to monitored listserves and chat

rooms for health concerns• Decision support, alerts, and reminders

IOM, A Focus on Communities, 2004

Health Information Networks:Vehicles for Information

Exchange• Secure access of authorized users to

information across providers, settings, times

• Critical information for patient care• Reporting for regulation, payment,

public health• Appropriate, secure access for research

IOM, A Focus on Communities, 2004

BioinformaticsFoundation for Life Sciences Research

• Mathematical research / new computational methods

• Research on genomics, genetics, molecular biology / dissemination and use of findings

• Education of biologists for 21st Century science

--NRC, 2003, 2004, 2005

Informatics Challenges and Opportunities

• Security of health information• Appropriate uses of the Internet for health

information• Reliability of hardware and software• Adaptation of emerging technologies for

health care, management, and science• Work redesign

NRC, 1997, 2000, 2004; NAE/IOM 2005

Current Initiatives

• Secretary of DHHS has created and chairs the American Health Information Community.

• Office of National Coordinator for Health Information Technology has issued RFPs for– Process to harmonize standards– Process to specify functional requirements for

health IT products and certify compliance– Models and prototypes for national health

information exchange– Process to address variations in privacy and

security practices

Current Initiatives (2)

• Centers for Medicare and Medicaid Services will make VHA VistA record system available at no charge.

• More than 100 initiatives in 45 states are working to exchange health information across providers.

• AHRQ is funding some of these for development and evaluation.

Current Initiatives (3)

• CDC is working with others to share information for monitoring, surveillance, data mining.

• HRSA is supporting telemedicine projects.

• Other significant HIT activities are underway at Department of Defense, Office of Personnel Management, NIH, and the VA.

Response to Hurricanes

• Creation of prescription drug database from combined commercial pharmacy databases

• In the works . . .– Support for implementing EHRs– Support for acquiring and using PHRs– Requiring compliance with standards to

receive support– Support for regional health information

networks

Work Yet To Be Done

• Use evolving computer science knowledge to create solutions to problems in health care and science.

• Continue development of standards and methods to share information and maintain privacy and security.

• Develop decision-support and knowledge-management systems for vulnerable populations such as children, the mentally ill, and the underserved.

Work Yet To Be Done (2)

• Develop and use systems engineering and change management knowledge to improve integration of informatics into health care and science.

• Address ethical, social, and economic issues in the development, communication, and use of genomic and genetic knowledge and information.

• Educate health professionals, scientists, and the public on the uses of health informatics.

Policy Issues

• The IOM and other units of The National Academies have taken a number of positions in their reports on the uses of informatics to improve health care and health sciences.

• The CCST may wish to consider some of these in formulating its policy agenda.

Improving Health Care: The Role of Informatics

• Health care has safety and quality problems because it relies on outmoded systems of work.

• Poor designs set the workforce up to fail, regardless of how hard they try.

• If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes.IOM, Crossing the Quality Chasm, 2001

Improving Health Care:The Role of Informatics (2)

• Information technology must play a central role in the redesign of the healthcare system if a substantial improvement in quality is to be achieved over the coming decade.

• Automation of clinical, financial, and administrative transactions is essential to – improving quality, – preventing errors, – enhancing consumer confidence in the health system,

and – improving efficiency.

IOM, Crossing the Quality Chasm, 2001

National Health Information Infrastructure (NHII)

• A national health information infrastructure is needed– To provide immediate access to complete

patient information and decision-support tools for clinicians and their patients, and

– To capture patient safety information as a byproduct of care and use this information to design even safer delivery systems

NRC, Patient Safety, 2004

Barriers and Risks to Adopting EHRs and RHIOs

• Concerns about privacy and confidentiality• Lack of national standards• Varied and complex transactions requiring

elegant but not simple solutions• Sizable capital investment and multiyear

commitment required to build systems• Behavioral adaptations required for patients,

clinicians, and organizationsIOM, Crossing the Quality Chasm, 2001

Strategies to Support Adoption of EHRs and RHIOs

• Promulgate national data standards• Set rules and regulations for functionality of

EHRs• Increase consumer awareness of the

importance of these tools• Finance EHRs: Develop the business case• Create a public utility to hold health data at

the local level (See County of Santa Cruz, CA)IOM, A Focus on Communities, 2004

Informatics and Life Sciences

• Progress in biology depends on quantitative methods and understanding.

• A top priority of science policy should be the creation and maintenance of a robust interface between biology and mathematics.

• Biologists require knowledge of math and computing to communicate with systems engineers who design software for modeling biological processes.

NRC, Mathematics & 21st Century Biology, 2005; NRC, Catalyzing Inquiry at the Interface of Computing and Biology, 2005

Questions for CCST

• Which of these or other policy issues is important to California now?

• Which of these or other policy issues is opportune for action now?

• How can CCST best use its expertise and prestige to influence the development of policy in the priority areas?

Thank you!

Questions and Discussion