National Alliance for Health Information Technology
When the American Hospital Association (AHA) conducted an 18-month, long-range
planning process, information technology emerged as a critical element to achieve
real reform in our health care system.
Yet, health care trails almost every other industry in applying information technology due to of a lack of consistent and uniform standards and protocols. Multiple scientific disciplines and medical specialties with individual, specific technical requirements and demands have created fragmented and isolated systems and databases.
To improve the situation, we need to approach the process more strategically. The recent Institute of Medicine report, "Crossing the Quality Chasm," (2001) calls for "a national consensus on comprehensive standards for the definition, collection, coding and exchange of clinical data." Compared to business and industry, health care has been slow to achieve this consensus. We've failed to leverage even our limited investment in information technology to improve patient outcomes and operational efficiency.
Now is the time for all partners involved in health care delivery — hospitals, health care systems, clinics, providers, payers, and vendors — to develop and implement standards-based information systems for more effective, efficient, and safe patient care.
The Time Is Now
A centrally-accessible airline reservation management system, universal cell phone use, a viable ATM network, and universal bar coding on consumer packaged goods became realities because interested parties met and adopted basic rules, thereby paving the way to greater efficiency and innovation. Rather than reinventing the wheel repeatedly, these industries established certain voluntary standards promoting interoperability with systems and applications that could communicate with one another for the benefit of the industry and the consumer.
Technology and manufacturing organizations also distinguished themselves through differentiated features and benefits built on a standards-based system. For example, Ford, Chrysler, and General Motors worked together to create a single, standardized process for auto parts order processing and achieved greater industry efficiency.
Opportunities in health care for improving interoperability, integration, and standardization are numerous, and include:
Bar Coding for Health Care Products
Bar coding technology could be used to standardize information in health care. Greater collaboration is imperative for its effective use in the field.
Electronic Patient Medical Records and a Common Patient Identifier
Multiple vendors with differing systems and data requirements make it difficult for health care organizations to create a universal electronic medical record (EMR) accessible to or by those in the delivery system. A common patient identifier would facilitate an effective transition toward a universal EMR.
Communication and Transaction Networks
The adoption of data-sharing technology would ease the burden on providers, including physician offices and hospitals, by conveying records electronically and exchanging information between physicians, hospitals, and payers. "Most Wired" survey results continue to show that the disappointing pace in moving toward electronic claims transactions between providers and payers costs health care billions of dollars. ("Most Wired" is the AHA's publication that identifies the best information technology practices in the health care industry.)
Applications Software and Automated Systems
As innovation continues in software applications development, it is critical that these systems work as part of the information technology architecture for health care organizations without prohibitive integration costs and unacceptable timing.
Lack of Standard Nomenclature
Confusion about multiple descriptors for similar health care concepts can lead to error and inefficiencies. Standardizing health care terms and names across the industry is essential prior to implementing information technology solutions that can achieve greater efficiencies.
Health care needs a "smart system" commensurate with its importance and size in the American economy and society. In 2000, health care comprised 13.2 percent, or $1.2 trillion, of the gross domestic product. Such an economically significant segment of the economy, and one that deals with human life every day, merits a sophisticated, integrated information technology system that can collect and use health care information in a safe, secure, and efficient manner. First, however, we need to align our leadership and resources to bring about this change and focus our attention on shared standards, protocols, formats, etc., to make this a reality.
The investment in technology solutions and standardization has the potential to generate returns for all health care partners in quality and in operational and/or financial efficiencies. Hospitals benefit through lower operational costs, more efficient system upgrades over time, and enhanced patient safety. The literature affirms these returns can be significant — both in terms of improved patient care and operational/supply chain savings.
For example, a standards-based system could assist in preventing medical errors in patient identification for blood transfusions. One analysis predicts the potential of $11 billion in supply chain savings, in conjunction with achieving improved administrative, claims, and billing processes. Already, several areas of health care are pursuing this ideal:
"Nearly 100 different efforts are ongoing to standardize a piece of the health care information technology puzzle. Leading efforts include Health Level Seven (HL7), which has developed protocols that allow software applications for different vendors to exchange clinical and administrative data; SNOMED, a vocabulary that includes diseases, clinical findings, therapies and outcomes; and electronic data interchange, which is popular among suppliers. Other efforts include bar coding, encryption, digital certification, and efforts to standardize care delivery protocols, clinical classifications, coding and patient outcomes." — Hospitals & Health Networks, January 2000
| Benefits of Implementing Industry Advances |
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Within An Enterprise and Across Enterprises and Geographies, Computer Systems Talk to One Another "Atlanta's Northside Hospital installed ORSOS, a surgical services information system, with an eye toward improving and monitoring operations in the hospital's 34 operating rooms, spread over four locations. The result, over a four-year span; surgery case volume at Northside increased by 64 percent, and the hospital experienced a 5 percent reduction in job turnover among O.R. nurses." — Hospitals & Health Networks, January 2002 "Both Beth Israel Deaconess Medical Center and Brigham and Women's Hospital utilized an integrated hospital system and reduced the time to collect unpaid bills from 65 days to 39 days and from 100 days to 59 days respectively. At the latter hospital, outstanding debts in the outpatient clinics have been reduced substantially over the three years since implementation." — Clinical Information Systems: Achieving the Vision, Kaiser Permanente, December 2001 Making Patient-Centered Data Accessible, and Efficiently Linking Clinical, Administrative, and Financial Data "A patient record system reduces the time it takes to drop a claim for Parkview Health, a six-hospital system based in Fort Wayne, Indiana, cutting A/R days dramatically." — Hospitals & Health Networks, January 2002 "Physicians at the Mayo Clinic have outpatient data available immediately when patients are admitted to the hospital. Prior to CIS implementation the charts might take several hours following patient admission to the hospital patient care floor."— Clinical Information Systems: Achieving the Vision, Kaiser Permanente, December 2001 "St. Luke's Hospital, Maumee, Ohio, took an average of 16 minutes to find and send patient charts to the emergency department. Now records are retrieved in seconds at more than 100 points of access."— Hospitals & Health Networks, January 2002 Better Patient Outcomes and Error Avoidance "In a survey of 500 patients, the Mayo Clinic documented that 90 percent felt that quality of care was the same or better with an electronic system for nurse charting at their bedside; 40 percent felt care was better because nurses spent more time in the room and were more aware of the patient's status." — Clinical Information Systems: Achieving the Vision, Kaiser Permanente, December 2001
"A computerized tracking system reduces medication errors by 50 percent at Montefiore Medical Center, New York." — Hospitals & Health Networks, January 2002
Lower Hospital and Health Care System Operating Costs
"Kaiser Permanente's Colorado and Northwest regions estimate large annual savings in facility cost after implementation of an electronic medical record." — Clinical Information Systems: Achieving the Vision, Kaiser Permanente, December 2001
"The University of Illinois Hospital at Chicago has been installing a system, requiring major technology investments plus ongoing operating costs. But the payoff is materializing: Besides providing caregivers complete and instant access to patients' records and reducing the potential for medical errors, hospital officials calculate a year ago that the system had produced substantial savings, largely in staff time." — Hospitals & Health Networks, January 2002
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Shaping the Future
On June 25, 2002, the AHA and other committed organizations convened health care leaders, providers, vendors, payers, supply chain organizations, and government stakeholders from across the country to announce the launch of the National Alliance for Health Information Technology (NAHIT), an alliance formed to achieve standards-based information systems for the United States' health care system.
The alliance is established as an independent, self-funded organization focused on an overall improvement in health care quality and operations, and therefore will not benefit, nor be controlled by, a single organization. It is conducive to private and public sector participation, ensuring inclusive involvement of all parties.
Through a collaborative effort, the standardization of information technology in the health care field will be a launching pad to a new era of health care for the 21st Century.
Strategic Direction
The NAHIT's mission is to "mobilize the field to address the fragmentation and lack of coordination in health care by improving quality and performance through standards-based information systems." This will require fundamental change driven by multiple stakeholders, through an inclusive and relentless process guided by three principles:
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1. Convening players in the alliance committed to meaningful change and willing
to participate in seeking better solutions.
2. Targeting real, understandable benefits.
3. Creating and implementing distinct projects that will yield a viable health care information systems infrastructure accessible to all parties.
The alliance intends to promote voluntary standards to facilitate the interoperability of information systems. Considerable barriers will have to be overcome in order to set this initiative apart and also to achieve previously elusive breakthroughs, including:
- Lack of understanding and commitment of industry leadership.
- A health care organizational and professional culture that has historically stressed uniqueness and customization.
- Difficulty in gaining widespread consensus across a fragmented health care continuum.
- Legacy information technology systems and the challenge of integrating different vendor hardware and software.
- Financial cost of change such as sunk costs/lack of capital.
- Meaningful measures/ability to demonstrate a return on investment.
- Perceived poor track record of information technology.
- Competing organizational priorities demanding resources and attention.
Expected Outcomes
The alliance will target key fundamental outcomes, including reducing clinical errors; decreasing operating costs; and improving networking and interoperability across departments and facilities.
Major Initiatives
Major emphasis will be on establishing standards with the greatest potential for breakthrough in improving the delivery of patient care. Standards-related priority areas include:
- Connectivity and networking.
- Automated order entry and medication administration.
- Electronic medical records.
- Universal patient identifiers.
- Claims processing/transaction standards.
- Technology-related nomenclature/lexicon.
Individual work plans will be developed for each project designated as a priority by the alliance's governing body. Immediate attention will focus on standardizing and uniformly applying bar codes on products for use in health care organizations meeting established criteria. These criteria include ensuring the project is technically and operationally feasible through the collaboration of known stakeholders; the project outcomes deliver identifiable benefits (quality, administrative, and financial); that private and public stakeholders working together can realize outcomes within a specific timeframe.
Initially, the alliance will focus on standardized bar codes and will work to establish uniform bar codes for all medication and biological product packaging down to the unit-of-use level. Subsequently, the alliance will promote the same treatment for medical-surgical supply packaging and for implementing machine-readable bar codes on packaging for use by providers.
NAHIT's Progress
The alliance membership has grown to 82 members representing health care providers, payers, information technology vendors, and supply chain organizations and has been moving its agenda forward as described in these milestones:
- In June, the NAHIT's Bar Code Committee was organized to develop a position
on bar code standards. This work was submitted and presented as part of testimony
at a Food and Drug Administration public hearing. The NAHIT continues to work
with the FDA, drawing on the expertise of its diverse member organizations,
to resolve outstanding issues related to the bar coding of drugs, biologicals,
and devices. The NAHIT stated its commitment to a consensus approach that
places the patients and their safety above all other interests.
- The first meeting of the NAHIT founding members took place on August 21,
2002, in Chicago. The meeting focused primarily on the governance structure
and proposed bylaws, and the organization's membership, financials, communications,
and current activities. The next steps were also proposed and approved to
define the NAHIT agenda and priorities beyond bar coding and staff leadership
and organizational considerations.
- On August 29, 2002, the NAHIT, at the invitation of the National Committee
on Vital and Health Statistics, presented testimony regarding system standardization
and integration. The NAHIT also stated its commitment to assist the committee
and other interested governmental agencies to resolve outstanding issues related
to the standardization of system interoperability.
- In November, the NAHIT responded to an invitation from the IOM Committee
on Patient Safety Data Standards to testify regarding the alliance's mission
and expected outcomes.
- In December, the NAHIT gave a presentation at a HHS-organized roundtable
that will lead to future work in creating a national health information infrastructure.
- The process to recruit a president and CEO has begun. The elected board of directors, recommended by a nominating committee consisting of NAHIT membership, called an initial meeting in February 2003. One of the board's important topics was to evaluate additional priorities beyond bar coding, including: connectivity and networking; automated order entry and medication administration; electronic medical records; universal patient identifiers; claims processing/transaction standards; and technology-related nomenclature/lexicon.
With commitment and collaboration, the alliance hopes to bring to fruition the type of interoperating, effective, and efficient system that patients and stakeholders deserve and demand.
