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Health IT Strategic Framework

Public-Private Leadership

Low adoption and use of HIT are attributable to many factors, including a challenging marketplace and a previous lack of cohesive federal policies supporting it.  Leaders across the public and private sector recognize that the adoption and effective use of HIT require a joint effort between federal, state, and local government and the private sector.

The Private Sector Role

While the federal government plays an important role in HIT adoption, the effective use of, and value creation from, this technology lies predominantly with the private sector.  The federal government will provide a vision and a strategic direction for a national interoperable health care system, but will rely on a competitive technology industry, privately operated support services, and shared investments in HIT adoption.  The private sector must develop the market institutions to deliver the products and services that can transform the paper-based health care system into an electronic, consumer-centered, and quality-based system.  The private sector can best ensure that HIT products are successfully implemented in ways that meet the varying needs of American health care across settings, cultures, and geographies.  The private sector can also continue constant innovation in HIT and ensure that products are delivered on an affordable basis.

Federal and state governments have delegated most components of quality assurance to voluntary private organizations, including but not limited, to the JCAHO, NCQA, the National Quality Forum, residency review committees, and others.  This will be true of quality and performance accountability in the future world of HIT.  New market institutions need to be developed that can support clinician adoption of HIT, provide interoperability, and enhance the value realized by these investments.  Close collaboration between public and private sectors can develop new methods for improving care without creating unnecessary regulation and minimizing reporting burdens on private industry.

The Federal Role

The federal government has substantial cause for addressing HIT adoption.  Although the public is only now becoming aware of errors and mistreatments in care delivery, the incidence and severity of errors has been known by researchers for some time.  The health status of Americans is lower than it would be if care were seamless, timely, and evidence driven.  Health care inefficiency and quality problems create economic burdens on other industries.  When working Americans spend large shares of their time moving between physicians, dealing with the morbidity of improperly treated chronic illness, handling care burdens for their elderly parents, and recovering from errors and unnecessary therapies, the productivity of the American labor force, and America's position as a global output leader, is harmed.

The federal government has numerous means of stimulating change in the health care industry, even if most of that change occurs in the private sector.  While the federal government should not seek to reform health care without industry collaboration through the use of information technology, neither should it let the status quo exist simply because change will be difficult, complicated, and challenging to the industry.  The DoD and VA are major federal health care delivery organizations and, increasingly, contractors for care in communities across the United States.  The lessons these organizations have learned about HIT are an invaluable national asset and should be diffused through relationships with private delivery networks.  Also, the Federal Employees Health Benefits Program (FEHB) contracts for care in most urban markets across the United States, and can drive positive economic change in general care delivery.  Beyond finance and contracting, the current operation of the health care industry results from a vast patchwork of federal regulations that create many unintended inhibitory consequences for quality and efficiency.

Role of the National Coordinator

Executive Order 13335 directed the appointment of the National Coordinator for Health Information Technology to coordinate programs and policies regarding HIT across the federal government.  The National Coordinator was charged with directing HIT programs within HHS and coordinating them with those of other relevant Executive Branch agencies.  In fulfillment of this, the National Coordinator has taken responsibility for the National Health Information Infrastructure Initiative (NHII), the Federal Health Architecture (FHA), and the Consolidated Health Informatics Initiative (CHI), and is currently assessing other health information technology programs and efforts.  In addition, the National Coordinator was charged with coordinating outreach and consultation between the federal government and the private sector.  As part of this, the National Coordinator was directed to coordinate with the National Committee on Vital Health Statistics (NCVHS) and other advisory committees.

The National Coordinator will collaborate with DoD, VA, and OPM to encourage the widespread adoption of HIT throughout the health care system.  To do this, the National Coordinator will gather and disseminate the lessons learned from both DoD and VA in successfully incorporating HIT into the delivery of health care, and facilitate the development and transfer of knowledge and technology to the private sector.  OPM, as the purchaser of health care for the federal government, has a unique role and the ability to encourage the use of EHRs through the Federal Employees Health Benefits Program, and the National Coordinator will assist in gaining the complementary alignment of OPM policies with those of the private sector.

Preliminary discussions indicate that the National Coordinator will fulfill its charge by performing six functions, as detailed below.

Provide leadership

The unified vision and strategic goals established by the President will be achieved by the development of common approaches to HIT.  To do this, the National Coordinator will work with agencies to develop strategies and metrics for monitoring progress to ensure that it is consistent with agency mission.  As the National Coordinator works with programs and policies across the government, gaps will be identified, along with solutions to fill these gaps.  The National Coordinator will ensure that the federal government plays a key role in leveraging federal resources to encourage the private sector to develop a strong health information infrastructure that will serve to improve health care delivery and public health functions.

Promote collaboration

Better collaboration would benefit HIT programs across the federal government.  Sharing information and expertise will facilitate the development and implementation of HIT programs and allow agencies and stakeholders to benefit from lessons learned by others.  To improve the strength and coherence of programs across federal departments and agencies, the National Coordinator will develop the mechanisms to reduce redundancy, to fill programmatic voids, to align programs with available resources, and to maximize the value of the programs to the end goals of health care delivery.

Develop policy

The National Coordinator, working through various agencies, will develop the many new policies needed to implement the strategic plan. It will bring together various work groups that will allow for an interdisciplinary approach to policy development.  Coordinated policies will be based on common principles and objectives across agencies.  The National Coordinator will also integrate private stakeholder perspectives in the policy development process through close collaboration with the private sector.

Support financial management

The National Coordinator will coordinate investments in HIT by maintaining a strategic plan that can be used as a guide and reference for prioritization in the budget process.  The National Coordinator will work with agencies and departments to ensure that budget requests for HIT are coordinated so that federal investments are unified, cost-effective, and aligned with overall federal strategy.

Enhance communication and outreach

Ongoing communication between public and private decision makers will be critical to success of the strategic plan.  The National Coordinator will work with federal agencies to transfer useful knowledge to the private sector where appropriate, and will ensure that public and private HIT efforts share information to the degree possible.  Also, the National Coordinator will work with NCVHS and other federal advisory bodies to ensure that private sector input is systematically incorporated into policies and programs, where applicable.

Evaluate effectiveness

The National Coordinator will work with agencies to assess the effectiveness of HIT policies and programs.  To do this, the National Coordinator will work with federal agencies to develop metrics that can assess progress toward strategic goals over time and across programs.  Also, the National Coordinator will identify model business processes that can support collaboration and harmonization of federal HIT programs.  The National Coordinator will also work with federal agencies to compare ongoing HIT programs to reference architectures, business requirements, and data standards so that variations and gaps can be assessed and addressed as possible within agency mission.

Last revised: July 23, 2004

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