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Health Care Information
Technology
Ramesh Rao
California Institute for Telecommunication and
Information technology
University of California, San Diego
Role of Cyberinfrastructure
Taxonomy of Cyberinfrastructure
Computational Technology for
Effective Health Care: Immediate
Steps and Strategic Directions
William W. Stead and Herbert S. Lin, Editors
Committee on Engaging the Computer Science Research
Community in Health Care Informatics
Computer Science and Telecommunications Board
National Research Council of the National Academies
Recommendations for the Federal
Government
Incentivize clinical performance gains rather than
acquisition of IT per se.
 Encourage initiatives to empower iterative process
improvement and small-scale optimization.
 Encourage development of standards and measures
of health care IT performance related to cognitive
support for health professionals and patients,
adaptability to support iterative process
improvement, and effective use to improve quality.
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Recommendations for the Federal
Government
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Encourage interdisciplinary research in three critical areas: (a)
organizational systems-level research into the design of health care
systems processes and workflow; (b) computable knowledge structures
and models for medicine needed to make sense of available patient data
including preferences, health behaviors, and so on; and (c) humancomputer interaction in a clinical context.
Encourage (or at least do not impede) efforts by health care institutions
and communities to aggregate data about health care people, processes,
and outcomes from all sources subject to appropriate protection of
privacy and confidentiality.
Support additional education and training efforts at the intersection of
health care, computer science, and health/biomedical informatics.
Current programs of the National Library of Medicine and other
institutes of the National Institutes of Health are exemplars of such
support.
Health Care Institutions
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Organize incentives, roles, workflow, processes, and
supporting infrastructure to encourage, support, and respond
to opportunities for clinical performance gains.
Balance the institution’s IT portfolio among automation,
connectivity, decision support, and data-mining capabilities.
Develop the necessary data infrastructure for health care
improvement by aggregating data regarding people,
processes, and outcomes from all sources.
Insist that vendors supply IT that permits the separation of
data from applications and facilitates data transfers to and
from other non-vendor applications in sharable and generally
useful formats.
Seek IT solutions that yield incremental gains from
incremental efforts.
Computer Science Community
Engage as co-equal intellectual partners and
collaborators with health care practitioners and
experts in health/biomedical informatics and other
relevant disciplines, such as industrial and process
engineering and design, in an ongoing relationship to
understand and solve problems of importance to
health care.
 Develop institutional mechanisms within academia for
rewarding work at the health care/computer science
interface.
 Support educational and retraining efforts for
computer science researchers who want to explore
research opportunities in health care.
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Proposition 1D
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$200 million in new bond funding
for five UC medical schools to
leverage telemedicine technology,
help support major new initiatives
in telemedicine and grow medical
student class size
“With Proposition 1D we will be able to connect our best hospitals
and our best medical schools with clinics in remote areas all over
the state of California.”
- Governor Arnold Schwarzenegger
CALIFORNIA TELEHEALTH NETWORK
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PALMS
Physical Activity Location Measurement System
An integrated suite of hardware and software to enable continuous
capture and subsequent analysis of data on physical activity, spatial
location and other sensor data important to understanding
physical activity--environment exposure
PALMS will support gathering data from multiple participants within
studies and aggregating and comparing data between and among
multiple researchers across studies
Funded through the NIH Gene, Environment and Health Initiative
Exposure Biology Program
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Copyright, Regents of the University of California and Santech, Inc, 2008
Visualize – Heart Rate
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Red and orange indicate higher heart rates
Copyright, Regents of the University of California and Santech, Inc, 2008
Mapping / GIS
Heart rate
shown in
ESRI ArcGIS
against land use
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Copyright, Regents of the University of California and Santech, Inc, 2008
Suggestions, Comments
Backup
What is HIT infrastructure?
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RAND (2005)
◦ Electronic Medical Records
◦ Decision Support Systems
◦ Computerized Physician Order Entry for
medications
Components of Health Information
Exchange: AHRQ
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Data-Sharing Agreements
Data Pipes
Interface Engines
Data Models
Record Locator Service
Master Patient Index
Data Repository
Standards
Interoperability
FCC Rural Health Care Pilot Program
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Announced Fall 2006: Up to $417 million available over three years
Purpose: “to facilitate the creation of a nationwide broadband network
dedicated to health care, connecting public and private non-profit
health care providers in rural and urban locations”
Pays 85% of telecommunication-related expenses
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Capital
Connection
Installation
Network Consulting/Design
Encourages regional broadband health care networks with connections
to national backbones, e.g., National Lambda Rail (NLR), Internet2 (I2)
CALIFORNIA TELEHEALTH NETWORK
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California’s Proposal - Goals
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Create statewide broadband network dedicated to health care
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Link the California Telehealth Network (CTN) to a national backbone
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Leverage and build upon recent investments in telehealth
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Utilize the CTN for ongoing disaster preparedness training
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Report back to the FCC on the pilot program and suggested
revisions to the FCC’s current rural health rules
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CTN - Strategic Purposes
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Create a highly reliable, interoperable, ubiquitous broadband
network, encompassing the majority of rural areas
Integrate current and emerging regional, statewide and
national networks, forming a “network-of-networks” supporting
peer-to-peer communications
Facilitate telehealth services over the network, showing
participants how to leverage the network to improve patient
care
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California’s Proposal - Details
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Proposed creation of a statewide, peer-to-peer network over three years,
connecting over 300 California health care sites, the majority of which are located in
Health Professional Shortage Areas (HPSAs)
Preliminary list of sites included:
 256 Rural Urban Commuting Area (RUCA) sites
 154 primary care clinics
 22 tribal clinics
 81 rural hospitals
 26 teaching hospitals
 One psychology clinic
Proposed also using the statewide network for:
 ongoing disaster preparedness training, outbreak surveillance, and
communication during emergencies/disasters
 continuing education for health professionals
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CTN - Proposed Sites
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California’s Proposal to the FCC
Background
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Fall 2006: Consortium formed by Governor’s Office
May 2007: Single California proposal submitted
University of California Office of the President and UC
Davis Health System selected as managing partners
November 2007: FCC awards California up to $22.1 million
to create the California Telehealth Network
Winter 2007: Matching funds granted by California
Emerging Technology Fund, and UnitedHealth/PacifiCare
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California Telehealth Network (CTN)
Consortium Members
California Business, Transportation and
Housing Agency (BTH)
California Department of Managed Health
Care (DMHC)
California Emerging Technology Fund (CETF)
California Health & Human Services Agency
(CHHSA)
California Health Foundation and Trust
(CHFT)
California Hospital Association (CHA)
California Institute for Telecommunications
and Information Technology (Cal IT2)
California Office of Emergency Services
(OES)
California Primary Care Association (CPCA)
California Public Utilities Commission (CPUC)
California Rural Telehealth Networks (various)
California State Rural Health Association
(CSRHA)
California Telemedicine & eHealth Center
(CTEC)
Corporation for Education Network Initiatives
in California (CENIC)
Office of Statewide Health Planning and
Development (OSHPD)
Office of the Governor
University of California Davis Health System
University of California Office of the President
University of California System
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Recent California Broadband, Technology,
and Telemedicine Initiatives
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California Telemedicine & eHealth Center (CTEC): regional eHealth
networks
Governor’s Health Information Technology (HIT) Executive Order (S12-06): $240 million for health information exchange
Governor’s Broadband Task Force Executive Order (S-23-06)
California Emerging Technology Fund: $60 million from SBC-AT&T,
and Verizon-MCI mergers, for ubiquitous broadband access and
emerging technologies
California Teleconnect Fund (CPUC): 50% discount to eligible
hospitals and clinics
Indian Health Service: Growth in Telemedicine
Blue Cross of California Telemedicine Network
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So we now have the opportunity to explore
interrelationships between and among health behaviors,
ecological factors, and physiological processes
Ecological factors
Interpersonal & psychosocial
factors
Physiological
factors
Medical & Exercise
Sciences
Psychological
& Social Sciences
Environment &
Policy Science
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