2002
Primary Health Care Policy Fellowship

Advancing the Use of Information Technology to Impove the Quality of Health Care

Sharon Marable, MD, MPH
National Medical Association
Providence RI

Cheryl Phillips, MD, CMD
American Geriatrics Society
Sacramento CA

Diane Viens, DNSc, CFNP
National Organization of Nurse Practitioner Faculties
Albuquerque NM

Kathie Westpheling, MPH, RD
Association of Clinicians for the Underserved
Vienna VA

Advancing the Use of Information Technology to Impove the Quality of Health Care

Information technology and sharing of health care information is essential to improve the quality of health care in this nation. While considerable work has been done by the Department of Health and Human Services and the private sector, there exist numerous opportunities to move forward, as evidenced by the Institute of Medicine, (IOM), report: Crossing the Quality Chasm. According to this report, Information Technology, (IT), has a critical role in providing quality health care that is safe, effective, timely, efficient and equitable. Although, some health care systems have made strides in building capacity for IT, the progress in those agencies which serve the most vulnerable populations has been, for the most part, limited.

Policy Proposal
Therefore, we look to the leadership of the Secretary of the Department of Health and Human Services to:

1. Adopt and implement standardized language through nomenclature systems such as LOINC and SNOMED. DHHS can serve to facilitate public and private IT vendors to develop models of inter-operability among federal agencies and private providers of health care.
2. Support the National Committee on Vital and Health Statistics recommendation to create a new senior position and office in DHHS, with resources and mandate, which would:
   • oversee and coordinate a broad range of health information policy, research and program activities, including specific applied research projects that integrate health care IT between federal agencies and private health care providers;
   • create the necessary interconnections in the public and private sectors through incentives and demonstration projects, and work with both public and private IT vendors to develop systems of computer interface;
   • provide on-going oversight of the barriers for information exchange after HIPAA implementation.
3. Direct specific resources within the Presidential Initiative in the Community Health Centers and also the Indian Health Service to:
   • obtain the essential technology required to participate in jointly sponsored federal and private sector information systems;
   • provide ongoing technical assistance and training of the workforce in these health care systems to use clinical information and data reporting systems that will measure improved access and reduce health disparities in underserved and vulnerable populations.

Supporting Evidence:

1. Most clinical language is currently site or system specific. When attempting to share patient safety and quality data, each health care site defines, measures and reports elements of data uniquely. Significant work has begun with groups such as SNOMED, LOINC, and NEDSS. However, until standards for language and transmittal are compatible, the ability to share aggregates of data between systems and agencies will be limited, at best.
2. There currently exists a patchwork of IT "connectiveness" among agencies and between public and private sectors. The Community Health Centers have worked to create horizontal linkages between sites, but there remains considerable work to be done in creating vertical information sharing systems which connect primary care centers with acute hospital and tertiary care providers, as well as other ambulatory site of service.
3. Twenty-six states have information-sharing and privacy regulations more stringent than those identified in HIPAA. There is a clear need to oversee health IT policy, identify barriers to health care information sharing among states, agencies and the private sector providers.
4. The DHHS and the private health care sector has made significant strides in improving and expanding the Community Health Centers that serve some of the most underserved and vulnerable populations. While some CHCs have developed remarkable clinical data sharing systems, (example: the Central Valley, California), many others have little to no information technology at the local level. Presently, 30% of the federally funded CHCs receive funding to build integrated practice management IT network capacity. Therefore, the remaining 70%, could benefit from enhanced information technology systems. Having consolidated and accessible data improves the ability to define population outcomes, improves the ability to collect measurements of quality and to disseminate evidence-based practice guidelines to providers.

The collecting and sharing of information across sites of care and between providers of care is truly the key to improving America's health care quality, efficiency, safety, and innovation. Each of these elements stated above serves to help create that seamless integration of essential information that will truly bridge "the quality chasm".

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