On The Issues

November 19th, 2013

Health IT, Emergency Preparedness and Public Health

IOM Forum: Presenting a Strategic Roadmap of National Goals

I recently joined a panel of learned colleagues working in public health, telemedicine and acute care at an Institute of Medicine (IOM) forum focusing on the state of our nation’s healthcare system relating to population health and emergency preparedness and response due to natural disaster or other factors.

Along with seeking programmatic opportunities within the Affordable Care Act (ACA), I was asked to represent the view of the healthcare information technology sector on ways to advance resilience through technology that keeps the focus on the patient.

Doing so means establishing an infrastructure around current national standards (i.e. Direct & C-CDA) for data exchange and readable content, as well as increasingly open architectures around application programming interfaces (APIs) that expand integration with emergency response departments, responders, hospital EDs and HIEs along with the current integration of EHRs.

The expansion of patient portals, personal health records and cloud technology must also keep pace with available standards such as Blue Button, along with the ability for providers to utilize mobile EHR innovations to access these standard and readable patient records. After all, hospitals and practices are not immune to disaster, as the nation experienced certainly with Hurricane Katrina and most recently during Hurricane Sandy.

Also, a national patient identifier strategy is equally crucial to develop, one that can link the needed clinical information to the right displaced patient.

Both the American Recovery and Reinvestment Act (ARRA, 2009) and ACA provide the means to put this infrastructure in place, and in fact such networks are already taking shape. The ACA’s Health Center Controlled Networks fund was primarily focused on EHR and meaningful use adoption in the front lines, and provides the opportunity for resiliency expansion.

ARRA’s HIE Cooperative Agreement Program seeded state and regional HIEs, from which a debut collaboration this year of 10 HIEs has formed under the name SERCH, specifically to manage emergency response using vetted exchange standards, all while some individual state HIEs are expanding linkage to include EMS and fire departments.

And yes, taking a measured, national and analytical approach to resilient, technology-driven strategies is a best practice for achieving best practices in the field. Here too ACA can be leveraged through a pair of well-funded and important programs, the Patient Centered Outcomes Research Institute (PCORI) and the Prevention and Public Health Fund, where respectively analysis and additional research options for emergency healthcare and IT exist, and where implementation can follow.

And finally, it’s again not just emergency response, but also preparedness, where for example outbreak surveillance, immunizations and registries have long been a national goal. Here there are new and existing collaborations between ONC, CDC and EHR developers that can be further integrated.

Right now the opportunities far outweigh the barriers toward establishing a coordinated national approach to population health when we may need it most, and it’s important to continue this discussion as the health IT industry itself continues to mature.

See the IOM panel presentation slides here.