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Letter Report
Letter Report
Pages 1-30
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Ebeler, Michelle Bruno, and Ted Schmitt, Editors
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2007. Opportunities for coordination and clarity to advance the national health information agenda: A brief assessment of the Office of the National Coordinator for Health Information Technology.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters.
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, Consultant, Reston, VA SUZANNE BAKKEN, Alumni Professor of Nursing and Professor of Biomedical Informatics, School of Nursing and Department of Biomedical Informatics, Columbia University, New York, NY J ROBERT BECK, Senior Vice President and Chief Academic Officer, Fox Chase Cancer Center, Philadelphia, PA PATRICIA FLATLEY BRENNAN, Moehlman Bascom Professor, School of Nursing and College of Engineering, University of Wisconsin–Madison ROBERT H
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SMITH, California HealthCare Foundation WILLIAM W STEAD, Department of Biomedical Informatics, Vanderbilt University Medical Center MARK TUTTLE, Apelon, Inc.
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To improve the adoption and implementation of standards for health IT, it recommends that the National Coordinator for Health Information Technology should: • Develop the strategic plan required by the Executive Order that established the office, providing a roadmap with specific objectives, milestones, and metrics for the national health information technology (IT) agenda.
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In response, IOM's Board on Health Care Services, in collaboration with the National Research Council's Computer Science and Telecommunications Board, convened the Committee on the Review of the Adoption and Implementation of Health Information Technology Standards by the U.S. Department of Health and Human Services Office of the National Coordinator for Health Information Technology (the Committee)
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, as well as those of the Healthcare Information Technology Standards Panel (HITSP) ; the American Healthcare Information Community (AHIC)
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The Office of the National Coordinator This section provides a brief description of the context in which the Committee made its assessment, and of ONC and its processes. In 2004, the President issued an executive order that called for the establishment of a national health information technology coordinator within the Office of the Secretary of Health and Human Services (Executive Order No.
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Key Health IT Standards Entities and Activities In addition to ONC itself, the key health IT standards entities and activities coordinated or supported by ONC discussed in this report are: • AHIC is a federally chartered advisory board created in 2005 to make recommendations to the Secretary of Health and Human Services on how to accelerate the development and adoption of health IT. Bringing stakeholders from pertinent areas together to analyze the issue, it originally identified four areas with potential for early breakthroughs in the advancement of standards toward interoperability (population health and clinical care connections, consumer empowerment, chronic care, and electronic health records)
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ONC views NHIN as a "network of networks," built out of state and regional health information exchanges and other networks to support the exchange of health information (HHS, 2007b)
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Ultimately, the pace of progress toward the goal of having in place interoperating electronic health records by 2014 is more important than the pace of ONC's health IT standards activities processes. The Committee believes that, in general, the activities coordinated by ONC should proceed as rapidly as feasible because nothing less than the public's health is at stake in the establishment of a national health information infrastructure.
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In his presentation to the Committee, the National Coordinator, Dr. Robert Kolodner, stated that although a number of strategic documents exist, there is currently no detailed strategic plan with strategic targets or deliverables.
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Accordingly, the Committee recommends that: The National Coordinator for Health Information Technology should clarify and improve the Office of the National Coordinator's processes for advancing the national health information technology agenda -- specifically, processes for decision making, workflow, coordination, and feedback. The specific areas for clarification and process improvement include: • Decision-making processes.
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Presenters also suggested that ONC could improve coordination among its standards activities and with other efforts, activities, processes, and entities. For example, better coordination with state and regional activities would allow ONC to take better advantage of advances being made by state and regional initiatives and foster interoperability nationwide.
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CONCLUSION To improve the adoption and implementation of standards for health IT, the Committee recommends that the National Coordinator for Health Information Technology should: • Develop the strategic plan required by the Executive Order that established the office, providing a roadmap with specific objectives, milestones, and metrics for the national health IT agenda. • Clarify and improve the Office of the National Coordinator's processes for advancing the national health IT agenda -- specifically, processes for decision making, workflow, coordination, and feedback.
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. Further, Rewarding Provider Performance calls for "pay for performance" in Medicare, and points specifically to the linkage between such payment changes and other conditions, such as the use of electronic health records, in driving system improvement (IOM, 2007)
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2007. Standards activities: Health Information Technology Standards Panel, http://www.ansi.org/standards_activities/standards_boards_panels/hisb/hitsp.aspx?
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. ONC (Office of the National Coordinator for Health IT)
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He trained in anatomic and clinical pathology at the DartmouthHitchcock Medical Center, followed by a fellowship in clinical decision making at the Tufts-New England Medical Center. He has held positions in blood banking, clinical pathology, and biomedical informatics at Dartmouth, the Oregon Health Sciences University, and Baylor College of Medicine before coming to Fox Chase.
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At Kaiser, he is also the physician lead for the enterprise terminology services team, responsible for deploying SNOMED in their national electronic health record. He is a member of the Health Level 7 (HL7)
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and is the 2002 recipient of the National CIO 20/20 Vision Leader Award. She is a member of the Healthcare Information Management and Systems Society, the Healthcare Advisory Council, the American Medical Informatics Association, and Educause.
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His interests in medical computing include web-based heterogeneous medical record systems, life-long personal health information systems, and design of cryptographic schemes for health identifiers. He teaches classes in artificial intelligence, programming languages, medical computing, medical decision making, knowledge-based systems, and probabilistic inference.
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, Department of Health and Human Services Rob Kolodner, National Coordinator, ONC John Loonsk, Director, Office of Interoperability and Standards, ONC 12:30 – 1:30 Lunch Speaker The HIT Standards Experience in Canada Dennis Giokas, Infoway Jamie Ferguson,* Kaiser Permanente 1:30 – 1:45 1:45 – 3:15 Key Activities Underway as Part of ONC Standards Efforts American Healthcare Information Community (AHIC)
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10 minutes for presentation and 5 minutes for Q&A per panelist Brian Kelly, Accenture Robert Tennant,* Medical Group Management Association 4:00 – 4:15 4:15 – 5:15 Existing HIT Standards Landscape 10 minutes for presentation and 5 minutes for Q&A per panelist Wes Rishel, Gartner Consulting Chris Chute, Mayo Clinic Virginia Lorenzi, New York Presbyterian Hospital Chuck Jaffe, HL7 5:15 – 5:30 Rob Kolodner, National Coordinator, ONC Follow-up Q&A with the committee Monday, September 17, 2007 8:30 – 10:00 Healthcare IT Vendors 10 minutes for presentations by each panelist, followed by 30 minutes for Q&A Charles Mead, National Cancer Institute through Booz Allen Hamilton Donald Rucker, Siemens Medical Solutions John Travis, Cerner Bruce Greenstein, Microsoft Hugh Zettel, General Electric Global Health Tim Leery, HIMSS/EHRVA 10:00 – 10:15 Break 25
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10:15 – 11:15 Institutional Healthcare IT Implementers 10 minutes for presentations by each panelist, followed by 20 minutes for Q&A Richard Umbdenstock, American Hospital Association Melanie Allison, CalRHIO, CTO Devore Culver, Maine HealthInfoNet Jan Root, Utah Health Information Network 11:15 – 12:00 Insurers and Plans 10 minutes for presentations by each panelist, followed by 15 minutes for Q&A Jeanette Thornton, America's Health Insurance Plans Joseph Smith, Arkansas Blue Cross Blue Shield Hayes Abrams, Blue Cross Blue Shield of Illinois, Texas, New Mexico, and Oklahoma 12:00 – 1:00 Lunch Break 1:00 – 2:00 Fostering Patient Participation, Protecting Privacy and Public Health 10 minutes for presentations by each panelist, followed by 20 minutes for Q&A Joy Pritts, Georgetown University Sam Karp, California Healthcare Foundation Stephen Downs, Robert Wood Johnson Foundation Carol Diamond, Markle Foundation 2:00 – 2:30 10 minutes for presentations plus 5 minutes for Q&A per person Lee Partridge, National Partnership for Women & Families Mark Frisse, Vanderbilt University 2:30 – 3:30 Healthcare IT Standards and the Medical Professional 10 minutes for presentations by each panelist, followed by 30 minutes for Q&A Bill Bria, Association of Medical Directors of Information Systems Don Mon, American Health Information Management Association Peter Basch, MedStar Health Clem McDonald, National Library of Medicine; Regenstrief Institute 3:30 – Public Comment Period Trish Hughes, MinuteClinic, Inc.
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Appendix D List of Abbreviations AHIC – American Health Information Community CCHIT – Certification Commission for Healthcare Information Technology EHR – Electronic Health Record GAO – Government Accountability Office HITSP – Health Information Technology Standards Panel HHS – Department of Health and Human Services IOM – Institute of Medicine IT – Information Technology NHIN – Nationwide Health Information Network OMB – Office of Management and Budget ONC – Office of the National Coordinator for Health Information Technology RHIO – Regional Health Information Organization SDO – Standards Development Organization 27
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In fulfilling its responsibilities, the work of the National Coordinator shall be consistent with a vision of developing a nationwide interoperable health information technology infrastructure that: (a) Ensures that appropriate information to guide medical decisions is available at the time and place of care; (b)
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(a) The National Coordinator shall, to the extent permitted by law, develop, maintain, and direct the implementation of a strategic plan to guide the nationwide implementation of interoperable health information technology in both the public and private health care sectors that will reduce medical errors, improve quality, and produce greater value for health care expenditures.
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The Director of the Office of Personnel Management shall report within 90 days of this order on options to provide incentives in the Federal Employee Health Benefit Program that will promote the adoption of interoperable health information technology; and (b) Within 90 days, the Secretary of Veterans Affairs and the Secretary of Defense shall jointly report on the approaches the Departments could take to work more actively with the private sector to make their health information systems available as an affordable option for providers in rural and medically underserved communities.
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