Health IT Strategic Framework
Attachment 3
I. Executive Summary
By Executive Order, the President directed that the Departments of Veterans Affairs (VA) and Defense (DoD) shall jointly report to the Office of the National Coordinator for Health Information Technology (ONCHIT) on the approaches the Departments could take to transform clinical practice and healthcare delivery in rural and medically underserved communities through the use of affordable health information systems. This report recommends the need for a common "blueprint" or "road map" from which all interested parties can proceed. Further, the report recommends approaches that focus on standards (e.g. data, security, messaging, technical, and communication) and interoperability; infrastructure considerations (e.g., networks, hardware, and software); contracting incentives; technology transfer; and sharing of lessons learned.
DoD and VA serve as catalysts for changing how healthcare is delivered in the future; specifically as it relates to the use of health information technologies to improve access, healthcare delivery, population health management, and patient safety. ONCHIT is coordinating with DoD, VA, other federal agencies and organizations to develop: (a) a framework for securely exchanging health data through a common federal health infrastructure, (b) electronic health records, and (c) standards for data, security, technology, and communication.
DoD has successfully implemented various types of health information technologies in comparable environments and for similar purposes as those found in rural and medically underserved communities. Examples of these technologies include:
Telehealth for radiology, mental health, dermatology, pathology, and dental consultations; Online personalized health record for beneficiary use; Bed regulation for disaster planning; Basic patient encounter documentation Pharmacy, radiology, and laboratory order entry and results retrieval for use in remote areas and small clinics; Pharmacy, radiology, and laboratory order entry and results retrieval, admissions and discharge, and appointments for use in small hospitals; and Online education offerings for healthcare providers
Technology products, outcomes, benefits, and cumulative knowledge should be shared with ONCHIT for use within the private sector and local/state organizations to help guide their planning efforts.
In response to the directive, DoD proposes the following approaches:
DoD will collaborate and coordinate recommendations with ONCHIT in support of the development of a strategic plan. DoD will communicate, encourage, and incentivize industry business partners to actively support the President's agenda. The National Governors' Association (NGA) or a similar organization should establish a consortium of local and state authorities to develop a "blueprint" or "road map" targeted at healthcare delivery in rural and medically underserved communities - this blueprint will serve as a common business reference point from which information technology investment decisions can be made. DoD and VA should continue to aggressively participate with Standard Development Organizations (SDOs) in the development of national health data, technical, security, and communication standards that foster interoperability and data exchange. DoD and VA should continue to work with professional organizations such as Health Information Management System Society (HIMSS), American Medical Association (AMA), and support initiatives such as National Health Information Infrastructure (NHII) to facilitate the adoption and implementation of standards. DoD and VA should continue to share with the private sector experiences and lessons learned from the many ongoing health data exchange initiatives. Working with other federal agencies and organizations, DoD should assist in drafting templates of standard contract language for use nationally, which encourages industry to produce products and services that are scalable and applicable to the rural and underserved communities. DoD recommends that the federal government establish regional or national contracting and acquisition centers of excellence to strengthen purchasing power (e.g., bulk buys) and sharing of contracting language and lessons learned. DoD and VA should share electronically based educational programs that serve to extend the use of professionals and paraprofessionals in remote areas and assist them in staying current on medically related topics. In coordination with ONCHIT, DoD should share lessons learned and clinical practice templates in various forums with national, regional, state, and local authorities and the private sector on such topics as:
Application of health information technologies in remote sites, Management of information technologies in remote sites, Implementing privacy and security measures, Business process reengineering, Unique infrastructure solutions, Application of health standards in Health Information Technology (HIT), Change management, and Implementation challenges.
ONCHIT, with input from DoD and VA, should lead federal efforts to develop and implement an electronic health record and common business rules. DoD should develop and implement the use of personal health records (e.g., TRICARE Online), demonstrating opportunities to educate providers and beneficiaries.
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