24 Jun Federal advisor to HHS describes the national information infrastructure
MADISON – In a speech given April 27, President Bush proclaimed that health care in America is in desperate need of aid, citing a “21st century health care system [which] uses a 19th century paperwork system.” While this seems to be a grim statement, Dr. William Yasnoff , a physician and computer scientist who serves as senior advisor for the National Health Information Infrastructure at the US. Dept of Human Services, declared it to be too generous.
According to Yasnoff, the health care industry that drives almost one-seventh of the national economy currently faces inconsistent quality and high error rates due to its outdated systems. He said that research suffers from an average lag period of 17 years between discovery and full implementation. The need for medical technology has risen in recent years due to aging baby boomers and bioterrorism, but the costs of technology prove to put a lock on progress, Yasnoff said.
However, Yasnoff unveiled one of the keys to that lock at the Digital Healthcare Conference that took place Wednesday in Madison. Dr. Yasnoff described plans for a National Health Information Infrastructure to govern medical files. Yasnoff shared the vision for a network of systems and files that operate in concert to streamline the sharing of information.
“It’s important to understand that health care is very far from this goal,” Yasnoff said of forming the system. “The health care system is basically an information-free zone, where things pretty much function without information on the patient.”
Yasnoff argued that the most viable solution for existing problems is using information technology, citing it as the best method to provide “anywhere, anytime health care information and decision support.” The system begins with electronic health record (EHR) systems, which keep the information separate from other servers and serve as the building blocks for NHII. Once brought together, EHRs are then able to connect on many levels for personal, public, clinical and research applications.
Yasnoff drew a comparison between NHII and the telephone network, pointing out that for a system to work it must be connected on the same levels. There are standards to set up which all units must conform to in both messaging information and consistent content, every participating body has to be connected so the information moves with the user and all exchanges and communication need to be automatic.
“Those systems have to talk to each other in order to get the complete information,” Yasnoff said. “If we’re going to bring that information together, we have to call things by the same name.”
To give an understanding of how the system works, Yasnoff showed an example of how HII’s work on a local scale. When a request for information is made, a patient can authorize his inquiry and the request will then go to an index of records. The records – including hospital, laboratory and specialist – are then moved to a temporary aggregate history, and then transferred to their destination. The goal of the NHII initiative is to move this from community to national level, so LHII’s have the ability to request data from each other and have it transferred between them.
The benefits of this widespread NHII system are enormous: being able to supply and access a complete medical record on a patient at any time cuts down on a great deal of bureaucratic damages which can exist to files. The links to medical care and public health would enable further prevention against bioterrorism, and the continual access to files would eliminate the need for repeated tests and x-rays. A consumer would always have access to their own records as well, so they can address each need individually.
“If we don’t allow patients access to information, there’s no way we can move out of the info-free zone,” Yasnoff said. “You don’t have to give up data in order to provide it where it is needed.”
This access however can also prove to be an obstacle to the system, with one of the top concerns being the issue of privacy. In addition to its complexity and fragmentation, medical knowledge is often highly confidential and some users may be deterred by the possibility of their data being in a location where it may be easily accessible. Yasnoff stressed that all data to be added to a system is voluntary and confidential, and that security will keep the data in a secured format.
“My sense is that the general public does not want confidentiality handed out the way we hand out speed limits … they want to practice affirmative communication, and they want it enforced,” Yasnoff observed.
Cost is also a roadblock to NHII, as the scope of the system has not been achieved at a comparable level and investors want to ensure a return on their original contribution, not speculation and promises. Yasnoff said the best way to continue the process is to continue research and collaboration with others, to find better ways to strengthen the system and work to the potential $131 billion net savings the system could provide. Additionally, he pointed out overwhelming support from several sources, including many articles in favor of NHII by the Institute of Medicine.
“If you’ve made investments in this technology, the reason you’ve made it is to provide better care,” Yasnoff said. “I feel it is important to maintain the confidence of a community in a project like this … what we need to do is provide the incentive so they can provide the investment.”
Audience members praised Yasnoff, both for his speaking skills and understanding of NHII key issues.
“I think it’s ultimately what’s about to happen,” said Dennis Roscoe of MPACS on NHII. “When you’re in another state or country, you’re concerned about health care information, and not starting from a blank slate.”
Les Chappell is a staff writer for the Wisconsin Technology Network and can be reached at firstname.lastname@example.org.