Health Care Information Technology Ramesh Rao California Institute for Telecommunication and Information technology University of California, San Diego

Health Care Information Health Care Information TechnologyTechnology

Ramesh RaoCalifornia Institute for Telecommunication and Information technologyUniversity of California, San Diego

Role of CyberinfrastructureRole of Cyberinfrastructure

Taxonomy of Taxonomy of CyberinfrastructureCyberinfrastructure

Computational Technology for Computational Technology for Effective Health Care: Effective Health Care: Immediate Steps and Strategic Immediate Steps and Strategic Directions Directions

William W. Stead and Herbert S. Lin, Editors Committee on Engaging the Computer Science Research Community in Health Care Informatics Computer Science and Telecommunications Board National Research Council of the National Academies

Recommendations for the Recommendations for the Federal GovernmentFederal Government

Incentivize clinical performance gains rather than acquisition of IT per se.

Encourage initiatives to empower iterative process improvement and small-scale optimization.

Encourage development of standards and measures of health care IT performance related to cognitive support for health professionals and patients, adaptability to support iterative process improvement, and effective use to improve quality.

Recommendations for the Recommendations for the Federal GovernmentFederal Government Encourage interdisciplinary research in three critical

areas: (a) organizational systems-level research into the design of health care systems processes and workflow; (b) computable knowledge structures and models for medicine needed to make sense of available patient data including preferences, health behaviors, and so on; and (c) human-computer interaction in a clinical context.

Encourage (or at least do not impede) efforts by health care institutions and communities to aggregate data about health care people, processes, and outcomes from all sources subject to appropriate protection of privacy and confidentiality.

Support additional education and training efforts at the intersection of health care, computer science, and health/biomedical informatics. Current programs of the National Library of Medicine and other institutes of the National Institutes of Health are exemplars of such support.

Health Care Institutions Health Care Institutions Organize incentives, roles, workflow, processes, and

supporting infrastructure to encourage, support, and respond to opportunities for clinical performance gains.

Balance the institution’s IT portfolio among automation, connectivity, decision support, and data-mining capabilities.

Develop the necessary data infrastructure for health care improvement by aggregating data regarding people, processes, and outcomes from all sources.

Insist that vendors supply IT that permits the separation of data from applications and facilitates data transfers to and from other non-vendor applications in sharable and generally useful formats.

Seek IT solutions that yield incremental gains from incremental efforts.

Computer Science Computer Science CommunityCommunityEngage as co-equal intellectual partners

and collaborators with health care practitioners and experts in health/biomedical informatics and other relevant disciplines, such as industrial and process engineering and design, in an ongoing relationship to understand and solve problems of importance to health care.

Develop institutional mechanisms within academia for rewarding work at the health care/computer science interface.

Support educational and retraining efforts for computer science researchers who want to explore research opportunities in health care.

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CALIFORNIA TELEHEALTH NETWORK

Proposition 1DProposition 1D

$200 million in new bond funding for five UC medical schools to leverage telemedicine technology, help support major new initiatives in telemedicine and grow medical student class size

“With Proposition 1D we will be able to connect our best hospitals and our best medical schools with clinics in remote areas all over the state of California.”

- Governor Arnold Schwarzenegger

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PALMS

Physical Activity Location Measurement System

An integrated suite of hardware and software to enable continuous capture and subsequent analysis of data on physical activity, spatial location and other sensor data important to understanding

physical activity--environment exposure

PALMS will support gathering data from multiple participants within studies and aggregating and comparing data between and among multiple researchers across studies

Funded through the NIH Gene, Environment and Health InitiativeExposure Biology Program

Copyright, Regents of the University of California and Santech, Inc, 2008

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Visualize – Heart Rate

Red and orange indicate higher heart ratesCopyright, Regents of the University of California and Santech, Inc, 2008

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Mapping / GIS

Heart rateshown inESRI ArcGISagainst land use

Copyright, Regents of the University of California and Santech, Inc, 2008

Suggestions, CommentsSuggestions, Comments

Backup

What is HIT infrastructure?What is HIT infrastructure?

RAND (2005)◦Electronic Medical Records◦Decision Support Systems◦Computerized Physician Order Entry for

medications

Components of Health Components of Health Information Exchange: Information Exchange: AHRQAHRQData-Sharing Agreements Data PipesInterface EnginesData Models Record Locator Service Master Patient Index Data Repository Standards Interoperability

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FCC Rural Health Care Pilot ProgramFCC Rural Health Care Pilot Program

Announced Fall 2006: Up to $417 million available over three years Purpose: “to facilitate the creation of a nationwide broadband network

dedicated to health care, connecting public and private non-profit health care providers in rural and urban locations”

Pays 85% of telecommunication-related expenses Capital Connection Installation Network Consulting/Design

Encourages regional broadband health care networks with connections to national backbones, e.g., National Lambda Rail (NLR), Internet2 (I2)

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California’s Proposal - Goals

Create statewide broadband network dedicated to health care Link the California Telehealth Network (CTN) to a national backbone Leverage and build upon recent investments in telehealth Utilize the CTN for ongoing disaster preparedness training Report back to the FCC on the pilot program and suggested revisions

to the FCC’s current rural health rules

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CTN - Strategic Purposes

Create a highly reliable, interoperable, ubiquitous broadband Create a highly reliable, interoperable, ubiquitous broadband network, encompassing the majority of rural areasnetwork, encompassing the majority of rural areas

Integrate current and emerging regional, statewide and Integrate current and emerging regional, statewide and national networks, forming a “network-of-networks” supporting national networks, forming a “network-of-networks” supporting peer-to-peer communicationspeer-to-peer communications

Facilitate telehealth services over the network, showing Facilitate telehealth services over the network, showing participants how to leverage the network to improve patient participants how to leverage the network to improve patient carecare

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California’s Proposal - DetailsCalifornia’s Proposal - Details Proposed creation of a statewide, peer-to-peer network over three years,

connecting over 300 California health care sites, the majority of which are located in Health Professional Shortage Areas (HPSAs)

Preliminary list of sites included: 256 Rural Urban Commuting Area (RUCA) sites 154 primary care clinics 22 tribal clinics 81 rural hospitals 26 teaching hospitals One psychology clinic

Proposed also using the statewide network for: ongoing disaster preparedness training, outbreak surveillance, and

communication during emergencies/disasters continuing education for health professionals

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CTN - Proposed Sites

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California’s Proposal to the FCC Background

Fall 2006: Consortium formed by Governor’s OfficeFall 2006: Consortium formed by Governor’s Office May 2007: Single California proposal submittedMay 2007: Single California proposal submitted University of California Office of the President and UC University of California Office of the President and UC

Davis Health System selected as managing partnersDavis Health System selected as managing partners November 2007: FCC awards California up to $22.1 million November 2007: FCC awards California up to $22.1 million

to create the California Telehealth Networkto create the California Telehealth Network Winter 2007: Matching funds granted by California Winter 2007: Matching funds granted by California

Emerging Technology Fund, and UnitedHealth/PacifiCareEmerging Technology Fund, and UnitedHealth/PacifiCare

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California Telehealth Network (CTN) Consortium Members

California Business, Transportation and California Business, Transportation and Housing Agency (BTH)Housing Agency (BTH)

California Department of Managed Health California Department of Managed Health Care (DMHC) Care (DMHC)

California Emerging Technology Fund (CETF) California Emerging Technology Fund (CETF) California Health & Human Services Agency California Health & Human Services Agency

(CHHSA)(CHHSA)California Health Foundation and Trust California Health Foundation and Trust

(CHFT) (CHFT) California Hospital Association (CHA) California Hospital Association (CHA) California Institute for Telecommunications California Institute for Telecommunications

and Information Technology (Cal IT2)and Information Technology (Cal IT2)California Office of Emergency Services California Office of Emergency Services

(OES) (OES) California Primary Care Association (CPCA)California Primary Care Association (CPCA)

California Public Utilities Commission (CPUC)California Public Utilities Commission (CPUC)California Rural Telehealth Networks (various)California Rural Telehealth Networks (various)California State Rural Health Association California State Rural Health Association

(CSRHA) (CSRHA) California Telemedicine & eHealth Center California Telemedicine & eHealth Center

(CTEC) (CTEC) Corporation for Education Network Initiatives Corporation for Education Network Initiatives

in California (CENIC)in California (CENIC)Office of Statewide Health Planning and Office of Statewide Health Planning and

Development (OSHPD) Development (OSHPD) Office of the Governor Office of the Governor University of California Davis Health SystemUniversity of California Davis Health SystemUniversity of California Office of the President University of California Office of the President University of California SystemUniversity of California System

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Recent California Broadband, Technology, Recent California Broadband, Technology, and Telemedicine Initiativesand Telemedicine Initiatives

California Telemedicine & eHealth Center (CTEC): regional eHealth networks

Governor’s Health Information Technology (HIT) Executive Order (S-12-06): $240 million for health information exchange

Governor’s Broadband Task Force Executive Order (S-23-06) California Emerging Technology Fund: $60 million from SBC-AT&T,

and Verizon-MCI mergers, for ubiquitous broadband access and emerging technologies

California Teleconnect Fund (CPUC): 50% discount to eligible hospitals and clinics

Indian Health Service: Growth in Telemedicine Blue Cross of California Telemedicine Network

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So we now have the opportunity to explore interrelationships between and among health behaviors, ecological factors, and physiological processes

Physiological factors

Interpersonal & psychosocial factors

Ecological factors

Medical & ExerciseSciences

Psychological& Social Sciences

Environment & Policy Science

Documents

Health Care Information Technology Ramesh Rao California Institute for Telecommunication and Information technology University of California, San Diego