Toward a National Health Information Infrastructure: A Key Strategy for Improving Quality in Long-Term Care. A. A National Health Information Infrastructure

05/01/2003

Demands for readily available health care information have increased dramatically in recent years. Demographic changes such as an aging population with increased chronic illness and a more mobile population have created needs for larger volumes of health information and more easily transferable information. Most recently, concerns about bioterrorism have focused attention on the need for a public health information infrastructure with the capability of providing aggregated information on a real-time basis. The delivery of cost-effective, high quality health care in order to meet national goals for healthy people and healthy populations is now clearly linked to the availability of information.

The NCVHS is a public advisory committee authorized by statute to advise the Secretary of Health and Human Services on national health information policy. It concluded in its NHII report that "implementation of the NHII will have a dramatic impact on the effectiveness, efficiency, and overall quality of health and health care in the U.S." (p. 2). Presently, health information is typically maintained in paper records, in many locations for each patient, including: physician offices, laboratories, hospitals and departments within hospitals (e.g., radiology departments), and with post-acute care providers such as nursing homes and home health agencies. Paper medical records are difficult to read, poorly organized, and are frequently incomplete or unavailable. These problems are particularly pronounced for nursing home patients, who frequently have chronic health conditions and may be transferred to and from providers across the health care continuum.

The vision of the NHII is premised on a foundation of sharing relevant information and knowledge appropriately so that it is available to people when they need it to make the best possible health decisions. The argument put forward by the NCVHS was that with federal leadership as the cornerstone, human, institutional, and technological factors could be developed and brought together in way that enables many forms of communication and support for personal, provider, and public health concerns. The NCVHS report provided examples of how the NHII could improve the quality of health care:

For Consumers

  • Real time remote medical consultations wherever the person is located,
  • Online search for health information and looking for health care providers,
  • Management of one's own health care needs and their health care decision making;

For Providers

  • Providing access to more accurate and complete real-time patient data,
  • Using clinical guidelines and protocols concurrently with the patient care process,
  • Preventing adverse events by providing real time practice warnings to clinicians integrated with the patient care process,
  • Supporting continuous quality improvement processes by providing more complete and comprehensive clinical data for outcomes analysis;

For Public Health/Regulators

  • Improving the ability to identify, monitor, and respond to health problems,
  • Accessing and reporting data needed for public health,
  • Increasing the scope, effectiveness, and efficiency of clinical research.

Key characteristics of the NHII include data capture, storage, processing, and presentation of health information, all within secure, confidential environments. Examples of the desired functionality that would result from a fully implemented NHII include:

  • Universal use of electronic medical records that capture all health information regardless of the setting in which a patient is receiving services;

  • The ability to send and receive messages across health care settings and communities about a patient's health status whenever and wherever needed;

  • Automatic electronic reporting to public health for early detection and response to unusual health patterns (such as bioterrorism);

  • The provision of real-time clinical decision support (for example, about the efficacy of certain drug treatments or the effectiveness of particular interventions) to health care professionals allowing more rapid widespread application of research findings in routine patient care;

  • The ability to aggregate non-identified patient care information to rapidly provide evidence regarding the outcomes and efficacy of health interventions;

  • The ability to more accurately and promptly monitor quality of health care services; and

  • Reducing the administrative burden on health care practitioners associated with filling out forms, thus allowing providers to focus on delivery of services.

Key to achieving such functionality is point of service documentation in electronic record systems. For example, clinical decision support systems can be developed that "trigger" alerts related to needed assessments or suggest interventions that reflect best practices known to influence quality outcomes. But first, relevant data needs to be documented and coded in a uniform manner so that it can be mapped from the clinical data to an electronic knowledge base.

It is important to recognize that the NHII does not describe a centralized database of patient information. Rather, the vision is for distributed health information built on a framework within secure networks with strict confidentiality protections. Given this system architecture, health information could be stored in many locations: electronic record systems in provider offices and health care facilities, organizational databases, personal health cards, etc.

The rapid development and deployment of new information technologies enable data to be captured at the point of acquisition, and then stored, indexed, and retrieved in electronic formats for selective use as required across multiple settings, health care systems, and software applications. This means that if clinical data are carefully structured and encoded in a uniform manner, those data can be electronically transferred, shared, exchanged, and meaningfully used to support a variety of uses such as decision support, quality assessments, individual patient or population surveillance and outcomes analyses, or regulatory reporting. The vision is for the algorithmic retrieval, aggregation, and reuse of data from clinical records to meet multiple needs. Achieving such "interoperability" across systems and applications requires agreement on and adoption of standards for health information systems.

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