Ticia Gerber, Vice President, International Programs eHealth Initiative and Foundation

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Establishing an American Health Information Infrastructure: Domestic Experience and

Global Implications

Ticia Gerber, Vice President, International ProgramseHealth Initiative and Foundation

European Health Forum GasteinOctober 2005

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Overview of Discussion

• Synopsis of eHealth Initiative

• Examine current bi-partisan e-Health (HIT) efforts within the United States and chronicle their global implications

• Compare/contrast these efforts with European e-Health developments

• Discuss opportunities for mutual learning, collaboration and partnership

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Increased Momentum in the U.S.

Enormous momentum around e-Health (HIT) and health information exchange

• U.S. Congress

• Administration

• Private Sector

• States and Communities

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eHealth Initiative - Role and Mission

• eHealth Initiative has been critical driver in creating and cultivating e-Health policy change in U.S. (community, state, federal activities)

• We are extending our reach to collaborate with and learn from key healthcare stakeholders around the globe through the Leadership in Global Health Technology (LIGHT) Initiative

• eHealth Initiative (eHI) is an independent, non-profit, multi-stakeholder consortium whose mission is to improve the quality, safety, and efficiency of healthcare through information and information technology

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eHealth Initiative Membership• Consumer and patient groups• Employers, healthcare purchasers, and payers• Health care information technology suppliers• Hospitals and other providers• Pharmaceutical and medical device manufacturers• Pharmacies, laboratories and other ancillary providers• Practicing clinicians and clinician groups• Public health agencies• Quality improvement organizations• Research and academic institutions• State, regional and community-based health information

organizations

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eHealth Initiative Driving Change CCBH Program

• $11 million program in cooperation with U.S. Health Resources and Services Administration/DHHS

• Provides seed funding to regional and community-based multi-stakeholder collaboratives that are mobilizing information across organizations

• Mobilizes pioneers and experts to develop resources and tools to support health information exchange: technical, financial, clinical, organizational, legal

• Disseminates resources and tools and creates a place for learning and dialogue across communities

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Communities Being Funded

• Connecting Colorado (Denver, CO)• Indiana Health Information Exchange (Indianapolis, IN)• MA-SHARE MedsInfo e-Prescribing Initiative (Waltham, MA)• MD/DC Collaborative for Healthcare Information Technology

(Baltimore/Washington Metro Area)• Santa Barbara County Care Data Exchange (Santa Barbara,

CA)• Taconic Health Information Network and Community

(Fishkill, NY)• Tri-Cities TN-VA Care Data Exchange (Kingsport, TN)• Whatcom County e-Prescribing Project (Bellingham, WA)• Wisconsin Health Information Exchange (National Institute

for Medical Informatics – Midwest) (Milwaukee, WI)

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Origins of Increased Momentum in the U.S.

• IOM To Err is Human Report (November 1999)

• NCVHS NHII Workgroup report Information for Health: A Strategy for Building the National Health Information Infrastructure (November 2001)

• Sunsetting of managed care and managed competition as panacea for health system ills

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9/11/01 placed increased emphasis on:

• Need to fund and implement electronic, interoperable exchange of health information, particularly for public health and bioterrorism surveillance (CHI)

• Importance of cooperation between federal agencies and the public and private sector (CFH)

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Example of post 9/11 momentum

Bioterrorism Preparedness Act of 2001 (PL

107-188)

• Introduced 12/4/01, enacted 6/12/02• Establishes intergovernmental Working Group

On Bioterrorism• Calls for development of national public health

communications and surveillance network

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Momentum in U.S. CongressA multitude of legislation is being considered in the House and Senate includes support for e-Health (HIT)

These bills call for:– More coordination and leadership within government– Federal adoption of data exchange standards– Revolving loan funds, loan guarantees, competitive

grants to eligible entities for the acquisition, development of qualified informatics systems ($50 million - $125 million in first year)

– Demonstration programs for linking payment to HIT, usage of HIT for chronic care management

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Momentum in U.S. Congress

First e-Health (HIT) bill introduced in May 2001 – The Medical Errors Reduction Act(S. 824) Called for:• HHS grant program for purchasing,

leasing, developing, and implementing standardized clinical health care informatics systems

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Medicare Prescription Drug, Improvement and Modernization Act (Enacted 12/8/03)

Contains:• Demonstration project linking Medicare payment

to better outcomes and use of HIT (Section 649)• National Chronic Care Improvement Program

(CCIP) pilot to establish payments for outcomes based on clinical quality improvement measures where HIT is essential to success (Section 721)

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Legislation Introduced in 2005 • S. 16 - Affordable Health Care Act (1/05)• HR 747 - National Health Information Incentive Act

(2/05)• S. 544 - Public Health Service Act (3/05)• Budget Reserve Fund included in Budget Conference

Report (4/05)• HR 2234 - 21st Century Health Information Act (5/05)• S 1227 Health Information Technology Act of 2005

(6/05)

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Legislation Introduced in 2005 • S 1262 - Health Technology to Enhance Quality Act of

2005 (6/05)• S 1355 - Health Information Technology Quality and

Improvement Act (6/05)• S 1356 - Medicare Value Purchasing Act (6/05)• S 1416 – Wired for Health Care Quality Act (7/05)• HR 3617 – Medicare Value-based Purchasing for

Physician Services Act (7/05)• Health Information Technology Promotion Act (draft-

7/05)

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Active legislation includes:

HIT bills • Senate

S 1416 – Wired for Health Care Quality Act • House

Health Information Technology Promotion Act (draft-7/05)

Medicare Pay for Performance• Senate

S 1356 - Medicare Value Purchasing Act • House

HR 3617 – Medicare Value-based Purchasing for Physician Services Act

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Common Legislation Themes • Need for standards—public-private sector collaboratives

designed to achieve consensus on and drive adoption of interoperability standards

• Grant and loan programs, for providers and regional health information technology networks – most link to use of standards and adoption of “quality measurement systems”

• Value-based purchasing programs – measures related to reporting of data, process measures including HIT, and eventually outcomes

• Role of government – catalyst, driver of change

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FORECAST• Action on HIT legislation this year not likely, physician payment bill possible

Important characteristics of bill negotiation process• Bi-partisan HIT issue support• 108th Congress spans both 2005 and 2006• Multi-committee discussions and drafting• House and Senate have very different solutions that must be worked out in

conference• Budget deficit environment (challenge of adequate funding, meaningful

incentives)• Lack critical mass of economic research on impact of HIT• Federal priority-shifting in wake of Hurricane Katrina• Congressional efforts must integrate with current Administration initiatives

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Momentum in U.S. Administration

• Leadership on all Sides– Office of Secretary of DHHS– Office of the National Coordinator for HIT– Agency for Healthcare Research and Quality– Centers for Disease Control and Prevention– Centers for Medicare and Medicaid Services– Department of Defense– Department of Veterans Affairs– Office of Personnel Management

• Executive and cabinet-level leadership critical in advancing the issue

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President George W. Bush, April 26, 2004“The 21st century health care system is using a 19th century paperwork system. These old methods of keeping records are real threats to patients and their safety and are incredibly costly. Modern technology hasn't caught up with a major aspect of health care and we've got to change that. We need a system where everyone has their own personal electronic medical record that they control and they can give a doctor when they need to.

“The federal government must create the incentives for health care providers involved with the federal government to use medical records, and in doing so, will go a long way toward introducing IT, information technology, into a part of medicine that desperately needs it.

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Former U.S. HHS Secretary Tommy Thompson, May 6, 2004"Health information technology promises huge benefits, and we need to move quickly across many fronts to capture these benefits. But the task is also enormously complex. We need more than a business-as-usual approach.”

Current U.S. HHS Secretary Mike Leavitt, June 6, 2005“The use of electronic health record and other information technology will transform our healthcare system. We will bring together the public and private health care sectors to transform health care as we know it.”

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• President George W. Bush announces in April 2004 plan for most Americans to have an electronic health record in ten years

• May 2004 appointment of sub-cabinet level position – National Health Information Technology Coordinator David J. Brailer, MD, PhD

• In February 2, 2005 State of the Union Address President Bush declares continuing support for IT to improve healthcare, by asking Congress to move forward on “…improved health information technology to prevent medical errors and needless costs.”

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• Summary of over 500 Responses to RFI for National Health Information Network released in 5/05

• HHS Secretary Michael Leavitt releases four RFP’s re Interoperability and Health Information Sharing Policies in 6/05

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Four RFP’s on Interoperability and Health Information Sharing Policies

• Contract to develop, prototype, and evaluate feasibility and effectiveness of a process to unify and harmonize industry-wide health IT standards development, maintenance and refinements over time – awarded by Fall 2005

• Contract to develop, prototype, and evaluate compliance certification process for EHRs, including infrastructure or network components through which they interoperate – awarded by Fall 2005

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Four RFP’s on Interoperability and Health Information Sharing Policies

• Contract to assess and develop plans to address variations in organization-level business policies and state laws that affect privacy and security practices, including those related to HIPAA – awarded by Fall 2005

• Six contracts for the development of designs and architectures that specify the construction, models of operation, enhancement and maintenance, and live demonstrations of the Internet-based NHIN prototype – awarded in FY 2006

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• Creation of American Health Information Community (AHIC)– Formed under auspices of FACA, it will provide input and

recommendations to HHS on how to make health records digital and interoperable and assure that privacy and security are protected

– 17 Commissioners – solicited nominations from consumer groups, providers, payers, hospitals, vendors, privacy interests, and any other member of public

– Dissolution within two to five years with goal of creating self-sustaining, private sector replacement

– American Health Information Community (AHIC) Commissioners announced 9/05

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American Health Information Communitydeliverables include:

• Adoption of non-governmental standard-setting and certification processes

• Groundwork for a national architecture that allows data to be shared securely using the Internet

• Applications that provide immediate benefits (drug safety, lab results, bioterrorism surveillance, etc.)

• Transition to a private-sector health information community initiative that will provide long-term governance

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AHIC Commissioners (9/13)• Scott P. Serota, President and CEO, Blue Cross Blue Shield

Association• Douglas E. Henley, M.D., Executive Vice President, American

Academy of Family Physicians• Lillee Smith Gelinas, R.N., Chief Nursing Officer, VHA Inc.• Charles N. Kahn III, President, Federation of American Hospitals• Nancy Davenport-Ennis, CEO, National Patient Advocate

Foundation• Steven S Reinemund, CEO and Chairman, PepsiCo• Kevin D. Hutchinson, CEO, SureScripts• Craig R. Barrett, Chairman, Intel Corporation• U.S. Government: CMS, CDC, VA, DoD, Treasury, OPM,

Commerce and IFSSA

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U.S. Agency for Healthcare Research and Quality• FY04: $139 million in grants and contracts for HIT• Over 100 grants to support patient safety and HIT – 38

states with special focus on small and rural hospitals and communities - $96 million over three years

• Five-year contracts to five states to help develop statewide networks – CO, IN, RI, TN, UT - $25 million over five years

• National HIT Resource Center: collaboration - $18.5 million over five years

• Currently in process of awarding up to $11.5M for state-level privacy and security practices research and proposed solutions

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CDC • Launched Biosense Program• National initiative to enhance nation’s capability

to rapidly detect, quantify, and localize public health emergencies by accessing and analyzing health data

• This program will establish near real-time electronic transmission of data to local, state and federal public health agencies from national, regional and local health data source (RFP expected soon)

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Policy Change: Role of Health Information Exchange (HIE)

• US contains more than 100 multi-stakeholder state, regional or community HIEs in 45 states and the District of Columbia

• HIE provides capability to electronically move clinical information between disparate healthcare information systems

• Community HIE organizations are geographically-defined entities which develop and manage a set of contractual conventions and terms, arrange for the means of electronic exchange of information, and develop and maintain HIE standards

• More than half of HIEs in a recent August 2005 eHI Foundation survey indicated they were in an advanced stage of development

• 91% of survey respondents cited “securing upfront funding” as either a very difficult or moderately difficult challenge

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Hurricane Katrina and Its Aftermath

Hurricane Katrina affected geographic area size of Great Britain. Federal disaster has been declared over 90,000 square miles.

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U.S. shelters are currently housing 89,400 survivors.

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It is estimated that as many as 1 million individuals’ paper medical records have been lost due to Hurricane Katrina.

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• Responding to urgent need, David Brailer, MD (ONCHIT) and John Loonsk, MD (CDC) and a number of public/private sector individuals are developing and implementing plans to support health information needs (electronically) of hurricane evacuees and survivors

• Four expert work groups launched: evacuee registry, information access, field medical record support and communication and dissemination

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• Federal government facilitated making prescription medication record information on Katrina evacuees available to authorized health professionals and pharmacists on-line (www.KatrinaHealth.org)

• Public-private sector effort involving more than 150 organizations

• Nearly 40% of evacuees taking prescription drug medications before Katrina

• As of 9/14/05 doctors in eight shelters could perform Internet prescription record search on more than 800,000 evacuees

• Evacuee medication and dosage information now accessible from anywhere in the country for purposes of prescription submission, renewal and care coordination (nationwide service launched 9/22/05)

• Medicaid, Veterans’ health and lab information may also soon be available

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Katrina has fundamentally altered the U.S. political landscape and national policy priorities.

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Momentum in U.S. Private Sector

The U.S. private sector has launched a variety of initiatives focused on HIT and better health

• Hospital-based – The Leapfrog Group has launched a new national program that rewards good outcomes and adoption of CPOE systems

• Health Plan-based – UHC, CIGNA, Aetna – they are all recognizing physicians that adopt and use HIT to varying degrees

• Physician-based Bridges To Excellence has a program focused on adoption of systems of care, including HIT

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Opportunities for Collaboration

and “Partnerships for Health”

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Global Partnerships for Health

Leadership in Global Health Technology (LIGHT) Initiative Background

• eHI and its Foundation founded LIGHT Initiative in 2004

• eHI LIGHT’s purpose is to facilitate learning and information sharing among HIT innovators and other nations, in both the developed and developing world

• Focus of these activities is to identify the key barriers, workable strategies and imperatives for implementing an interconnected, electronic health information infrastructure to support better health and healthcare

• Participants include high-level healthcare officers and executives from the public and private sectors around the globe

• eHI LIGHT’s project work and interests span six continents

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eHI LIGHT has:• Hosted two global HIT conferences involving over 17 nations (Geneva,

Washington DC)• Begun discussions about mutual lessons learned and other issues with

government health, science and technology representatives (England, Finland)

• Sponsored regional health improvement discussions and HIT summits for different epicenters around the globe (Example: Finland, Japan)

• Developed an inventory of HIT-related efforts from different countries across the world

• Launched an on-line Resource Center with global HIT information• Arranged “site visits” for global partners who are interested in learning

from the U.S. HIT • Convened eHI Working Group on LIGHT – meets monthly• Initiated outreach to relevant policymakers to increase global HIT

collaboration and funding in the long-term.

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In addition to current activities, in early 2006 eHI LIGHT will: • Release a “global who’s who” directory designed to help

those involved in HIT across the globe connect• Host ambassadorial health event (100 nations targeted)

in Washington• Host Asian HIT Summit in Tokyo • Release 30-nation survey on HIT and better health• Undertake project on electronic, interoperable digital

signatures and identity assurance in the global biopharmaceutical environment

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In Europe specifically, we desire to:

• Engage with European health and technology leaders (EU, EHTEL, individual nations) to share current HIT policy and market developments and lessons learned

• Fill knowledge gaps, facilitate targeted and helpful collaboration

• Crosswalk progress on EU eHealth Action Plan and EU eHealth I2 project with US HIT agenda*Note: Growing interest in US about how domestic HIT policy aligns/compares with EU policy

• Share information gained from US community HIE projects (legal, technical, financial, clinical, consumer)

• US-European summit on health improvement and HIT discussed

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Summary

• US is moving in a targeted, coordinated and expeditious way towards implementation of HIT and health information exchange in 2005 and 2006

• EU and Member States are also at critical point in e-Health, interoperability and connectivity efforts

• eHI and its LIGHT Initiative enthusiastically seek out collaborative endeavors and partnerships

• Look forward to the opportunity for mutual learning between the US and European nations

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Ticia GerberVice President, International Programs

eHealth Initiative and Foundation

www.ehealthinitiative.org1500 K Street, N.W., Suite 900

Washington, D.C. 20005202.624.3264

[email protected]

Ticia Gerber, Vice President, International Programs eHealth Initiative and Foundation

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