Abstract
BackgroundAmerican public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help measure progress toward that goal.DiscussionThe NHII comprises a set of clusters, such as Regional Health Information Organizations (RHIOs), which, in turn, are composed of smaller clusters and nodes such as private physician practices, individual hospitals, and large academic medical centers. We assess progress in terms of the availability and use of information and communications technology and the resulting effectiveness of these implementations. These three attributes can be studied in a phased approach because the system must be available before it can be used, and it must be used to have an effect. As the NHII expands, it can become a tool for evaluating itself.SummaryThe NHII has the potential to transform health care in America – improving health care quality, reducing health care costs, preventing medical errors, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care. While the President has set an ambitious goal of assuring that most Americans have electronic health records within the next 10 years, a significant question remains "How will we know if we are making progress toward that goal?" Using the definitions for "nodes" and "clusters" developed in this article along with the resulting measurement framework, we believe that we can begin a discussion that will enable us to define and then begin making the kinds of measurements necessary to answer this important question.
Highlights
American public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014
This article presents recommendations regarding specific aspects of a conceptual and measurement framework that will help us to measure progress toward that goal. It represents a starting point for what will hopefully be a wideranging discussion of exactly how we should measure progress toward the achievement of a functional National Health Information Infrastructure (NHII) [Note: Other terms have been used to describe this rather nebulous concept including National Health Information Network (NHIN), National Health Information Infrastructure (NHII), Regional Health Information Organization (RHIO), and Local Health Information Infrastructure (LHII), we will use NHII to refer to this concept
We propose a three-phase iterative approach to beginning the measurements: Phase I will consist of the measurements required to demonstrate "Availability" of the systems; Phase II will consist of the measurements required to demonstrate "Use" of the systems; and Phase III will consist of the measurements required to demonstrate the effect of these systems on various outcome measures that are often associated with health information technology (HIT) use
Summary
A conceptual model of the NHII "Human endeavor is caught in an eternal tension between the effectiveness of small groups acting independently and the need to mesh with the wider community" [4]. The NHII can be thought of as a collection of healthcare delivery providers that share patient-level information electronically. We define a node as a physical healthcare environment with the requisite health information management technology to collect, store, display and transmit patient-identifiable, structured, clinical data in an electronic format. To create a functional network infrastructure, individual nodes must be connected in a way that permits sharing of information. Connections rely on the application of agreed upon conventions, or standards for describing clinical and administrative information (i.e., controlled vocabularies, standard identifiers) and for transmitting that information electronically (i.e., message exchange standards, e.g., HL-7 and X.12). Recent research on the growth and behavior of networks suggests we should anticipate significant increases in the capability of these networks as the number of connections grows [6]
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