Personal Health Records: Increasing Health Care Value Through Enhanced Patient Engagement

Personal Health Records: Increasing Health Care Personal Health Records: Increasing Health Care Value Through Enhanced Patient EngagementValue Through Enhanced Patient Engagement

National Health Policy ConferenceNational Health Policy Conference

February 5, 2008February 5, 2008

Jodi G. Daniel, JD, MPHJodi G. Daniel, JD, MPHDirector, Office of Policy and ResearchDirector, Office of Policy and ResearchOffice of the National Coordinator for Health Information Technology (ONC)Office of the National Coordinator for Health Information Technology (ONC)U.S. Department of Health and Human ServicesU.S. Department of Health and Human Services

2February 5, 2008 HHS ONC - Health Policy Conference

Agenda

• Background on Federal Health IT Efforts• Roles for Federal Government in Health IT• ONC Activities• Other Federal Agency Activities


Change is Underway: Drivers of Health IT Adoption

Industry Leadership

Strong Endorsement from Industry and

Commercial Leaders

Rising HealthCare Costs

and HealthInformation

Technology asA Solution

PoliticalLeadership

on Health InformationTechnology

Adoption

Substantial Benefits

for Consumersand the

Economy

Drivers of Health Information Technology Drivers of Health Information Technology

Clinical Leadership to Achieve

Highest Quality Care


The Future of Health Care - Individuals

• More emphasis on prevention

• Elimination of barriers to care at multiple sites

• Increased use of telehealth & telemonitoring

• Individualized health education information provided directly to patients

• Patient management of own care

• Emphasis on self-care


Federal Government Roles

• Federal government serves various roles with regard to health and health care:– Convener/Coordinator – ONC (e.g., NHIN, AHIC)– Insurer – CMS– Provider – DoD, VA, IHS– Purchaser – OPM– Promoter of population health - CDC


Executive Order, April 2004:

The President created the National Coordinator position– To advance the vision of developing a nationwide interoperable health information

technology infrastructure– To achieve the President’s goal of widespread adoption of interoperable electronic

health records (EHR) by 2014

Key Role for ONC:

Provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve – The quality and efficiency of health care and – The ability of consumers to manage their health

Office of the National Coordinator for Health IT (ONC)


Some ONC Activities

• Nationwide Health Information Network (NHIN)• American Health Information Community (AHIC)• Definitions of Key Terms


Nationwide Health Information Network (NHIN)

NHINHIE

Consumers

`

PHR

Clinicians

EHR

NHINHIE

NHINHIE

NHINHIE


NHIN Trial Implementations

• NHIN – A set of standards and specifications that allow health information

to flow over the internet in a secure, reliable fashion

• Trial Implementation Awards – 9 state & regional health information exchanges (HIEs)

• NHIN Cooperative – Test, implement, and demonstrate core services by Sept. 2008

• Plan to include other types of HIEs:– Multi-community Integrated Delivery Systems– Health plans– Health data banks


NHIN Core Services

• Key Data Services– Data delivery– Patient look-up in an NHIE and between

NHIE’s– Supporting access to data for secondary

uses

• Key User and Identity Management Services– User identity proofing, authentication and authorization or attest for

connected organizations– Identity adjudication between NHIEs

• Key Management Services– System and trusted user protection– Emergency access (individual and community)


NHIN Core Services, cont.

• Key Consumer Services– Identify a personal health record home– Be supported in getting data there– Search for other places where data about them exists– Control who can access their personal health record– View who has accessed their PHR or made NHIE look-ups and

how their data may have been disclosed– Send change requests to data providers when they think the

data are wrong– Choose to not use network services


QUALITY

CONFIDENTIALITY, PRIVACY & SECURITY

May 16, 2006

PERSONALIZED MEDICINE

(GENOMICS)

October 31, 2006

American Health Information Community (AHIC)

November 29, 2005

CONSUMER EMPOWERMENT

CHRONIC CARE

EHRs

POPULATION HEALTH

• A federal advisory committee (FACA)

• Chaired by Secretary Leavitt

• Public and private sector members

• Provides input and recommendations to HHS – How to make health records digital and interoperable– How to assure health information privacy and security is protected


AHIC Workgroup – Consumer Empowerment

• Broad Charge for the Workgroup: – Make recommendations to the AHIC to gain wide

spread adoption of a personal health record that is easy-to-use, portable, longitudinal, affordable, and consumer-centered.

• Past Activity– Focus on medication history and registration

summary• Recent Activity

– Focus on needs of special populations– Testimony focused on disabled and racial/ethnic

communities


AHIC Successor

Federal AdvisoryCommittee

Public/PrivatePartnership


AHIC 2.0

• Inclusive of all stakeholders

• Manages prioritization and trade-offs

• Three Phases

1. Governance by HHS Secretary with AHIC guidance. ONC coordinates all core activities & staffs the governance functions

2. AHIC 2.0 – An early hybrid of a public, private partnership. ONC continues to coordinate all core services

3. AHIC 2.0 – Self-sustaining Public Private Partnership. ONC continues to coordinate activities related to population issues


AHIC 2.0 Timeline

AHICapproves approach to the AHIC successor

Secretary’s public invitation for participation

July 31 Aug 17

20072007

May - Jun

Launch group for AHIC successorselected and announced

AHIC successorformally incorporated and funded

20082008

Nov - Dec

Transition interoperability functions from AHIC to AHIC successor

Jun - Nov

Last meeting of the AHIC

Jan 22

LMI-Brookings Team to fully establish AHIC 2.0 by December 2008


Health IT Definitions Project

• Create consensus-based definitions and context of use for five key Health IT terms– Personal Health Record (PHR)– Electronic Health Record (EHR)– Electronic Medical Record (EMR)– Regional Health Information Organization

(RHIO)– Health Information Exchange (HIE)

• Late February/Early March 2008public comment period (www.definitions.nahit.org)

• End March 2008 – Final report to ONC


Federal PHR Activities

• Centers for Medicare and Medicaid (CMS) Request for Information (2005)

Feasibility test of using claims data to populate PHRs (2006)

Pilot projects to encourage Medicare beneficiary use of PHRs (2007)

• Indian Health Service (IHS) Initial plans to develop an online PHR portal that will enable patients to securely

log in and view elements from their record.

• Centers for Disease Control (CDC) Interest in PHRs for health promotion, equity, and monitoring

Enhancing use of preventative services, adherence to guidelines

Actionable health messages within PHRs


Federal PHR Activities (cont.)

• Department of Defense (DoD) MHS Beneficiaries with Common Access Cards (CAC) can access a PHR

application via TRICARE Online to securely access EHR data

Includes: Personal Information, Health History, Medication Profile, Allergy Profile, Personal Health Summary

• Veteran’s Administration (VA) My HealtheVet: A web-based product that gives veterans information and tools

to improve their health. They are able to:

Add information to a personal health journal about over-the-counter medications, allergies, military health history, medical events, tests & allergies.

Record and track personal information such as contact information, emergency contacts, health care providers, and health insurance information.

Record and track personal health measurements (blood pressure, blood sugar, cholesterol, heart rate, body temperature, weight, and pain).

Office of Personnel Management Encourage contracting health plans in the Federal Employees Health Benefits

(FEHB) Program to adopt health IT, quality and cost transparency, and PHRs.


For More Information:For More Information:

www.hhs.gov/healthitwww.hhs.gov/healthit

Documents

Personal Health Records: Increasing Health Care Value Through Enhanced Patient Engagement