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National Initiatives
The Office of the National Coordinator for Health Information Technology was created by Presidential Executive Order in 2004 and charged with leading in the development of a National Health Information Network (NHIN). The overall goal is to for most all Americans to have access to an interoperable electronic medical record by 2014. The primary objectives of the Executive Order are to:
- Provide incentives and reduce the risk of electronic medical record adoption by clinical practices;
- Interconnect physicians by fostering regional networks and a national network;
- Encourage personal health records and consumer choice and promote telehealth; and
- Improve population health through unified surveillance systems, streamlined quality monitoring, and an accelerated dissemination of evidence.
More information about the Office of the National Coordinator for Health Information Technology is available at http://www.hhs.gov/healthit/
Several other national offices, commissions and public private collaboratives play key roles in shaping NHIN. Information on these efforts is available at http://nyehealth.org/links |
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A recent report of the US Congressional Budget Office concluded that new medical technology, devices and specialty drugs are the primary factors driving health care costs nationally, not the aging of the population or increased access to health insurance.
Medicare data for Central New York suggest a similar trend. While the region is among the lowest nationally in inpatient and ambulatory health care costs, levels of medical technology costs appear to be high.
The Health Advancement Collaborative of Central New York is working to analyze and address drivers of health care costs through a multi-stakeholder committee of providers, insurers and business. One objective is to pilot test a mechanism for reviewing technology costs that is data-driven and consistent with four guiding principles:
- be focused on optimizing, not artificially limiting new and innovative uses of technology;
- be open and objective and driven by evidence-based scientific and community data;
- provide for two-way evaluation of new and new use technology and payer coverage policies; and
- generate data to support the adoption of best practice standards.
Articles and other resources related to capacity management and technology costs are available in the resources section of this web site.
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Growing national attention is focused on issues of access, cost and safety related to pharmaceuticals and medication management. Generic substitution has been a primary approach to maintaining patient access to affordable medication while lowering the rate of increase in brand drug costs. These savings are being offset by increases in the availability of high costs specialty drugs, many of which have not been clearly demonstrated to have a measurable advantage to lower cost alternatives. Medication safety issues also arise from the increased number and variety of drugs and potential risk of adverse drug reactions.
The Collaborative’s work in the area of pharmaceuticals focuses on the following issues and opportunities.
- The promotion of bioequivalent generic drugs among consumers and providers.
- Increasing medication safety through the development of electronic prescribing as part of the Collaborative’s plans for a communitywide electronic clinical information system.
- Analyzing and developing a mechanism to promote best practice alternatives in the use of high cost specialty drugs among providers.
Articles and other resources related to pharmaceutical economics capacity are available in the resources section of this web site.
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Most every developed country in the world except the United States has the ability to exchange clinical information electronically on patients across providers and treatment sites in a secure manner. Developing this ability in the US is the newest frontier of health care. This ‘ATM’ of health care will allow a patient and the providers he/she authorizes to have immediate access to their clinical information no matter where or when they are seen. This can lead to more accurate and timely treatment, a reduction in duplicate tests and procedures, more efficient referrals to other providers, and less paper work for all concerned. In the emergency room, having immediate access to patient information can be life-saving.
Most all states and hundreds of local communities are working to create the ability to exchange clinical information electronically. Developing the technology (software and hardware) is just part of the story. Policies and standards are also needed to ensure that different software solutions can ‘talk’ to one another and that a patient’s information and privacy are secure. Having the right technology and policies are essential, but not sufficient to realize the benefits of an information exchange. Providers also need to make the switch to electronic records and incorporate them into their daily treatment routines, which can be costly and disruptive. Many believe that financial incentives and changes in how providers are reimbursed will be needed for a majority of providers to leap the digital divide.
The focus of the Collaborative's work initially is on the electronic exchange of lab, radiology and medication information.
Several articles and surveys are included in the resource section of this web that talk about the history of clinical information exchange, about current initiatives and issues related to building successful networks.
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Health Advancement Collaborative of CNY Initiatives
In 2007, the Collaborative partnered with Southern Tier Health Link (STHL) www.sthlny.com , an existing regional health information network (RHIO) to develop the capacity to share patient clinical information across Central New York providers. The two organizations co-applied and were award $7.8 million in state funds in March 2008 for their ‘Southern Tier and Central New York HealthLink' initiative, with STHL as the awardee.
Grant funds will build the capacity for physicians, patients, hospitals, pharmacies, and labs to exchange patient information electronically across seven counties in the Southern Tier and Central New York regions. Ultimately, the goal is for our region to connect with others across the state as part of the planned State Health Information Network of New York (SHIN-NY). A description of the Southern Tier and Central New York HealthLink initiative is available here. A press release on the award is available here.
In Onondaga County, funds would allow patient information to be shared among the four local hospitals, four large physician practices, the local community health center, and a large lab. The focus of the Collaborative's work initially is on the electronic exchange of lab, radiology and medication information.
One of the Collaborative's core principles is that the clinical information exchange must be self-sustaining over time. To date, $500,000 in matching funds has been pledged in start-up costs by Excellus BlueCross BlueShield, Anheuser-Busch, MVP Heath Care, and National Grid. The Collaborative is the final stages of developing a business plan that will allow the exchange to be self-supporting. |
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Initiatives
