Scott Young | The next steps for a national health IT infrastructure

The next steps for a national health IT infrastructure<@VM>Question and Answer<@VM>Submit a question

GCN staff writer Mary Mosquera moderated an online forum about federal efforts to jump-start development of a national health IT infrastructure. The guest was Scott Young, M.D., director for health information technology at the Agency for Healthcare Research and Quality, a division of the Health and Human Services Department. Dr. Young answered questions about how the government is working in collaboration with industry to establish standards for interoperability. This standards effort will improve the ability of physicians and hospitals to exchange patient data and improve the quality of care and reduce medical mistakes.<@vm><>
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$qna_responses[] = "Moderator: Welcome and thank you for participating in GCN's online forum. Dr. Scott Young, director for health information technology at HHS' Agency for Healthcare Research and Quality, has joined us to answer your questions about the next steps by the federal government toward a national health IT infrastructure. Let's get started.
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$qna_responses[] = "Dr. Paul Brusil, Beverly, MA: Given the health care continuity issues brought out by Katrina, are there national health IT infrastructure contingency plans for providing health care and patient record access without the availability of the Internet? Has any thought been given to patient data traveling with patients rather than patient data being stored on centralized servers that may not always be readily accessible?
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Scott Young:

Dr. Brusil,



The health care issues brought out by events surrounding Katrina are significant and far reaching. Health care leaders and stakeholders are, as you know, currently responding to both short term and long range issues. The availability of accurate and timely health information has emerged as a critical and in many instances life-saving issue. You bring up the issue of a personal health record as one solution to the data gap so prevalent in current scenario.
Lessons learned from the hurricane will help inform both private sector and public stakeholders regarding the best solution (or combination of solutions) to insure data readiness in the future.



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$qna_responses[] = "Chris:

Privacy and security is an issue with patient records...what safeguards will be put in place to ensure the handler's (MD, nurse, administrator, courier, volunteer, temp) of the records will not sell, steal, loose, misplace or file incorrectly patient data.



Thanks



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Scott Young:

Chris,
Thank you for the question. We at AHRQ believe issues regarding data privacy and security are of the utmost importance. To that end we have funded a number of projects to better understand the challenges and solutions to bolster an environment of trust between data stewards and patients.





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Mary Mosquera: Chris, HIPAA regulations also require doctors, hospitals, and other groups to protect and secure medical data. Despite the concern over data files being mishandled, paper files have perhaps a greater opportunity to be misused.
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$qna_responses[] = "Jeff Martell, Maryland:

Dr. Young,



HHS is embarking on and incredible worthwhile task of creating a National Healthcare Network. I am sure that HHS is putting forth an incredible effort to ensure proper security measure are being taken to protect all the data. Unfortunately, organizations spend millions of dollars every year on Network Security, like firewalls, intrusion detection, and authentication, trying to keep unauthorized people out. However, recent events indicate that those types of security solutions are not enough. What measures will HHS take to ensure Software Security? What steps will HHS take to make sure that the software that has been posted to the network is free of vulnerabilities? Implementing vulnerability free software is the only real way of protecting our applications and data from.



Thank you.



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Scott Young:

Jeff,



The creation of a system of interoperable health care records is a critical component to move towards a safer, more effective and higher quality system of care. One of the issues facing the nation is the components or attributes of this data system. HHS will be awarding a series of contracts to help inform the Department regarding the challenges and potential solutions involved in the creation of such a system.



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$qna_responses[] = "Joe Binayao- Houston, Texas: How does national health IT infrastructure comply with HIPAA?
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Scott Young: Joe, all health care activities need to comply with applicable federal, state and local laws and regualtions.
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$qna_responses[] = "Dr.Zhou:

Where will the ONCHIT and its to be formed 4 subordinate offices be located?



What roles will AHRQ play?



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Scott Young: Dr. Zhou, AHRQ works closely with the Office of National Coordinator for Health IT. We look forward to continuing with that strong relationship. The office will be physically located in Washington, D.C.
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$qna_responses[] = "Erica, Virginia: Could you talk about some of the financial incentives that the government will be offering for small physician practices to adopt the standards of EHR?
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Scott Young:

Erica,



AHRQ recently awarded a number of grants to entities to integrate and evaluate the impact of health information technology solutions. These entities included a number of physcian practices (including physician offices with five or fewer providers).



With regards to other financial incentives I need to refer you to my colleaques at CMS.



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$qna_responses[] = "Daniel Blum: How will VA and DOD work together as part of the national infrastructure to set standards?
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Scott Young:

Daniel,



DOD, VA and the Department of Health and Human Services are part of the Consolidated Health Informatics consortium.





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Mary Mosquera: Daniel, VA and DOD are also part of the public/private organization that HHS formed to decide on standards for interoperability and early use cases for health IT. Yesterday, HHS listed the 16 members of that group, the American Health Information Community, and it includes VA and DOD.
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$qna_responses[] = "Bill from Washington: Can you describe a couple of AHRQ's health IT demonstration projects that you think could help bring about a national health IT network?
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Scott Young:

Bill,



Many AHRQ projects will inform or feed into a health IT network. These projects range from initiatives exploring the value of health information exchange (Dr. Marc Overhage, Indiana University) to state wide demonstrations of health IT (Utah Health Information Network).



A complete listing of our projects can be found at:



http://healthit.ahrq.gov/portfolio /



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$qna_responses[] = "Wanda Gamble Falls Church Virginia: AHRQ Patient Safety Initiatives...How will those initiatives fold into the NHIN Infrastructure?
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Scott Young:

Wanda,



Thank you for the quesion. Health IT has been demonstrated to improve both the safety and quality of care. We at AHRQ are actively exploring and demonstrating the knowledge and expertise needed to implement this important and emerging technology. The intersection between Health IT and patients safety has been demonstrated at multiple levels in health care settings and systems of care...all of which will be needed in the greater NHIN infrastructure.



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Mary Mosquera: Wanda, the American Health Information Community, which is made up of public and private members, including representatives of several federal agencies, will weigh standards, best practices and early uses that have been tried or come out of the experience of agencies like AHRQ, and also local and regional health IT networks under development now and contracts that HHS will award over the next several weeks. Those contracts will develop a process to harmonize standards, design prototypes for a health IT infrastructure, certify products for interoperability standards compliance and assess the variations of state privacy laws.
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$qna_responses[] = "Sylvia Webb, CA: There are a plethoria of existing IT standards for health that are not interoperable or international. It also seems that some standards activities are driven by individuals with conflicts of interests. What if anything will be done to harmonize these standards and eliminate the "not created in my backyard" syndrome?
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Scott Young:

Sylvia,



You have touched on an important and compelling issue. The Office of the National Coordiantor for Health IT currently has contract solicitation out to develop, create prototypes for, and evaluate a process to unify and harmonize industry-wide health IT standards development, maintenance and refinements over time.



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$qna_responses[] = "Mike from Maryland: Will Section 508 Standards be considered for interoperability, and how will testing for compliance be implemented?
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Scott Young:

Mike,



Thank you for your question regarding Section 508 standards. Let me refer you to the Consolidated Healthcare Informatics webpage for more information. That address is:
http://www.hhs.gov/healthit/chiinitiative.html



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$qna_responses[] = "Mark Renfro: What initiatives can the rural community health organziations implement now in order to jump start the NHIN program?
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Scott Young:

Mark, 57 percent of all AHRQ Health IT projects are currently invested in either rural or small community settings. As you know the challenges and barriers involved in rural and frontier settings are varied and, at times, significant.



Rural health organizations are well-positioned to inform private and public leaders regarding the unique needs of the rural and frontier community regarding Health IT.



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$qna_responses[] = "G.K.Patel: Can health IT include the status
of health with statistics of each state & city in USA?
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Scott Young: Health IT can allow a signifcant breadth of deidentified data to be available for evaluation. The challenges are many fold including provisions for protecting individually identifiable data.

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Mary Mosquera: G.K., You bring up another benefit to health IT when data is de-identified and can be exchanged. Health IT will allow for timely public health information in the case of potential pandemics or bio-terrorism events. Symptoms gathered from emergency rooms across the country can be shared so public health officials can determine the seriousness or not and the course of action.
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$qna_responses[] = "P. Brusil, MA: Scott, In response to Chris's questions, you indicated "HHS will be awarding a series of contracts to help inform the Department regarding the challenges and potential solutions involved in the creation of such a system." What is the time frame when RFP's for these contracts will become available and where is the best place to become aware of the existance of such RFPs?
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Scott Young:

Dr. Brusil,



The contracts are due to be awarded before the end of this fiscal year (Sept. 30, 2005). Further information can be found at:
http://www.hhs.gov/healthit/contracts.html





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$qna_responses[] = "Moderator: Our time is up. Thank you, Scott, for sharing the work of AHRQ in advancing health IT. And thank you all for submitting your questions; unfortunately, time constraints prevented us from answering them all. Stay tuned for future GCN forums.
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