FAQs about NHII
The National Health Information Infrastructure (NHII) is:|
an initiative set forth to improve the effectiveness, efficiency and overall quality of health and health care in the United States
a comprehensive knowledge-based network of interoperable systems of clinical, public health, and personal health information
that would improve decision-making by making health information available
when and where it is needed.
the set of technologies, standards, applications, systems, values, and
laws that support all facets of individual health, health care, and
NOT a centralized database of medical records or a government regulation
To improve patient safety (alert for medication errors, drug allergies, etc)|
To improve healthcare quality (includes having the availability of complete medical records, test results and x-rays at the point of care, integrating health information from multiple sources and providers, incorporating the use of decision support tools with guidelines and research results, etc)
For Bioterrorism detection (NHII will enable real-time aggregation of health data to detect patterns)
To better inform and empower health care consumers regarding their own personal health information
To better understand health care costs
|The NHII dimensions are represented by three overlapping circles, each representing a particular focus with overlap into the adjacent areas. Additionally, the scope would include healthcare research. The three dimensions are:|
Personal Health-includes a personal health record that is created and controlled by the individual or family, plus non-clinical information such as self-care trackers and directories of health care providers. The confidentiality of personal health records and consumers' control over their own records are basic tenets of this vision, consistent with the HHS privacy regulations.
Health care delivery -includes information such as provider notes, clinical orders, decision-support programs, digital prescribing programs, and practice guidelines. Healthcare providers will retain responsibility for their own patients' medical records.
Public health-enable sharing of information to improve the clinical management of populations of patients such as vital statistics, population health risks and disease registries.
The nature of health care: |
Health care is a large sector of the economy that involves multiple provider associations, health systems, payer organizations, consumers, and local, state, and federal agencies. It is highly fragmented and largely delivered by the private sector. Medical information is complex and there are few incentives in place for information sharing. Organizational and change management issues are also difficult to manage in a clinical environment.
The nature of Information Technology in health care:
Information Technology is expensive and it has been difficult to generate the capital needed for IT investment. It is often regarded as an add-on cost.
Connectivity -electronic connections must exist among all providers and institutions. Currently there is fragmented use of technology with minimal interoperability, legacy systems, etc
Standards for content (how the meaning of medical terms are represented) are not yet agreed upon nor are the standards for how messages are to be sent and received.
Information capture -it is difficult to capture medical information in machine readable form
Privacy and security has not yet been assured--authentification of users, data encryption, etc must be in place
Lack of Standards (prevents interoperability and sharing of data) |
Lack of Incentives (value of collecting data electronically not appreciated at the point of care)
Insufficient Funding (refers to the funding of projects that lead to improved health care delivery using measures of better quality, improved patient safety and reduced costs based on evidence.)
Privacy concerns (security and confidentiality)
The stakeholders include the Federal Government, State and local
governments, Health care provider organizations, Health care provider
membership and trade organizations, Health care plans and purchasers,
Standards development organizations, the information technology industry,
consumer and patient advocacy groups, community organizations and academic
and research organizations. It is essential for all stakeholders to
participate in developing the national action plan.
The major role is one of leadership--a facilitator in the
development of NHII to bring about the collaboration between
stakeholders in the private and public sectors and among all
levels of government. The federal government can play a major
role in helping to adopt Standards for communication and
interoperability between systems, incorporate Privacy and Security
matters, and fund projects where there is evidence that specific
projects have benefited health care. At HHS, The National
Committee on Vital and Health Statistics (NCVHS) serves as a
public advisory committee to the Secretary of Health and Human
Services on national health information policy. Their
report "Information for Health: A Strategy for
Building the National Health Information Infrastructure"
released in November 2001 outlines a vision and a
process for building the NHII. Complete report available at:|
The objectives of NHII can be met by:|
Using Information Technology to enhance connectivity and knowledge sharing (via appropriate system architecture and use of data standards)
Fostering collaboration between the public and private sectors (include all relevant stakeholders in the health sector--patients, citizens, practitioners, public health officials, managers, policy-makers, and researchers.)
Encouraging capital investment and promoting market-based solutions
Having the federal government assume a leadership role in guiding its development though appropriate funding, use of incentives, application of standards with attention to privacy issues (confidentiality and security)
Using evidence of effectiveness (patient safety, quality, cost, access) to guide future directions in changes to our health care system.
Providing incentives for collecting data electronically
Using "Lessons-learned" from other National systems (Canada, United Kingdom, Australia) and ongoing projects.
|The NCVHS report outlines a three-stage process over 10 years
for achieving the vision. The first stage (within 2 years) includes developing
leadership within the Department of Health and Human Services (HHS)
and other agencies and fleshing out the vision for implementation
and policy. The second stage (within 5 years) focuses on building collaboration
among stakeholders. The third stage (within 10 years) involves carrying out the plan
in all relevant public and private sectors.
|The NHII website from the US Department of Health and Human Services will be a resource for ongoing projects,
meetings and documents relevant to this initiative. It can be found at:|
Public meetings of the NCVHS NHII working group can be found at: