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Health IT Strategic FrameworkExecutive SummaryOn April 27, 2004, President Bush called for widespread adoption of interoperable EHRs within 10 years, and also established the position of National Coordinator for Health Information Technology. On May 6, 2004, Secretary Tommy G. Thompson appointed David J. Brailer, M.D., Ph.D., to serve in this new position. The federal government has already played an active role in the evolution and use of health information technology (HIT), including adoption and ongoing support for standards needed to achieve interoperability. Executive Order 13335 requires the National Coordinator to report within 90 days of operation on the development and implementation of a strategic plan to guide the nationwide implementation of HIT in both the public and private sectors. In fulfilling the requirements of the Executive Order, this report outlines a framework for a strategic plan that will be dynamic, iterative, and implemented in coordination with the private sector. In addition, this report includes attachments from the Office of Personnel Management (OPM), the Department of Defense (DoD), and the Department of Veterans Affairs (VA). Collectively, this report and related attachments represent the progress to date on the development and implementation of a comprehensive HIT strategic plan. Readiness for ChangeThere is a great need for information tools to be used in the delivery of health care. Preventable medical errors and treatment variations have recently gained attention. Clinicians may not know the latest treatment options, and practices vary across clinicians and regions. Consumers want to ensure that they have choices in treatment, and when they do, they want to have the information they need to make decisions about their care. Concerns about the privacy and security of personal medical information remain high. Public health monitoring, bioterror surveillance, research, and quality monitoring require data that depends on the widespread adoption of HIT. Vision for Consumer-centric and Information-rich CareMany envision a health care industry that is consumer centric and information-rich, in which medical information follows the consumer, and information tools guide medical decisions. Clinicians have appropriate access to a patient's complete treatment history, including medical records, medication history, laboratory results, and radiographs, among other information. Clinicians order medications with computerized systems that eliminate handwriting errors and automatically check for doses that are too high or too low, for harmful interactions with other drugs, and for allergies. Prescriptions are also checked against the health plan's formulary, and the out-of-pocket costs of the prescribed drug can be compared with alternative treatments. Clinicians receive electronic reminders in the form of alerts about treatment procedures and medical guidelines. This is a different way of delivering health care than that which currently exists, but one that many have envisioned. This new way will result in fewer medical errors, fewer unnecessary treatments or wasteful care, and fewer variations in care, and will ultimately improve care for all Americans. Care will be centered around the consumer and will be delivered electronically as well as in person. Clinicians can spend more time on patient care, and employers will gain productivity and competitive benefits from health care spending. Strategic FrameworkIn order to realize a new vision for health care made possible through the use of information technology, strategic actions embraced by the public and private health sectors need to be taken over many years. There are four major goals that will be pursued in realizing this vision for improved health care. Each of these goals has a corresponding set of strategies and related specific actions that will advance and focus future efforts. These goals and strategies are summarized below. Goal 1: Inform Clinical Practice. Informing clinical practice is fundamental to improving care and making health care delivery more efficient. This goal centers largely around efforts to bring EHRs directly into clinical practice. This will reduce medical errors and duplicative work, and enable clinicians to focus their efforts more directly on improved patient care. Three strategies for realizing this goal are:
Goal 2: Interconnect Clinicians. Interconnecting clinicians will allow information to be portable and to move with consumers from one point of care to another. This will require an interoperable infrastructure to help clinicians get access to critical health care information when their clinical and/or treatment decisions are being made. The three strategies for realizing this goal are:
Goal 3: Personalize Care. Consumer-centric information helps individuals manage their own wellness and assists with their personal health care decisions. The ability to personalize care is a critical component of using health care information in a meaningful manner. The three strategies for realizing this goal are:
Goal 4: Improve Population Health. Population health improvement requires the collection of timely, accurate, and detailed clinical information to allow for the evaluation of health care delivery and the reporting of critical findings to public health officials, clinical trials and other research, and feedback to clinicians. Three strategies for realizing this goal are:
Key ActionsThe Framework for Strategic Action will guide the development of a full strategic plan for widespread HIT adoption. At the same time, a variety of key actions that have begun to implement this strategy are underway, including: Establishing a Health Information Technology Leadership Panel to evaluate the urgency of investments and recommend immediate actions Private sector certification of health information technology products Funding community health information exchange demonstrations Planning the formation of a private interoperability consortium Requiring standards to facilitate electronic prescribing Establishing a Medicare beneficiary portal Sharing clinical research data through a secure infrastructure Commitment to standards Public-Private PartnershipLeaders across the public and private sector recognize that the adoption and effective use of HIT requires a joint effort between federal, state, and local governments and the private sector. The value of HIT will be best realized under the conditions of a competitive technology industry, privately operated support services, choice among clinicians and provider organizations, and payers who reward clinicians based on quality. The Federal government has already played an active role in the evolution and use of HIT. In FY04, total federal spending on HIT was more than $900 million. Initiatives range from supporting research in advanced HIT to the development and use of EHR systems. Much of this work demonstrates that HIT can be used effectively in supporting health care delivery and improving quality and patient safety. Role of the National Coordinator for Health Information TechnologyExecutive Order 13335 directed the appointment of the National Coordinator for Health Information Technology to coordinate programs and policies regarding HIT across the federal government. The National Coordinator was charged with directing HIT programs within HHS and coordinating them with those of other relevant Executive Branch agencies. In fulfillment of this, the National Coordinator has taken responsibility for the National Health Information Infrastructure Initiative (NHII), the FHA, and the Consolidated Health Informatics Initiative (CHI), and is currently assessing other health information technology programs and efforts. In addition, the National Coordinator was charged with coordinating outreach and consultation between the federal government and the private sector. As part of this, the National Coordinator was directed to coordinate with the National Committee on Vital Health Statistics (NCVHS) and other advisory committees. The National Coordinator will collaborate with DoD, VA, and OPM to encourage the widespread adoption of HIT throughout the health care system. To do this, the National Coordinator will gather and disseminate the lessons learned from both DoD and VA in successfully incorporating HIT into the delivery of health care, and facilitate the development and transfer of knowledge and technology to the private sector. OPM, as the purchaser of health care for the federal government, has a unique role and the ability to encourage the use of EHRs through the Federal Employees Health Benefits Program, and the National Coordinator will assist in gaining the complementary alignment of OPM policies with those of the private sector. Reports from OPM, DoD, and VAThe Executive Order also directs the OPM, the DoD, and the VA to submit reports on HIT to the President through the Secretary of Health and Human Services. These reports are included in this report as Attachments 1 through 3. OPM administers the Federal Employees Health Benefits Program for the federal government and the more than eight million people it covers. As the nation's largest purchaser of health benefits, OPM is keenly interested in high-quality care and reasonable cost. The adoption of an interoperable HIT infrastructure is a key to achieving both. OPM is currently exploring a variety of options to leverage its purchasing power and alliances to move the adoption of HIT forward. OPM will be strongly encouraging health plans to promote the early adoption of HIT. Details on these options can be found in OPM's report, "Federal Employees Health Benefits Program Initiatives to Promote the Use of Health Information Technology" (Attachment 1). The VA, collaboratively with DoD, provides joint recommendations to address the special needs of these populations (Attachment 2). As mirrored in the DoD Report (Attachment 3), these recommendations focus on the capture of lessons learned, the knowledge and technology transfers to be gained from successful VA/DoD data exchange initiatives, the adoption of common standards and terminologies to promote more effective and rapid development of health technologies, and the development of telehealth technologies to improve care in rural and remote areas. The DoD has significant experience in delivering care in isolated conditions such as those encountered in wartime or overseas peacekeeping missions, which can be compared to the conditions in some rural health care environments. Examples of the technologies used in these conditions include telehealth for radiology, mental health, dermatology, pathology, and dental consultations; online personalized health records for beneficiary use; bed regulation for disaster planning; basic patient encounter documentation; pharmacy, radiology, and laboratory order entry and results retrieval for use in remote areas and small clinics; pharmacy, radiology, and laboratory order entry and results retrieval; admissions and discharges; appointments for use in small hospitals; and online education offerings for health care providers. Technology products, outcomes, benefits, and cumulative knowledge will be shared for use within the private sector and local/state organizations to help guide their planning efforts (see Attachment 3 for more details). The VA's report, "Approaches to Make Health Information Systems Available and Affordable to Rural and Medically Underserved Communities" (Attachment 2), also highlights its successful strategy to develop high-quality EHR technologies that remain in the public domain. These technologies may be suitable for transfer to rural and medically underserved settings. VA's primary health information systems and EHR (VistA and the Computerized Patient Record System [the current system] and HealtheVet-VistA, the next generation in development) provide leading government/public-owned health information technologies that support the provision, measurement, and improvement of quality, affordable care across 1300 VA inpatient and ambulatory settings. The VA continues to make a version of VistA available in the public domain as a means of fostering widespread development of high-performance EHR systems. The VA is also incorporating the CHI approved standards into its next-generation HealtheVet-VistA. Furthermore, the VA is developing PHR technologies such as My HealtheVet, which are consistent with the larger strategic goal of making veterans (persons) the center of health care. Finally, the VA's health information technologies, such as bar code medication administration, VistA Imaging, and telehealth applications, provide the VA with exceptional tools that improve patient safety and enable the increasingly geographically dispersed provision of care to patients in all settings. These and other technologies are proposed as federal technology transfer options in furtherance of the President's goals. ConclusionHealth information technology has the potential to transform health care delivery, bringing information where it is needed and refocusing health care around the consumer. This can be done without substantial regulation or industry upheaval. It can give us both better care - care that is higher in quality, safer, and more consumer responsive - and more efficient care - care that is less wasteful, more appropriate, and more available. The changes that will accompany the full use of information technology in the health care industry will pose challenges to longstanding assumptions and practices. However, these changes are needed, beneficial, and inevitable. Action should be taken now to achieve the benefits of HIT. A well-planned and coordinated effort, sustained over a number of years, can deliver results that will better support America's health care professionals and better serve the public. |
Last revised: July 23, 2004