Personal Health Records: Increasing Health Care
Value Through Enhanced Patient Engagement
National Health Policy Conference
February 5, 2008
Jodi G. Daniel, JD, MPH
Director, Office of Policy and Research
Office of the National Coordinator for Health Information Technology (ONC)
U.S. Department of Health and Human Services
Agenda
•
•
•
•
Background on Federal Health IT Efforts
Roles for Federal Government in Health IT
ONC Activities
Other Federal Agency Activities
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Change is Underway: Drivers of Health IT Adoption
Rising Health
Care Costs
and Health
Information
Technology as
A Solution
Substantial
Benefits
Clinical
Leadership
for Consumers
and the
Economy
to Achieve
Highest
Quality Care
Industry
Leadership
Political
Leadership
Strong Endorsement
from Industry and
Commercial
Leaders
on Health
Information
Technology
Adoption
Drivers of Health Information Technology
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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
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Federal Government Roles
• Federal government serves various roles with
regard to health and health care:
–
–
–
–
–
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Convener/Coordinator – ONC (e.g., NHIN, AHIC)
Insurer – CMS
Provider – DoD, VA, IHS
Purchaser – OPM
Promoter of population health - CDC
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Office of the National Coordinator for Health IT (ONC)
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
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Some ONC Activities
• Nationwide Health Information Network (NHIN)
• American Health Information Community (AHIC)
• Definitions of Key Terms
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Nationwide Health Information Network (NHIN)
EHR
`
PHR
Consumers
Clinicians
NHIN
HIE
NHIN
HIE
NHIN
HIE
NHIN
HIE
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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
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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)
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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
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American Health Information Community (AHIC)
• 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
November 29, 2005
May 16, 2006
CONSUMER
EMPOWERMENT
CONFIDENTIALITY,
PRIVACY & SECURITY
CHRONIC CARE
QUALITY
October 31, 2006
PERSONALIZED
MEDICINE
(GENOMICS)
POPULATION
HEALTH
EHRs
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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
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AHIC Successor
Public/Private
Partnership
Federal Advisory
Committee
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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
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AHIC 2.0 Timeline
LMI-Brookings Team to fully establish AHIC 2.0 by December 2008
July 31
Aug 17
Jan 22
May - Jun
Jun - Nov
2007
AHIC
approves
approach to
the AHIC
successor
Secretary’s
public
invitation for
participation
February 5, 2008
Nov - Dec
2008
Launch
group for
AHIC
successor
selected
and
announced
AHIC
successor
formally
incorporated
and
funded
HHS ONC - Health Policy Conference
Last meeting
of the AHIC
Transition
interoperability functions
from AHIC to AHIC
successor
16
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 2008
public comment period
(www.definitions.nahit.org)
• End March 2008 – Final report to ONC
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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
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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.
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For More Information:
www.hhs.gov/healthit
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