New Framework for Collaboration

While much has been accomplished, much remains to be done to accelerate adoption and interoperability of health IT. After an 18 month process involving hundreds of stakeholders, the National eHealth Collaborative (NeHC) was created to carry forward this work. NeHC is structured as a voluntary consensus standards body to bring together consumers, the public health community, health care professionals, government, and industry to accelerate health IT adoption by providing a credible and transparent forum to help establish priorities and leverage the value of both the public and private sectors.  As a public private partnership, it is able to reach broadly into all sectors of health care, including health professionals, government agencies, health systems, academic medicine, patient advocates, major employers, non-profits, technology providers, and others.

This balancing of interests and expertise is critical to accelerating adoption and would be difficult to replicate in a purely public or purely private sector setting. Past competing interests and priorities within each sector have contributed to the historically low creation and adoption of compatible enabling technologies. By expanding the role of the private sector beyond what was available through a public-driven forum, NeHC can leverage industry resources and best practices—at the same time, assured public sector and consumer participation engenders activities that are transparent and supportive of high-quality, patient-centric coordinated care. The National eHealth Collaborative has refined and expanded the process for establishing priorities developed under AHIC. The National eHealth Collaborative’s goals for the prioritization process are to:

• Identify breakthrough strategies to increase interoperability by prioritizing stakeholder-initiated value cases for national action

• Provide broader stakeholder input into which value cases and interoperability initiatives are pursued
• Place more emphasis on the value proposition of each proposed set of interoperability initiatives.

Building on experiences with use cases, NeHC has developed the “value case,” a new tool for setting national priorities which describes the utility and projected benefits of an initiative addressing a specific obstacle to achieving interoperability. Value cases may focus on standards harmonization, but may also address other breakthrough strategies for driving interoperability, including model processes (such as a model of the “ideal” care coordination process); best practices (such as incorporation of ePrescribing into provider workflow or managing the communication of results out to the referring physician); and frameworks (such as a service oriented architecture for health information exchange). Each value case includes an assessment of the feasibility of implementing the proposed standard or other construct and the extent of stakeholder commitment required to ensure widespread adoption.

The processes and criteria to efficiently move the value case process forward begins with a national strategy and national call for submission of cases, both from government and the private sector. High level government participation plays a key role in guiding the value case process. As value cases are developed, NeHC will facilitate the appropriate action.  If standards harmonization is required, HITSP will be consulted to develop use cases and recommend standards for adoption, or expert panels may be convened to address architectures, best practices, terminologies, or other issues. Once approved by the NeHC Board, outputs will be provided to CCHIT for potential incorporation into certification criteria and as a signal to developers for their product modifications.

Roadmap 


Given the resources of the proposed stimulus package, our country is poised for great success in health care IT. As a nation, we will work together to ensure every patient has a secure, interoperable electronic health record. But what does this mean for patient care?

• We will improve the quality of care by coordinating hand-offs between providers. No longer will you be asked to fill out the clipboard with the basics of who you are, what medications you take and your existing medical conditions.
• Medications will be checked for interactions as they are prescribed. Caregivers will be electronically notified of critical values in lab results and important results on x-rays.
• Patients will be able to access their medical records electronically, communicate with their doctors, and use home monitoring devices to coordinate care without a visit to the doctor’s office.
• Beyond these improvements in quality, safety, and convenience, the coordination of care will result in better value for our health care dollar by minimizing redundancy and waste.

The roadmap for standards harmonization, certification of health care IT products, and secure data sharing of medication, laboratory, and clinical summary information is clear. Completing this work is a journey and all our organizations, NeHC, HITSP and CCHIT, are unified to walk that road together.

The momentum created by the close collaboration of all these groups is based on trust, established working relationships and clearly defined roles/responsibilities. Together, they constitute a healthy ecosystem of organizations, each with clear accountability, transparency, and governance to ensure they are all aligned. We are committed to working together to meet the expectations of consumers and other health care stakeholders in the future.

Vision

The past four years have seen significant accomplishments, despite the limited funding made available.  Beyond the complex mechanics of setting up these activities, what is probably more important has been the development of engagement and trust from stakeholders throughout the health care sector, something that can not be rushed.  With the increased funding available in the economic stimulus legislation, we will build on the momentum, trust, and leadership that has already been painstakingly established. 

Our vision is one of a Twenty-first century health system in which all health information is electronic, delivered instantly and securely to individuals and their care providers when needed, and capable of analysis for constant improvement and research.  With better information upon which to base decisions, the challenging process of health reform can successfully proceed – measuring quality, rewarding value, engaging individuals -- and lead the way to better health for all Americans.

John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chief Information Officer of Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician.

Mark Leavitt, MD, PhD, is Chair of the Certification Commission for Healthcare Information Technology (CCHIT).

John Tooker, MD, MBA, FACP is the Executive Vice President and Chief Executive Officer of the American College of Physicians (ACP), Chair of the board for the National Committee for Quality Assurance (NCQA), and Chair of the board of the National eHealth Collaborative (NeHC).

This blog first appeared at The Health Care Blog.

More recent posts at The Health Care Blog:

Grand Rounds

Jon Cohn: Obsessed with baseball and a hopeless optimist

How Goo-Goos Listen to the Grassroots

Why Clinical Groupware May Be the Next Big Thing in Health IT

Stimulus bill offers docs big incentives for technology, but demands effective use