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The US Stimulus Package and Investment in the American Health Care Information Infrastructure

 
医療・介護 2010年12月15日

Rapid Access International, Inc.

November 2010

http://www.rapidaccess.com/

Background:

The American Recovery and Reinvestment Act (the “US Stimulus Package”) is being used as the primary funding vehicle for the development of a nationwide medical records and information system called the Nationwide Health Information Network (NHIN). This program falls under an Act entitled the Health Information Technology for Economic and Clinical Health (HITECH) which promotes the use of health IT via the Internet and other delivery mechanisms. Congress is currently offering healthcare-providers $27 billion in electronic health- record subsidy money. This will create a new national network of health care information and its development has taken on a new urgency.

The NHIN is a program to facilitate the exchange of data across organizational and geographic boundaries as well as through health information service organizations including: federal government agencies (such as the National Institutes of Health), delivery systems (such as data providers or software companies), health plans (such as Blue Cross / Blue Shield), providers (doctors and nurses), pharmacies, laboratories, and other health care providers with a need to access or view a patient’s medical information. In order to build the National Health Information Network, the Office of the National Coordinator for Health IT was developed in order to make sure communication between two point-to-point entities (or members of the NHIN) can occur.

Key Features of the NHIN Program

There are two main features of the NHIN program called “Direct” and “Exchange”. The “Direct” feature allows a doctor or a healthcare provider to have “direct” or two-way communication with one other party (such as the patient or the pharmacy) to release information from a given person’s data file. It is a “point-to-point” exchange of information system between two parties. It is also used by laboratories to send the results of a lab test to the doctor or physician, for example.

The “Exchange” feature supports many types of “multiple” enquiries and is a network of data (in a way it is a type of Intranet) within the larger health data environment. The exchange of data over the Exchange network is secure and is available to more simultaneous users than the “Direct” program. Typical users of the Exchange network include state and regional health information organizations, integrated delivery systems, health plans, federal agencies, and other large organizations). The Exchange network provides for:

  • An Internet-based network for the secure and encrypted communication of data;
  • Reliability and assurance that only valid and trusted users can participate in;
  • Legal agreements and disclaimers to protect privacy and security and to protect the user;
  • Governance activities to define activities, roles and responsibilities.

Key benefits of earlier prototypes of the NHIN that were developed starting in 2004 include:

  • The ability to find and extract health information among a wide and diverse group of health organizations.
  • The delivery of appropriate date to the correct recipients.
  • Ability to provide user identity information, authentication of users, and authorization to use the system.
  • Ability to match patients to their data without a national patient identifier number.

During a second phase of the NHIN prototype project conducted in 2007 and 2008, new sources of data were added to the population of information content including:

  • Emergency responder electronic health records;
  • Lab results (blood work, urine samples, etc.)
  • Management of medication
  • Access to clinical information by patients;
  • Medication history
  • Quality of care
  • Bio surveillance (such as DNA testing, cancer screening, etc.)

The Opportunity:

The development of the NHIN will bring jobs and new technologies to the health care sector as well as streamline and radically reduce the management of paperwork in the management of healthcare data. The NHIN brings together a wide spectrum of information providers, doctors and nurses, hospitals, pharmacies and other contributors to the healthcare market. It also has opened up new opportunities in software development for the management of digital health files as well as data storage and other IT industries. Eventually, a majority of US healthcare information will be available through this online digital medium through systems that protect the privacy of the patient.

Key Advantages of Managing Health Care Records in an Online Environment:

There are a number of benefits for managing health care records online including:

  • Ability to quickly identify and retrieve patient information in an Internet-based environment;
  • Lowered cost of managing healthcare administration;
  • Expanding market to include many health care professionals and service organizations;
  • Speed of access to patient records and information in emergency situations;
  • Reduction of paper costs, mailing costs, and telecommunications costs.

Challenges:

  • A key problem is the reluctance of many US citizens to have their healthcare information digitized and made available over the Internet. The healthcare providers have promised security of the information through the use of computer encryption, firewalls, and other protective measures, but many US citizens are concerned about privacy and security.
  • Much of the adoption of the NHIN is not at the federal level, but at the state or local level, and this means compliance and regulatory issues need to be overcome.
  • Inability to access critical information that may not be on the system or in the network or has not yet been digitized.
  • How to handle “legacy” data or medical records from the past that are only available in hard copy files.

Some Examples of Early Adopters of the NHIN Include:

US Department of Veterans Affairs (http://www.va.gov). This agency is an obvious target for the testing of a new system for the digitization of health information. With the US involved in a global war on terrorism, many wounded veterans are returning home and need to have more efficient access to healthcare information for immediate treatment as well as the follow up and care of wounded veterans over several years. This includes management of pharmaceutical prescriptions, outpatient care (means when a patient takes care of their illness from home or through a small clinic), psychiatric records, etc.

The State of Indiana (http://www.in.gov). The State of Indiana was the first state to use the NHIN “Exchange” for public health information. The initial test involved sending data on influenza and pneumonia data to the Center for Disease Control (CDC).

MedVirginia (http://www.medvirginia.net). This organization was founded in 2000 by various Virginia healthcare providers to focus on the quality, safety, and efficiency of healthcare services through the use of Information Technology. The organization is owned by Virginia not-for-profit hospitals and physicians who represent a wide cross-section of Virginia’s healthcare delivery system. MedVirginia uses technical solutions to collect data from hospitals, physicians, labs, and pharmacies and make this data easy to read and view in a user-friendly secure web portal. MedVirginia was the first organization to be live on the Nationwide Health Information Network (NHIN) and is a leader in the use of IT in the medical information environment. MedVirginia has partnered with IBM to help develop many of its IT solutions.

Sources used for this article include:

California HealthCare Foundation
The Advisory Board Company
Modern Healthcare

Key Words:

Data Storage
Online medical Records
E-Health
MedVirginia (http://www.medvirginia.net)
US Department of Veterans Affairs (http://www.va.gov)
State of Indiana (http://www.in.gov)
IBM

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