Is it worth connecting HIV service providers through a computer network and the Internet? John Milberg Office of Science and Epidemiology HRSA- HIV/AIDS Bureau
Recommendation From the National Academy of Science, Committee on Enhancing the Internet for Health Applications The Dept. of Health and Human Services should fund pilot projects and larger demonstration programs to develop and demonstrate interoperable, scalable internet applications for linking many health organizations. (2000) Source: Networking Health: Prescriptions for the Internet. National Research Council. National Academy Press, Washington, D.C. 2000.
The Day Ahead Big Benefits: Improve the quality, management and coordination of HIV care Improve ability to efficiently monitor, evaluate and report Bigger Challenges? Data security, confidentiality: Gaining the trust of consumers Running a secure network; Can you use the data? (data analysis skills) Introducing just one more MIS in clinics doing many other things and beholden to other funders What about providers not participating in the network (sometimes the biggest providers)?
The Day Ahead Current tales and experience: Lessons from the field How can you pay for it? What about all those providers who lack internet access?
Who Benefits and How? (and can you demonstrate it ) Consumers/PLWHA Providers of HIV Care Grantees HRSA/HAB
Who Benefits and How? (and can you demonstrate it ) For Consumers/PLWHA Better clinical management, receipt of preventive services-- improved outcomes? Network/shared database yields administrative efficiencyreduced burden to register and enroll Improved coordination of services, referrals and follow-up Can electronic access to medical record promote client buy-in to treatment regimen? Quick way to send messages and updates to client? What are your evaluation criteria?
Who Benefits and How? (and can you demonstrate it ) Providers of HIV Care Centralized network means reduced database administration (now you just have to worry if your network connection is up or too slow ) Improved coordination of services, referrals and follow-up within network participants Improved access to patient data for clinical decision-making More efficient reporting (now the grantee can run your CADR!) What are your evaluation criteria?
Who Benefits and How? (and can you demonstrate it ) Grantees All the data are at your electronic fingertips Improved coordination of services, referrals and follow-up within network participants; Dramatically improved ability to assess the quality of care within your jurisdiction, in real-time, and with unduplicated data (just think how easy grant-writing will be now ) More efficient reporting (now you can run the CADRs and produce one merged report across all providers) Evaluation criteria:
Who Benefits and How? (and can you demonstrate it ) HRSA/HAB Data gathered from network systems are unduplicated and more reliable, standardized. Therefore: HAB in a much improved position to report more accurately and efficiently on who is receiving care and quality of services funded by the CARE Act Evaluation criteria:
Challenges-Trust Data Security Must gain the trust and buy-in from people whose very sensitive data you will be storing and sending over the network (How do you do this?) If no one agrees to allow their personal health info to be stored and shared over the network, then the system loses utility
Data Security and Confidentiality Computers:Technological methods User Ids, Passwords, authentication, encryption, audit trails and logs, firewalls Human component: Establish clear rules and roles: Who s responsible in your agency (see HIPAA)?
Evaluate IT Does all this help you provide and manage your HIV care; Can you better evaluate and understand the services you provide (at specific agencies, overall)? Are you using the data fully? **How much of a network of care already exists in your area? Are we superimposing an electronic grid over a group of generally disconnected agencies? Think ahead about ways of showing the utility of your network system
So: Is it worth connecting HIV service providers through a computer network and the Internet? Benefits clearly outweigh the challenges and costs, but a panacea it is not. Source: Me Sites must develop technical capacity, health service analysis skills
So: Is it worth connecting HIV service providers through a computer network and the Internet? Other Sources: Medical Informatics, 2 nd ed. Shortliffe and Perreault, eds. Springer, New York., 2001. American Medical Informatics Assn. and their journal: http://www.amia.org/index.html