ANIA Supports the National Health Information Infrastructure

The American Nursing Informatics Association (ANIA) was invited to represent nursing informatics at the first National Health Information Infrastructure (NHII) conference. ANIA was privileged to be listed among the endorsers with such groups as AMIA, JCAHO, eHealth Initiative, the Leapfrog Group, HIMSS, Department of Defense, AHIMA, American Association of Colleges of Nursing, American Academy of Family Physicians, American Accreditation Healthcare Commission National Committee for Quality Assurance, and others.

The conference theme was Developing a National Action Agenda for NHII. The conference was hosted by the US Department of Health and Human Services. This conference brought together key stakeholders to develop a consensus national action agenda to guide the further development of NHII. The following is a brief report; more detailed information will be forthcoming as the project develops.

The conference was organized around topic tracks. Each track had preliminary work completed as to the current state of the topic with some initial proposals for a national action agenda. The plenary sessions included presentations from the Assistant to the Secretary of the US Department of Health and Human Services (HHS); Don Detmer, MD, MA, Professor at the Judge Institute of Management, University of Cambridge and University of Virginia; John R. Lumpkin, MD, MPH, Director at the Robert Wood Johnson Foundation; Marc Overhage, MD, PhD, Senior Scientist, Regenstreif Institute for Health Care; William Raub, PhD, Acting Assistant Secretary for Planning and Evaluation, HHS; David Bates, Brigham and Women's Hospital; Reed Tuckson, MD, Senior Vice President, United Health Group and Harvey Fineberg, MD, PhD, President of the Institute of Medicine.

Scattered among the plenary sessions were working group sessions. The national healthcare informatics infrastructure was proposed to consist of eight tracks:

* Architecture

* Consumer health

* Financial incentives

* Homeland security

* Privacy and confidentiality

* Research and population

* Safety and quality

* Standards and vocabulary

The most exciting day of the conference was July 1, 2003 when the Secretary of HHS, Tommy G. Thompson, announced an agreement with the College of American Pathologists (CAP) to license the College's standardized medical vocabulary system and make it available without charge throughout the United States. This action opens the door to establishing a common medical language as a key element in building a unified electronic medical records system in the United States. For nursing, this is very exciting as SNOMED includes NANDA and NIC. NOC is already included in the National Library of Medicine's Metathesaurus for a Unified Medical Language, which is available as public domain for widespread use and has applied for certification for inclusion in SNOMED.

The Secretary also announced that HHS has commissioned the Institute of Medicine to design a standardized model of an electronic health record. The healthcare standards development organization known as HL7 has been asked to evaluate the model once it has been designed. HHS will share the standardized model record at no cost with all components of the US healthcare system. The Department expects to have a model record ready in 2004. Third, Secretary Thompson has created a new council within HHS to coordinate all agencies implementing an Electronic Health Record (EHR). He pledged HHS financial assistance in implementing the EHR. He announced efforts to persuade Congress to provide funds from the Fraud and Abuse budget to assist in the movement toward an EHR.

Finally, Secretary Thompson promised to support the development of benchmarks for the adoption of the EHR by the United States with quarterly report cards. He pledged Disease Management support via electronic monitoring, for example, with Smart cards or chips that are highly portable.

It is difficult to articulate the impressive presentations and enthusiasm for the development and deployment of the EHR. The implementation of the EHR is a major initiative of HHS and all of the agencies represented at this conference. EHR may be a new term to some readers, but the HHS believes that any medical record is a record of a person's health journey and the name should reflect that concept. There was general agreement and support for this terminology.

Donna Gloe, RNBC, EdD, President-Elect, represented ANIA at this conference and attended the Standards and Vocabulary working group. Unfortunately, all groups met simultaneously so there was only the opportunity to attend one group. The description of the track is:

The Standards and Vocabulary participants will focus on identifying actions that will promote the development, ongoing maintenance, and widespread use of health data content and transmission standards. It will look beyond the Health Insurance Portability and Accountability Act (HIPAA) administrative standards (and the fairly well-established processes for providing input in their selection and modification) to focus on actions required to promote additional data standardization to support clinical care, publish health, and research. The track will not address standards related to privacy, security, and software.

There were Facilitators and Invited Experts to assist in guiding all working groups. The first session included introductions and the review of the description of the track. Each attendee was given the Framework Action Agendas for all working sessions as a stimulus for discussion. Many hours of work went into the preparation of these frameworks and were an excellent stimulus for discussion. During the five working sessions the frameworks were reviewed and the working group provided discussion resulting in 10 recommendations for Standards and Vocabulary. The recommendations were agreed upon and presented the last morning of the conference along with recommendations from the other seven groups. These recommendations can be found on the conference Web site http://aspe.os.dhhs.gov/sp/nhii/along with the presentations.

Each of the track attendees presented their recommendations the final morning of the conference. Several recommendations were overlapping and consistent between the groups. The recommendations of each group were designated as short term, medium term, or long term. The timeframes for the recommendations indicated the urgency and critical need for recommendation, adoption, and implementation as most of the recommendations were designed as short term! The groups were highly cognizant of cost, barriers, and social and technology challenges as well as the extensive scope of the undertaking.

HHS will use these recommendations to propel the nation forward in the design, development, and implementation of the NHII and the EHR. It is unclear at this point how the work will be organized but the Secretary of HHS is requiring quarterly reports as to the progress so the path of the work should be known very soon. ANIA's participation in this conference testifies to the commitment and involvement of the organization in national initiatives in healthcare informatics.