Health Information Infrastructure: What, Why, and How William A. Yasnoff, MD, PhD, FACMI Managing...

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Health Information Infrastructure: What, Why, and How William A. Yasnoff, MD, PhD, FACMI Managing Partner, NHII Advisors Rural Telecon ‘06 Little Rock, AR October 24, 2006 © 2006 N H I I ADVISORS

Transcript of Health Information Infrastructure: What, Why, and How William A. Yasnoff, MD, PhD, FACMI Managing...

Page 1: Health Information Infrastructure: What, Why, and How William A. Yasnoff, MD, PhD, FACMI Managing Partner, NHII Advisors William A. Yasnoff, MD, PhD, FACMI.

Health Information Infrastructure:

What, Why, and How

Health Information Infrastructure:

What, Why, and How

William A. Yasnoff, MD, PhD, FACMIManaging Partner, NHII Advisors

Rural Telecon ‘06Little Rock, AR

October 24, 2006

© 2006

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I. Patient Records in Today’s Health Care “System”I. Patient Records in Today’s Health Care “System”

Most records are paper Records are created where care is

given and left there (in many locations, potentially worldwide)

No one has access to their complete health records

Collecting all the records not easy or helpful since they are mostly paper

RESULT: Health care practiced in mostly “information free” zone

Most records are paper Records are created where care is

given and left there (in many locations, potentially worldwide)

No one has access to their complete health records

Collecting all the records not easy or helpful since they are mostly paper

RESULT: Health care practiced in mostly “information free” zone

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II. What is the NHII?II. What is the 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 national database of medical records

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 national database of medical records

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II. What is the NHII? (continued)II. What is the NHII? (continued)

Includes not only systems, but organizing principles, procedures, policies, and standards, e.g. Organization & governance Alignment of financial incentives Operational policies Message & content standards

Individual provider Electronic Health Record (EHR) systems are only the building blocks, not NHII

Includes not only systems, but organizing principles, procedures, policies, and standards, e.g. Organization & governance Alignment of financial incentives Operational policies Message & content standards

Individual provider Electronic Health Record (EHR) systems are only the building blocks, not NHII

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III. How does NHII help address current health care problems?

III. How does NHII help address current health care problems?

A. Improving Healthcare Delivery at Point of Care (Improving Quality) Complete patient information Decision support

B. Reducing Costs & Achieving Efficiencies Eliminate duplicate tests & imaging Eliminate duplicate communication

channels (labs, x-rays, etc.)C. Support Public Health Initiatives &

Biosurveillance Automated disease reporting Automated syndrome reporting

A. Improving Healthcare Delivery at Point of Care (Improving Quality) Complete patient information Decision support

B. Reducing Costs & Achieving Efficiencies Eliminate duplicate tests & imaging Eliminate duplicate communication

channels (labs, x-rays, etc.)C. Support Public Health Initiatives &

Biosurveillance Automated disease reporting Automated syndrome reporting

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IV. How Can We Organizethe Creation of the

NHII?

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CompleteElectronicPatientInformation

Stakeholder cooperation

FinancialSustainability

PublicTrust

Components of a Community Health Information

Infrastructure

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CompleteElectronicPatientInformation

Most information is already electronic: Labs, Medications, Images, Hospital Records

Outpatient records are mostly paper Only 10-15% of physicians have EHRs Business case for outpatient EHRs weak

For outpatient information to be electronic, need financial incentives to ensure that physicians acquire and use EHRs

Requirement #1: Financial incentives to create good business case for outpatient EHRs

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CompleteElectronicPatientInformation

Need single access point for electronic information Option 1: Gather data when needed (scattered model)

Pro: 1) data stays in current location; 2) no duplication of storage

Con: 1) all systems must be available for query 24/7/365; 2) each system incurs added costs of queries (initial & ongoing); 3) slow response time; 4) searching not practical; 5) huge interoperability challenge (entire U.S.); 6) records only complete if every possible data source is operational

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CompleteElectronicPatientInformation

Need single access point for electronic information Option 2: Central repository

Pro: fast response time, no interoperability between communities, easy searching, reliability depends only on central system, security can be controlled in one location, completeness of record assured, low cost

Con: public trust challenging, duplicate storage (but storage is inexpensive)

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CompleteElectronicPatientInformation

Need single access point for electronic information Requirement #2: Central repository for storage

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Voluntary Impractical Financial incentives

Where find $$$$$? Mandates

New Impractical Existing

– HIPAA requires information to be provided on patient request

Requirement #3: Patients must request their own information

Stakeholder cooperation

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Funding options Government

– Federal: unlikely– State: unlikely– Startup funds at best

Healthcare Stakeholders– Paid for giving care– New investments or transaction

costs difficult Payers/Purchasers

– Skeptical about benefits– Free rider/first mover effects

Consumers– 72% support electronic records– 52% willing to pay >=$5/month

Requirement #4: Solution must appeal to consumers so they will pay

FinancialSustainability

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A. Public Trust = Patient Control of Information

Requirement #5: Patients must control all access to their information

PublicTrust

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B. Trusted Institution Via regulation (like banks)

impractical Self-regulated

Community-owned non-profit Board with all key stakeholders Independent privacy oversight Open & transparent

Requirement #6: Governing institution must be self-regulating community-owned non-profit

PublicTrust

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C. Trustworthy Technical Architecture Prevent large-scale information loss

Searchable database offline Carefully screen all employees

Prevent inappropriate access to individual records State-of-the-art computer

security Strong authentication No searching capability Secure operating system

Easier to secure central repository: efforts focus on one place

Requirement #7: Technical architecture must prevent information loss and misuse

PublicTrust

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Health Record Banking ModelHealth Record Banking Model All information for a patient stored in

Health Record Bank (HRB) account Patient (or designee) controls all access

to account information [copies of original records held elsewhere]

Each HRB has three interfaces: Withdrawal window - record access Deposit window - receives new info Search window - authorized requests

When care received, new records sent to HRB for deposit in patient’s account

All data sources contribute at patient request (per HIPAA)

All information for a patient stored in Health Record Bank (HRB) account

Patient (or designee) controls all access to account information [copies of original records held elsewhere]

Each HRB has three interfaces: Withdrawal window - record access Deposit window - receives new info Search window - authorized requests

When care received, new records sent to HRB for deposit in patient’s account

All data sources contribute at patient request (per HIPAA)

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eHealthTrust™ Business Model for Health Record BankingeHealthTrust™ Business Model for Health Record Banking

Charge $5/patient/month ($60/year) Paid by patient, payer, or purchaser

Operating Cost < $20/year/patient Payments to clinicians for submitting

standard electronic clinical info provides incentives for EHR acquisition (~$3/encounter)* $10-20K/year for EHR system

Charge $5/patient/month ($60/year) Paid by patient, payer, or purchaser

Operating Cost < $20/year/patient Payments to clinicians for submitting

standard electronic clinical info provides incentives for EHR acquisition (~$3/encounter)* $10-20K/year for EHR system

*patent pending

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Clinical Encounter

Health Record Bank

Clinician EHRSystem

Encounter Data Entered in EHR

Encounter Data sent to

Health Record Bank

PatientPermission?

NODATA NOT

SENT

Clinician Inquiry

Patient data delivered to

Clinician

YES

$3 payment

Clinician’s BankSecure patient

health data files

Health Record Bank / eHealthTrust™

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Questions?Questions?

William A. Yasnoff, MD, PhD, [email protected]/527-5678

For more information:www.healthbanking.orgwww.ehealthtrust.com

www.yasnoff.com

For more information:www.healthbanking.orgwww.ehealthtrust.com

www.yasnoff.com


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