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Health IT Strategic Framework

Implementation

This Framework for Strategic Action (Framework) defines the four broad goals that will give rise to consumer-centric and information-rich care. It also specifies the 12 strategies that will be followed to accomplish these goals. The goals and strategies in the Framework outline a general approach to how the President's vision for high-quality and efficient care will be realized. The National Coordinator will work with federal agencies and the private sector to develop a full strategic plan and also to take actions that build upon current progress toward the vision.

Executive Order 13335 directed the National Coordinator to develop, maintain, and direct the implementation of a strategic plan to guide the nation's implementation of interoperable HIT in both the public and private health care sectors. As directed by the Executive Order, this plan will:

Advance the development, adoption, and implementation of health care information technology standards nationally through collaboration among public and private interests, and ensure that these standards are consistent with current efforts to set HIT standards for use by the federal government;
Ensure that key technical, scientific, economic, and other issues affecting the public and private adoption of HIT are addressed;
Evaluate evidence on the benefits and costs of interoperable HIT and assess to whom these benefits and costs accrue;
Address privacy and security issues related to interoperable HIT and recommend methods to ensure appropriate authorization, authentication, and encryption of data for transmission over the Internet;
Not assume or rely upon additional federal resources or spending to accomplish adoption of interoperable HIT; and
Include measurable outcome goals.

The Framework and related actions will follow three phases of implementation. Phase one will focus on the development of market institutions. Many of the agents and entities that are necessary for the health care industry to realize better value do not exist and must be developed and made operational before widespread change can occur. Certification organizations, group purchasing entities, and low-cost implementation support organizations are examples of market institutions that do not exist at this time, but which are necessary to support clinicians as they procure and use information technology. Likewise, although there are a variety of regional health information organizations, there is no consistent institution that can provide a platform through which financial investment or other support can be channeled to clinicians.

Market institutions will stabilize the market and thereby create a better environment for investment and accountability. They will lower the risk of HIT procurement, thereby enhancing demand and making more efficient use of resources that are invested. They will enhance the depth and confidence of HIT buyers and will accelerate the introduction of quality and efficiency into the mainstream of care delivery. Through these institutions, lasting and positive change in the way care is delivered will be made, and subsequent phases will be readied.

Phase two will involve investment in clinical management tools and capabilities. Once market institutions are in place, substantial investments can be made in the deployment of EHRs, PHRs, telemedicine, health information exchange, and other mechanisms for high-performance care delivery. Along with this, the development of the interoperability tools that are required to exchange health information in a secure and useful manner can proceed. This infrastructure will result in the capacity for most physician offices, hospitals, and other settings to improve care provided to patients, to share information across settings, to incorporate new knowledge, and to allow unobtrusive monitoring and reporting. This will require large capital investments in technology, business process reengineering, and professional development. These investments will be made less risky and more effective by the experiences and practices of the market institutions deployed in phase one. They will enable the industry to manage according to principles of accountability and to systematically produce the quality and service in health care that is expected by Americans.

Phase three will transition the market to robust quality and performance accountability. In this phase, clinicians will have the tools and capabilities to manage patients and populations, and to deliver consistently high-quality care in an efficient manner. These capabilities will give clinicians the means for constant improvement in practice. Clinicians can then be subjected to stringent quality and clinical performance monitoring, linked to public reporting and reimbursement, without concern about being unable to perform under such scrutiny or expectations. Through performance accountability, the priorities of clinicians can become aligned with society's expectations for care.

Last revised: July 26, 2004

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