Health IT Strategic Framework

Preface

The Administration and the Department of Health and Human Services (HHS) have recognized the importance of fostering the development and diffusion of technology to improve the delivery of health care.  Over the past few years the federal government and the strong, talented leadership of the private sector have made progress in setting the stage for transforming health care delivery through vastly improved use of health information technology (HIT).

In 1998, the National Committee on Vital and Health Statistics (NCVHS), a federal advisory committee composed of private sector experts, reported that the nation's information infrastructure could be an essential tool for promoting the nation's health in its seminal concept paper, "Assuring a Health Dimension for the National Information Infrastructure."  Since that time, other initiatives have helped to further define the best approach to apply information and communication technologies to the health sector.

In 2002, the Markle Foundation organized a public-private collaborative, Connecting for Health, which brought together leaders from government, industry, and health care, and consumer advocates to improve patient care by promoting standards for electronic medical information.  A year later, the collaboration of more than 100 public and private stakeholders achieved consensus on an initial set of health care data standards and commitment for their adoption from a wide variety of national health care leaders.

In March 2003, the Consolidated Health Informatics (CHI) initiative involving HHS, the Departments of Defense (DoD), and Veterans Affairs (VA), announced uniform standards for the electronic exchange of clinical health information to be adopted across the federal health care enterprise.  These standards will facilitate information exchange, with privacy and security protections, to make it easier for health care providers to share relevant patient information and for public health professionals to identify emerging public health threats.

At the end of 2003, President Bush signed into law the Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003.  Among other new initiatives, the law includes important provisions for HIT. MMA requires the Centers for Medicare and Medicaid Services (CMS) to develop standards for electronic prescribing, which will be a first step toward the widespread use of electronic health records (EHR).  In addition, the MMA requires the establishment of a Commission on Systemic Interoperability to provide a road map for interoperability standards.

In April 2004, President Bush issued Executive Order 13335 calling for widespread adoption of interoperable EHRs within 10 years, and established the position of National Coordinator for Health Information Technology.  The Executive Order signed by the President directs the National Coordinator to produce a report within 90 days of operation on the development and implementation of a strategic plan to guide the nationwide implementation of interoperable HIT in both the public and private sectors.

The President's Information Technology Advisory Committee (PITAC) in June 2004 issued a draft report, "Revolutionizing Health Care Through Information Technology," which stated that the overall quality and cost-effectiveness of U.S. health care delivery bear directly on three top national priorities of national, homeland, and economic security.

In July 2004, Connecting for Health released a timely report that details specific actions the public and private sectors can take to accelerate the adoption of information technology in health care.  Connecting for Health's "Preliminary Roadmap for Achieving Electronic Connectivity in Healthcare" contains recommendations in three categories: creating a technical framework for connectivity, developing incentives to promote improvements in health care quality, and engaging the American public by providing information to promote the benefits of electronic connectivity and to encourage patients and consumers to access their own health information.

Collectively, these accomplishments have laid the groundwork for a widespread effort to drive adoption of interoperable HIT.  This report, and the actions that will follow, will build upon this foundation to realize the vision for consumer-centric and information-rich care.

This report was published by the Office for the National Coordinator for Health Information Technology (ONCHIT), Department of Health and Human Services, and the United States Federal Government.

This report is intended to guide discussion and investigation so progress can be made towards widespread adoption of health information technology.  This report does not constitute a change in policy nor does it call for statutory changes in its own right.

Specific reports by the Office of Personnel Management (OPM), Department of Defense (DoD), and the Department of Veterans Affairs (VA) that respond to the President's April 27, 2004, Executive Order are also included in this bound report.

The following staff should be acknowledged for their contribution to this report:  Clay Ackerly, Kelly Cronin, Lori Evans, Arlene Franklin, Kathleen Fyffe, Natalie Gravette, Jennie Harvell, Mary Hollander, Lee Jones, Al Kaylani, Missy Krasner, Barbara Ricks, and Helga Rippen.  The efforts of leaders and key staff from each federal agency involved with this report should be acknowledged.

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