Patient Safety Achieving a New Standard for Care (2004) / Chapter Skim
Currently Skimming:
3 Federal Leadership and Public-Private Partnerships
3 Federal Leadership and Public-Private Partnerships
Pages 96-126
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 96... ...
Delays in the ability of health care organizations to implement data standards will likely slow investment in information technology and necessitate sizable reworking of the information technology systems that currently exist to enable connec tivity. Successful transition to and operation of the national health information infrastructure will require a more efficient, streamlined mechanism for standards development and implementation processes that can be achieved only through strong federal leadership and effec tive public–private partnerships.
|
From page 97... ...
Both standards and methods have remained rather uncoordinated to date, resulting in overlaps and gaps in the comprehensive set of data standards needed for full operation of the national health information infrastructure. This chapter describes current processes for setting each type of standard; reviews current standards activities in the federal and private sectors; and presents the committee's recommendations for how the standards development, implementation, and dissemination process can be streamlined and coordinated for greater usefulness and efficiency.
|
From page 98... ...
NOTE: AAMI = American Association of Medical Instrumentation; ASC = Accredited Standards Committee; ASTM = American Society for Testing and Materials; DICOM = Digital Imaging and Communication in Medicine; HL7 = Health Level Seven; IEEE = Institute for Electrical and Electronics Engineers; NCPDP = National Council for Prescription Drug Programs; NIST = National Institute of Standards and Technology.
|
From page 99... ...
They include the National Uniform Billing Committee, which develops a single billing form and standard dataset to be used nationwide by institutional providers and payers for handling health care claims, and the National Uniform Claims Committee, which develops a standardized dataset for use by the noninstitutional health care community in transmitting claim and encounter information to and from all third-party payers. BOX 3-1 Primary Standards Development Organizations Setting Standards for Data Interchange in the United States ASC X12N -- the ANSI committee responsible for developing health care–related electronic data interchange (EDI)
|
From page 100... ...
If neither of these situations occurs, comments are sent to the entire balloting group for consideration. The resulting vote determines the content of the standard; for health care data interchange standards, over 90 percent agreement among the parties is usually required for a standard to be approved (American National Standards Institute, 2002)
|
From page 101... ...
wide variation in the maturity and ease of implementation of ANSI voluntary consensus standards, and (2) the fact that even where mature, usable
|
From page 102... ...
Another important issue in standards development and implementation is financial support. Producing a standard is expensive in terms of both time and money.
|
From page 103... ...
Thus, one laboratory system has not been able to communicate with another without great difficulty. This "custom" approach incurs high costs and inhibits efforts to reuse clinical data to understand and prevent patient safety events.
|
From page 104... ...
Final decisions are made by the director of the National Committee on Health Statistics and the administrator of the Coordination and Maintenance Committee (National Center for Health Statistics and Centers for Disease Control and Prevention, 2003)
|
From page 105... ...
-- developed genetics-related terminologies 4. Standards Development Organizations • Health Level Seven (HL7)
|
From page 106... ...
Three-quarters of the members of a group must vote on ballots of official documents, and of those who vote, three-quarters must support the document for it to be accepted. The HL7 process for obtaining consensus on terminologies is not as formal as that for data interchange standards since HL7 is not actually a terminology developer per se but maps registered terminologies for encoding in its messaging formats.
|
From page 107... ...
, which will be even more important to the evolution and maintenance of the National Committee on Vital and Health Statistics (NCVHS) –Consolidated Health Informatics (CHI)
|
From page 108... ...
. Because the UMLS has the informatics infrastructure to cross-reference many different terminology systems and provides its services in the public domain, NLM is ideally positioned to lead the oversight and maintenance of the core terminology group to be determined by the CHI initiative and associated patient safety data standards.
|
From page 109... ...
. To date, the PBRNs have studied such topics as the role of antibiotics in improving outcomes in children with acute otitis media, the referral process in pediatric care, and primary and secondary prevention of coronary artery disease and stroke (Agency for Healthcare Research and Quality, 2001)
|
From page 110... ...
It is made up of nine partners, selected because they provide health care services to large populations in a variety of organizational settings. Each partner is working with several collaborators, including other health care systems, research institutions, and managed care organizations, to conduct research within their integrated delivery systems and then disseminate the scientific evidence obtained (i.e., organizational best practices related to care delivery)
|
From page 111... ...
. Standardized measurement and reporting mechanisms not only will facilitate the building of effective information technology systems and reduce confusion over reporting requirements but also could drive quality improvement in other ways, such as assisting efforts to reward quality care through payment or other means.
|
From page 112... ...
(For further information on federal patient safety reporting systems, see Appendix C.) In the area of best practices, the Quality Interagency Coordination Task Force (QuIC)
|
From page 113... ...
It measures the quality of care for many common health conditions and incorporates other established measure sets, including the Consumer Assessment of Health Plans, the Diabetes Quality Improvement Project, and the Health Outcomes Survey. Another private-sector group working in the area of standardization of performance measures is the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
|
From page 114... ...
With the exception of morbidity and mortality codes for public health reporting (i.e., ICD-9 codes) and code sets for reimbursement (i.e., ICD-9, CPT, and the Healthcare Financing Administration Common Procedure Coding System)
|
From page 115... ...
Its role was broadened by HIPAA to include identifying and recommending standards for administrative simplification and for the privacy and security of health care information, as well as to "study the issues related to the adoption of uniform data standards for patient medical record information (PMRI) and the electronic exchange of such information." While NCVHS has the lead in identifying and recommending clinical data standards, it has only an advisory role to DHHS and has not been empowered to designate or mandate standards.
|
From page 116... ...
CHI's mission is to articulate and execute a coherent vision and strategy for the adoption of federal interoperability standards for health care information while providing technical support to selected projects. As noted earlier in this report, in March 2003 the secretary of DHHS announced that DHHS, the Department of Defense, and VHA would be adopting an initial set of clinical data interchange standards recommended to the secretary by NCVHS, including HL7, NCPDP, IEEE 1073, DICOM, and the Logical Observation Identifiers, Names, and Codes (LOINC)
|
From page 117... ...
It is intended to provide assistance in developing and executing the electronic transfer of health care systems data for reporting purposes to local, state, and federal agencies that use the data for monitoring utilization rates, assessing patterns of health care quality and access, and other purposes required by legislative and regulatory mandates. Given the past difficulties and financial constraints of state-based public health organizations, the consortium could serve as one of the key facilitators helping states to implement national data standards for the NHII and guiding implementation of the common format for reporting to the AHRQ national patient safety database.
|
From page 118... ...
The purpose of the alliance is to develop and promote interoperability standards for health care information technology systems in order to improve patient outcomes and increase patient safety. In the near term, the alliance is focusing on standardized bar codes for products used by health care organizations.
|
From page 119... ...
Principal Partnership: Consolidated Health Informatics, National Committee on Vital and Health Statistics, and National Library of Medicine It is critical that Congress provide clear direction, enabling authority, and financial support for the establishment of national data standards to support patient safety. DHHS should be given the lead role in establishing and maintaining a public–private partnership for the promulgation of national standards for data interchange, terminologies, knowledge representation, and reporting (see Figure 3-2)
|
From page 120... ...
Designate Lead Organization and Provide Support 120 Specialty Societies Define "Best Practice" Academic Institutions Care Process Clinical AHRQ Professional Terminology Organizations Evidence-Based NLM Practice Centers Public Domain NQF Contracts NCQA QUIC Advisory Bodies Reporting CHI JCAHO Collaboration Requirements Collaboration • Quality and • Promulgate • NCVHS Leapfrog Group Safety Reporting Data Requirements • Standards Standards Professional Setting Bodies Organizations Reporting Data Requirements Standards Implementation by Government Programs • DHHS • VHA • DOD • OPM • Others FIGURE 3-2 Proposed public-private partnership to establish national standards. NOTE: AHRQ = Agency for Healthcare Research and Quality; CHI = Consolidated Health Informatics; DHHS = Department of Health and Human Services; DOD = Department of Defense; JCAHO = Joint Commission on Accreditation of Healthcare Organizations; NCQA = National Committee for Quality Assurance; NCVHS = National Committee on Vital and Health Statistics; NLM = National Library of Medicine; NQF = National Quality Forum; OPM = Office of Personnel Management; QuIC = Quality Interagency Coordinating Task Force; VHA = Veterans Health Administration.
|
From page 121... ...
NLM also will need to assume new responsibilities for ensuring the establishment of national data standards for patient safety. As noted earlier in this chapter, NLM has worked to develop standardized mappings from one terminology to another through the UMLS and is therefore ideally positioned to become the primary oversight body for maintenance of the core terminology group to be established by CHI and associated patient safety data standards.
|
From page 122... ...
Additionally, AHRQ is playing a key role with providers and public health entities in addressing the challenges of building the NHII and has allocated $50 million of its $84 million fiscal year 2004 budget to support health information technology initiatives ($24 million for safety- and quality-related projects and $26 million for community and rural projects) ; $10 million of the budget has been allocated for standards adoption projects (Agency for Healthcare Research and Quality, 2003b)
|
From page 123... ...
At the same time, the committee believes that the NHII office must step forward more aggressively with stronger leadership and an accelerated approach to the integration of information technology into the health care delivery system. REFERENCES Agency for Healthcare Research and Quality.
|
From page 124... ...
. Diabetic Retinopathy Study Research Group.
|
From page 125... ...
2002. Serious Reportable Events in Patient Safety: A National Quality Forum Consensus Report.
|
From page 126... ...
2002. The National Alliance for Health Information Technology Prospectus.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.