Posts Tagged ‘NHIN’

A Few Reflections from the National Health Information Network Forum

December 18th, 2008 | Popularity: 26%
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One of the great advantages of living in Washington, DC, is access to lots of great (and affordable) learning opportunities, and this week’s National Health Information Network Forum was one of them.

The most important thing I learned is that there is one (a NHIN), and through the days’ demonstrations that progress is being made. I should qualify my comments with the fact that a good family practitioner knows what they don’t know, and this part of HIT is not central to my area of expertise, which is more focused on interactions closer to patients and providers in large heathcare systems.

In any event, I livetweeted my impressions on the fly, which you can read here, and will add some bullet points:

  • As a learning session, the Forum was executed really well. Scripts were prepared and there were teams of people accessing live systems on the side (see photographs) while panelists described what was going on.
  • A bright spot for me was to learn (more) about our Surgeon General’s Family History Initiative . It is going to enter a “2.0″ stage in January, 2009, and seems to have all of the abilities that could make this very simple genetic test (family history) more widely available in health care, including being open-source based, brandable, and based on standards. I especially applaud this effort because one of the great things about family history is that it is a test that involves listening to patients – the act of obtaining the information as well as using it is therapeutic in my opinion.
  • I got to see some of the use cases I have studied, like the Consumer Empowerment Use Case, acted out using real systems. The patient experience was followed from PHR through to physician’s office through to NHIN and back. This was impressive.
  • I saw a session on the Emergency Responder Use Case which did not cover the area that I’ve had a little bit of interest in on the personal health record side of things, the times when the responder encounters someone who cannot provide identifying information. As I have discussed previously, this is an area where personal health records linked to other identifying information (consented to by the patient) such as vehicle identification number or employee identification, may improve the ability to provide care in emergency situations. Beyond that specific situation, however, interagency/provider connections were demonstrated well.
  • I saw good demonstrations of health information exchange across various boundaries. It would be interesting to see some of these great projects in the communities where they are being used.
  • It would be great in the future if there were unaffiliated patients on panels, and if groups also talked about how they involved patients in the development of their work.

Overall, I am very thankful for the generosity of our Department of Health and Human Services for putting this public forum together. Many of the comments and thinking were well received by me, such as Secretary Mike Leavitt’s comment that the days of test results delivered at the convenience of the physician should end.

Photos at the top of this post, click on any to see larger.

“Developing Trust Agreements to Support Exchange of Health Information” Steven D. Gravely, M.H.A., J.D.

December 16th, 2008 | Popularity: 12%
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Data use and reciprocal support agreement (DURSA)

December 15th, 2008 | Popularity: 15%
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Verizon Pill Phone for Adherence; A Place for NHIN News; Lee Aase’s Social Media University; Merck and Web 2.0

April 29th, 2008 | Popularity: 34%
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Now Reading: Gauging the Progress of the National Health Information Technology Initiative: Perspectives from the Field

February 3rd, 2008 | Popularity: 35%
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The highly respected California Healthcare Foundation has been putting out an impressive array of topical work in the health information technology lately, and I thought this one deserved its own post.

The piece, Gauging the Progress of the National Health Information Technology Initiative: Perspectives from the Field, is a summary of activities to date in the United States’ Health Information Technology Adoption Initiative along with interviews of nearly two dozen leaders and experts in the HIT community about progress to date. If, like me, you eagerly read the initial “Decade of Health Information Technology” document when it came out in 2004 and were filled with hope, this piece is definitely for you. Even if you didn’t read the initial document, this piece will get you up to speed, because it describes the four cornerstones of the HIT initiative and talks about what has happened since.

And how’s the news? Mixed. It appears that success has been achieved in creating awareness globally, and in the cornerstone of certifying electronic health records (I should mention here that I am on one of the Foundation Workgroups for the Certification Commission for Health Information Technology).

I am studying a lot of LEAN Hoshin Kanri principles right now, so visual rating systems are on my mind. If I were therefore going to create a visual for the cornerstones, based on what I read here, I would put a Red light (danger) next to Nationwide Health Information Network, Red light next to adopting interoperability standards, Green light next to certifying EHRs, and Yellow light next to Reconciling laws.

There isn’t a lot of clarity about what we mean by HIT, as the paper highlights. Does this mean that consumers/patients will use an EHR because they have access to a PHR? We can’t know because we aren’t there yet. That’s the bad news.

There’s some good news, such as this nice quote from Carolyn Clancy, MD, of AHRQ:

If there was a tipping point here, my guess is it was probably Kaiser [Permanente] turning to Epic [Systems Corporation]. I think what a lot of people are beginning to see is that these investments can actually change the nature of health care to a series of transactions that are far more proactive, that can happen right now even without payment reform.

On the not so good side, there is more debate about the role of interoperability as a priority, or even as a separate cornerstone. From what I read, I think this article gets tagged in my growing collection of what I call “HIT_before_HIE,” which are the voices of a growing number of experts who question the value of pursuing interoperability before operability. Feel free to peruse the collection in the link cloud I have set up on the topic:

http://del.icio.us/tedeytan/HIT_before_HIE

What has my own experience been during this time? Well, in the time period from 2004-2007, I was involved in implementing one of the world’s largest personal health records, and a successful statewide electronic health record, in an organization that shares a lot of the “ideal” characteristics of care model that Kaiser Permanente does. I have seen that it can be done. I was also involved in the setting up of a Hoshin Kanri system to guide strategy deployment, to make sure that we got the right things done in maintaining and further developing our HIT capabilities.

In my sabbatical experience, I have seen that the desire is as strong as it is within the walls of my organization, but it is not happening at the same pace. This is why I take works like this seriously – the results I see in my on the ground work corroborate what is said here.

In addition, I find some congruence between the opinions of the experts in the article and my experience at the recent Joint Commission Roundtable in Chicago, where I learned about the paths to success in HIT in peer countries. Each has a strong public commitment to HIT.

There is more to be done. One of the comments I made in Chicago was that 4-14 % adoption for EHRs in small practices is too low for 2008. It’s too low for 2005. I wonder about prioritizing EHR with PHR adoption and studying work to quantify the value of incentives that has already been done (see Roger Taylor et al., “Promoting Health Information Technology: Is There A Case For More-Aggressive Government Action?,” Health Aff 24, no. 5 (September 1, 2005): 1234-1245, http://content.healthaffairs.org/cgi/content/abstract/24/5/1234. ). I also wonder about applying LEAN methodology to the strategy and deployment of HIT policy by our government. I think a Hoshin Kanri approach would make a difference by establishing focus and a sustained deployment plan.

Thanks for reading my thoughts. I welcome your comments.