Sunday, June 6, 2010

Capitol Hill Event

The Congressional Luncheon Seminar coordinated by the Institute for e-Health Policy on June 2nd, addressed several high level issues related to data. As Neal Neuberger, Executive Director of the Institute and moderator for the event said, “Data is critical and key to so many processes plus it is at the core of many issues related to healthcare reform.”

Looking at data from the federal viewpoint, J. Michael Fitzmaurice, PhD, Senior Science Advisor for Information Technology at AHRQ, explained how AHRQ’s U.S. Health Information Knowledgebase (USHIK), is populated with data elements and information models from standards development organizations and other healthcare organizations.

The specific goal for USHIK is to coordinate the data elements and the metadata from health data standards that the HHS Secretary endorses. USHIK supports the implementation of data standards for HIPAA, the Consolidated Health Informatics initiative, and for the Health Information Technology Standards Panel (HITSP) and links to all use cases, interoperability specifications, and other documents.

In addition, USHIK contains specifications needed to electronically report patient safety events to patient safety organizations, to the public, and also reports data element specifications from the states and their all-payer data base. To date about 11 states have gone live with all-payer claims databases to helps consumers with specific payment information. USHIK is now developing a two state pilot with information available from their State All-Payer Claims Databases.

AHRQ contracted with DCG Inc. and Abt Associates to produce detailed specifications for meaningful use quality measures, to provide an information model for meaningful use quality measures, and to develop a pilot USHIK portal with the required data elements based on that information model.

The lessons learned from the development of USHIK is that it is important to use an information model, trade off the value of what USHIK supplies against the cost of supplying it, understand that intellectual property has value, and work to anticipate the needs of the users

Kasey Benton Poon, M.D., Internist in Salt Lake City, discussed how to make data actionable for research, decision support, for reimbursement, meaningful use, and information exchange. He stressed that this can be achieved by using structured, encoded, and interoperable data in the electronic health record.

Dr. Poon emphasized that the first step is to adopt standards. The next step is to address the levels of interoperability in terms of basic and functional interoperability along with semantic interoperability to be able to establish explicit meaning and context. This is done by using the same set of codes to encode data throughout a system to use in hospitals, organizations, regions, the country, and the world.

He recommends the use of the 3M Healthcare Data Dictionary (HDD) as it provides a single source for information, is interoperable, complies with standards, and addresses meaningful use. HDD provides a controlled medical vocabulary with a collection of clinical concepts organized to support synonyms and other lexical characteristics, a knowledge base showing the relationships among concepts, and a medical information model. All of this information is used to establish clinical context, provide alerts, and support medical decisions.

Mark Rempe, as Vice President, for Record Center Operations for North America for Iron Mountain, Inc., pointed out that the company has a large healthcare focus and does $260 million in digital archiving and backup business.

According to Rempe, a major problem in dealing with information is that patient information is trapped in silos resulting in higher costs but not better care. The approach needed is to connect disparate patient records by breaking down the information silos and by consolidating patient information currently stored in different systems.

As Rempe views the situation, the cost of patient recordkeeping is enormous and rising with hospitals continuing to struggle as they move to the EHR. However, if workflow and process issues are addressed, then there will be an opportunity to reduce costs, improve service, establish the correct infrastructure, and permit the healthcare system to transition to a fully digital environment.

Bart Harmon, M.D., MPH, Chief Medical Officer at Harris Corporation, described how important the collection of medical data can be and how it affects the individual. For example, his 90 year old mother has a complex medical history, takes a number of medications, plus sees several doctors. Today, like his mother, most patients have to act as their own health record and fill out forms with all the information for each doctor for every visit. This process is always the same with the patient since they are always entering and reentering data.

Both patients and providers are now requesting better ways to process and obtain information. The goal is to have one central record but at the same time, the economic model must be viable and storage must be provided cheaper and faster.

Progress is being made with the development of NHIN, an interoperable health information infrastructure to connect providers, consumers, and others to support health and healthcare. NHIN Connect an open source software solution is in process to exchange health information both locally and at the national level.

Dr. Harmon summed up by saying that while government systems and big organizations can be innovative, small practices and rural communities are getting left behind and not getting the attention needed. As a result, small groups and rural areas find it difficult to be innovative especially since the reimbursement model without incentives makes it very difficult.

Be sure to attend the “Health Information Technology Showcase and Demonstration” as part of National HIT Week in Washington. This event will be held on June 17th, 10:00am to 3:00pm in room SD-G50 Dirksen Senate Office Building.

For more information, email Neal Neuberger, at