Ladies and Gentleman, I am Bert Reese, Chief Information Officer for Sentara Healthcare, Norfolk, Virginia. Sentara Healthcare is a 1.6 billion-dollar organization consisting of six hospitals, twelve nursing homes, an insurance company (300,000 members) employed physicians and other healthcare related entities. I am here today on behalf of the National Alliance for Health Information Technology (NAHIT). NAHIT is a group of approximately seventy organizations representing providers, payers, technology vendors and supply chain organizations that are committed to "mobilize the field to address the fragmentation and lack of coordination in healthcare…improving quality and performance through standards-based information systems." We are pleased to have the opportunity to testify on an issue of critical importance for the healthcare industry and the people they serve.
Sentara is a founding member of the NAHIT and is committed to the initiatives of the Alliance. Today I would like to describe NAHIT’s case for action, mission statement, expected outcomes and strategic directions to the NCVHS and begin a conversation with you about how the work of NAHIT can dovetail with the work of the NCVHS.
The adoption and application of information technology is essential to reform healthcare and meet the needs of patients in the coming decades. By harnessing the power of information technology for the health care field, we can enhance the effectiveness of the care we provide; achieve patient-centered coordinated care; advance quality and patient safety; increase workforce productivity and satisfaction; streamline payment-billing and administrative systems; efficiently manage assets and resources; and meet consumer expectations for service and access to information.
When the American Hospital Association (AHA) conducted an 18-month, long range planning process, information technology emerged as a critical element to achieve new models and real reform in our health care system.
But health care trails almost every other field in information technology application because of a lack of consistent and uniform standards and protocols, and a make-up of multiple scientific disciplines and medical specialties, with individual, specific technical requirements and demands. As a result, health care information technology is fragmented, with isolated systems and databases.
To improve the situation, we need to approach the process more strategically. The 2001 Institute of Medicine report, "Crossing the Quality Chasm," calls for "a national consensus on comprehensive standards for the definition, collection, coding and exchange of clinical data." Compared to other fields, health care has been slow to achieve this consensus. Our limited investment in information technology has not achieved as significant an improvement in patient outcomes and operational efficiencies as it might have if we had achieved better integration of existing technologies through standardization.
Now is the time for all partners involved in health care delivery--hospitals, health care systems, clinics, providers, payers, vendors, and government organizations-- to develop and implement standards-based information systems, for safer and more effective, efficient patient care.
The adoption of standards by the industry would provide much needed simplification within organizations like Sentara. We currently spend over $600,000 annually in resources focused on integrating products and systems from various vendors. Approximately 60% of this is directly attributable to the need to massage data when moving from one system or environment to another. We currently run interfaces to or from approximately forty systems with over one hundred and thirty actual system connections. The variability of the standards and/or lack of standards prevent systems from talking directly thus requiring technology (integration engine, enterprise indexes, data dictionaries, etc.) to arbitrate data issues between systems. The adoption of a new standard with the ability to support the vast data needed in healthcare, yet provide the consistency necessary to move toward consolidated repositories of clinical information.
Our experience with healthcare data standards, where they exist, leads us to believe that the term guideline would be more accurate. In order to gain industry acceptance the standards are not as rigorous as in other industries. This flexibility/variability allows “tweaking” among vendors, payers and healthcare providers implementing standards into their systems. The impact of these implementation variances among vendors, healthcare providers and payers causes hospitals, health systems, vendors and other information technology stakeholders to spend significant resources translating or transforming from one “standard” to another. The main problem being that because of the lack of precision in these standards, two implementations of the same data can be different, but within the “standard”. Even compliant systems may need customization to achieve full interoperability for a healthcare provider.
Other industries have been more successful in adopting more precise standards. This adoption allows those industries to interoperate at a much more efficient level. The “publish and subscribe” model works very well in industries that have these standards. This model allows for one system to publish a message and those systems interested can simply subscribe to the appropriate messages. This model typically does not have the need for significant translation and/or transformation since either the industry has agreed on a standard or one has been mandated. From the National Alliance for Health Information Technology perspective it is essential that we dramatically improve the integration among the systems in order to continue to provide the best care possible to our patients.
Apply bar coding technology, which has been used for decades in the grocery business and is now used extensively in service and manufacturing sectors. Why can't health care use it as well? More collaboration is needed to standardize information and codes necessary for its effective use in the health care field.
Multiple vendors with differing systems and data requirements make it difficult for health care to create a universal electronic medical record, accessible to all in the health care delivery system.
Improve the exchange of critical information about the patient and ease the burden on all providers, including physician offices and hospitals, by electronically conveying records and exchanging information between physicians, hospitals and payers. Most Wired survey results continue to show that the disappointing pace of change in moving toward electronic claims transactions between providers and payers costs health care billions of dollars.
As innovation continues in software applications development, it is critical that these systems work as part of the information technology architecture for health care organizations without prohibitive integration costs and unacceptable timing.
Confusion over multiple descriptors for similar health care concepts can lead to error and inefficiencies. Standardizing health care terms and names across the field is essential prior to implementing information technology solutions that can achieve greater efficiencies.
Health care needs a "SMART SYSTEM," commensurate with its importance and size in the American economy and society. In 2000, health care comprised 13.2 percent, or $1.2 trillion, of the Gross Domestic Product. Such an economically significant segment of the economy, and one that deals everyday with human life merits a sophisticated, integrated information technology system that can collect and use health care information in a safe, secure and efficient manner. Information technology can be the highly efficient agent for the timely and secure flow of information in health care.
First, though, we need to align our leadership and resources to bring about this change, and focus our attention on shared standards, protocols, formats, etc., to make this a reality.
The investment in technology solutions and standardization will generate returns for our patients as well as all health care partners in quality, as well as operational and financial efficiencies. Hospitals benefit through lower operational costs, more efficient system upgrades over time, and enhanced patient safety. Literature affirms that these returns can be significant--both in terms of improved patient care and operational/supply chain savings.
For example, a standards-based system could assist in preventing medical errors, and in patient identification for blood transfusions. One analysis predicts the potential of $11 billion in supply chain savings, along with achieving improved administrative, claims and billings processes.
Already, several areas of health care are pursing this ideal:
"Nearly 100 different efforts are ongoing to standardize a piece of the health care information technology puzzle. Leading efforts include Health Level Seven (HL7), which has developed protocols that allow software applications for different vendors to exchange clinical and administrative data; SNOMED, a vocabulary that includes diseases, clinical findings, therapies and outcomes; and electronic data interchange, which is popular among suppliers. Other efforts include bar coding, encryption, digital certification, and efforts to standardize care delivery protocols, clinical classification, coding and patient outcomes." (H&HN, January 2002)
On June 25, the AHA and other committed organizations convened with health care leaders, providers, vendors, payers and government stakeholders from across the country to announce the launch of the National Alliance for Health Information Technology--an alliance to achieve standards-based information systems for the U.S. health care system. With collaborative efforts from all members of the Alliance and existing efforts underway, the standardization of information technology in the health care field will be a launching pad to a new era of health care for the 21st century.
"Mobilize the field to address the fragmentation and lack of coordination in health care…improving quality and performance through standards-based information systems."
The Alliance will target some fundamental outcomes as represented in the case studies and associated benefits described below.
The Alliance's mission to "improve quality and performance through standards-based information systems" will require fundamental change driven by multiple stakeholders, through an inclusive and relentless process.
Critical guiding principles:
The Alliance intends to promote voluntary standards to facilitate the interoperability of information systems. Considerable barriers will have to be overcome in order to set this initiative apart and obtain previously elusive breakthroughs. These internal and external barriers include:
NAHIT would like to thank the NCVHS for this opportunity to address the issues regarding system standardization and integration. We stand ready to work with the NCVHS, drawing on the expertise of our diverse member organizations to resolve the outstanding issues related to standardization of system interoperability and invite the NCVHS and other interested government agencies to join us in NAHIT as we pursue these goals. We are committed to a consensus approach that places the patients and their safety above all other interests. Only through such a broad-based and committed partnership will we achieve the promise of high quality patient care.
Founding Members list attached.
National Alliance for Health Information Technology