Health Information Technology
HHS is Continuing Efforts to Define a National Strategy Gao ID: GAO-06-346T March 15, 2006As GAO and others have reported, the use of information technology (IT) has enormous potential to improve the quality of health care and is critical to improving the performance of the U.S. health care system. Given the federal government's influence in the health care industry, it has been urged over the years to take a leadership role in driving change to improve the quality and effectiveness of medical care, including the adoption of IT. In April 2004, President Bush called for widespread adoption of interoperable electronic health records within 10 years; established the position of the National Coordinator for Health IT, who was appointed in May 2004 and released a framework for strategic action two months later. In May 2005, GAO recommended that HHS establish detailed plans and milestones for each phase of the framework and take steps to ensure that those plans are followed and milestones are met. HHS agreed with our recommendation. GAO (1) assessed the progress being made by the Department of Health and Human Services (HHS) since 2005 to develop a national health IT strategy and (2) provided an overview of selected federal agencies' health IT initiatives related to the national health IT strategy.
HHS has continued efforts to develop a national health IT strategy. For example, HHS--through the Office of the National Coordinator for Health IT--has established the organizational structure of the office and awarded $42 million in contracts intended to advance the use of health IT. These contracts address a range of issues important to encouraging the adoption of IT such as reviewing standards activities for gaps and duplication. In addition, HHS has established the American Health Information Community to obtain public and private sector input on how to make health records digital and achieve interoperability for health information exchange. HHS intends to use the results of the contracts and the Community proceedings to define future direction. Key HHS divisions also continue funding and supporting the development of health IT initiatives that support the goals of the framework. According to the National Coordinator, he intends to release a strategic plan with detailed plans and milestones later this year. Several federal agencies collaborating with HHS--namely, the Departments of Veterans Affairs, Defense, and Commerce, and the Office of Personnel Management--also have responsibility for their own health IT initiatives related to the national health IT strategy. These agencies participate in the American Health Information Community. Veterans Affairs and Defense play critical roles in the advancement of electronic health records, which they have developed and are implementing in their facilities. The Office of Personnel Management is attempting to use its position as one of the largest purchaser of employee health care benefits by encouraging its carriers to use applications such as enabling a physician to transmit a prescription electronically to a patient's pharmacy of choice. The National Institute for Standards and Technology is also providing technical expertise in the standards development and harmonization process and established a Web site to assist in standards development efforts.
GAO-06-346T, Health Information Technology: HHS is Continuing Efforts to Define a National Strategy
This is the accessible text file for GAO report number GAO-06-346T
entitled 'Health Information Technology: HHS is Continuing Efforts to
Define a National Strategy' which was released on March 16, 2006.
This text file was formatted by the U.S. Government Accountability
Office (GAO) to be accessible to users with visual impairments, as part
of a longer term project to improve GAO products' accessibility. Every
attempt has been made to maintain the structural and data integrity of
the original printed product. Accessibility features, such as text
descriptions of tables, consecutively numbered footnotes placed at the
end of the file, and the text of agency comment letters, are provided
but may not exactly duplicate the presentation or format of the printed
version. The portable document format (PDF) file is an exact electronic
replica of the printed version. We welcome your feedback. Please E-mail
your comments regarding the contents or accessibility features of this
document to Webmaster@gao.gov.
This is a work of the U.S. government and is not subject to copyright
protection in the United States. It may be reproduced and distributed
in its entirety without further permission from GAO. Because this work
may contain copyrighted images or other material, permission from the
copyright holder may be necessary if you wish to reproduce this
material separately.
United States Government Accountability Office:
GAO:
Testimony:
Before the Subcommittee on Federal Workforce and Agency Organization,
Committee on Government Reform, House of Representatives:
For Release on Delivery:
Expected at 3:15 p.m. EST March 15, 2006:
HQ 1413106, p. 37:
Health Information Technology:
HHS is Continuing Efforts to Define a National Strategy:
Statement of David A. Powner:
Director, Information Technology Management Issues:
GAO-06-346T:
GAO Highlights:
Highlights of GAO-06-346T, a report to Subcommittee on Federal
Workforce and Agency Organization, Committee on Government Reform,
House of Representatives:
Why GAO Did This Study:
As GAO and others have reported, the use of information technology (IT)
has enormous potential to improve the quality of health care and is
critical to improving the performance of the U.S. health care system.
Given the federal government‘s influence in the health care industry,
it has been urged over the years to take a leadership role in driving
change to improve the quality and effectiveness of medical care,
including the adoption of IT. In April 2004, President Bush called for
widespread adoption of inter-operable electronic health records within
10 years; established the position of the National Coordinator for
Health IT, who was appointed in May 2004 and released a framework for
strategic action two months later. In May 2005, GAO recommended that
HHS establish detailed plans and milestones for each phase of the
framework and take steps to ensure that those plans are followed and
milestones are met. HHS agreed with our recommendation.
GAO (1) assessed the progress being made by the Department of Health
and Human Services (HHS) since 2005 to develop a national health IT
strategy and (2) provided an overview of selected federal agencies‘
health IT initiatives related to the national health IT strategy.
What GAO Found:
HHS has continued efforts to develop a national health IT strategy. For
example, HHS”through the Office of the National Coordinator for Health
IT”has established the organizational structure of the office and
awarded $42 million in contracts intended to advance the use of health
IT. These contracts address a range of issues important to encouraging
the adoption of IT such as reviewing standards activities for gaps and
duplication (see table). In addition, HHS has established the American
Health Information Community to obtain public and private sector input
on how to make health records digital and achieve interoperability for
health information exchange. HHS intends to use the results of the
contracts and the Community proceedings to define future direction. Key
HHS divisions also continue funding and supporting the development of
health IT initiatives that support the goals of the framework.
According to the National Coordinator, he intends to release a
strategic plan with detailed plans and milestones later this year.
Health IT Contracts Awarded by HHS‘s Office of the National
Coordinator:
[See PDF for image]
[End of table]
Several federal agencies collaborating with HHS”namely, the Departments
of Veterans Affairs, Defense, and Commerce, and the Office of Personnel
Management” also have responsibility for their own health IT
initiatives related to the national health IT strategy. These agencies
participate in the American Health Information Community. Veterans
Affairs and Defense play critical roles in the advancement of
electronic health records, which they have developed and are
implementing in their facilities. The Office of Personnel Management is
attempting to use its position as one of the largest purchaser of
employee health care benefits by encouraging its carriers to use
applications such as enabling a physician to transmit a prescription
electronically to a patient‘s pharmacy of choice. The National
Institute for Standards and Technology is also providing technical
expertise in the standards development and harmonization process and
established a Web site to assist in standards development efforts.
www.gao.gov/cgi-bin/getrpt?GAO-06-346T.
To view the full product, including the scope and methodology, click on
the link above. For more information, contact David A. Powner (202) 512-
9286 or pownerd@gao.gov.
[End of section]
Abbreviations:
CHCS: Composite Health Care System:
CMS: Centers for Medicare and Medicaid Services:
Community: American Health Information Community:
DOD: Department of Defense:
EHR: electronic health record:
HHS: Department of Health and Human Services:
IT: information technology:
NIST: National Institute for Standards and Technology:
ONC: Office of the National Coordinator for Health Information
Technology:
OPM: Office of Personnel Management:
VA: Department of Veterans Affairs:
Mr. Chairman and Members of the Committee:
I am pleased to be here today to comment on federal efforts to advance
the use of information technology (IT) for health care delivery and
public health. As we and others have reported, the use of IT has
enormous potential to improve the quality of health care and is
critical to improving the performance of the U.S. health care system.
The federal government has been working to promote the use of IT in
public and private health care settings. With the growing momentum
behind a national health IT strategy, leveraging federal efforts is an
important component of this strategy. Several federal agencies are
collaborating with the Department of Health and Human Services (HHS)--
namely, the Departments of Veterans Affairs, Defense, and Commerce, and
the Office of Personnel Management--as it works toward developing a
national strategy to advance the use of health IT.
At your request, today we will (1) discuss our assessment of the
progress being made since 2005 by HHS's Office of the National
Coordinator for Health IT and other key divisions toward the
development of a national IT strategy and (2) provide an overview of
selected federal agencies' initiatives related to the national health
IT strategy. In preparing this statement, we reviewed agency documents
that describe the current status of HHS's and other federal agencies'
activities related to a health IT strategy and supplemented our
analysis with interviews of agency officials. We also summarized our
prior reports. Our work was performed in accordance with generally
accepted auditing standards.
Results in Brief:
HHS--through the Office of the National Coordinator for Health IT--has
continued efforts to define a national health IT strategy. HHS has
established the organizational structure of the Office of the National
Coordinator and awarded about $42 million in contracts intended to
advance the adoption of health IT. These contracts address a range of
issues important in advancing the use of IT, such as reviewing
standards activities for gaps and duplication and reviewing privacy and
security laws across federal and state governments. In addition, the
Secretary of HHS has established an advisory body called the American
Health Information Community to obtain public and private sector input.
The Community, composed of representatives from federal agencies and
the private sector, began meeting in October 2005 to advise HHS on how
to make health records digital and achieve interoperability for health
information exchange. HHS plans to use the results of the contracts and
the Community proceedings to define future direction. HHS also has
other important health IT programs and initiatives, such as the
demonstration grants awarded by the Agency for Healthcare Research and
Quality and the Centers for Disease Control and Prevention's Public
Health Information Network. These initiatives are intended to address a
variety of issues to accelerate and encourage the adoption of health IT
across the health care industry and support the goals of the framework
for strategic action. According to the National Coordinator, he intends
to release a strategic plan later this year that will guide the
nationwide implementation of interoperable health IT by establishing
milestones and performance metrics.
Several federal agencies collaborating with HHS--namely, the
Departments of Veterans Affairs, Defense, and Commerce, and the Office
of Personnel Management--also have responsibility for their own
initiatives related to the national health IT strategy. Many of these
agencies, as well as a representative from the Department of the
Treasury, participate in the American Health Information Community,
HHS's newly formed Health IT Policy Council, and the Federal Health
Architecture.[Footnote 1] Veterans Affairs and Defense, as major
federal health care providers, play critical roles in the advancement
of electronic health records (EHR). Veterans Affairs has developed and
implemented an EHR system; Defense is still in the process of
implementing one in their facilities. The Office of Personnel
Management is planning to use its position as one of the largest
purchasers of employee health care benefits to encourage its carriers
to use applications such as electronic prescribing.[Footnote 2] When
the agency issued its 2005 annual call letter to carriers last April,
it requested that plans describe their health IT initiatives, including
any currently in place for doctors and pharmacies to use electronic
prescribing. The National Institute for Standards and Technology is
also providing technical expertise, largely in the standards
development and harmonization process, and has established a Web site
containing information on health care standards, organizations, and
resources to assist in standards development, implementation, and use
by developers and other stakeholders.
Background:
Studies published by the Institute of Medicine and others have
indicated that fragmented, disorganized, and inaccessible clinical
information adversely affects the quality of health care and
compromises patient safety. In addition, long-standing problems with
medical errors and inefficiencies increase costs for health care
delivery in the United States. With health care spending in 2004
reaching almost $1.9 trillion, or 16 percent of the gross domestic
product, concerns about the costs of health care continue. As we
reported last year, many policymakers, industry experts, and medical
practitioners contend that the U.S. health care system is in
crisis.[Footnote 3]
Health IT--the technology used to collect, store, retrieve, and
transfer clinical, administrative, and financial health information
electronically--is seen as a promising solution to improve patient
safety and reduce inefficiencies. Hence, it has great potential to
improve the quality of care, bolster preparedness of our public health
infrastructure, and save money on administrative costs. As we reported
in 2003, technologies such as electronic health records[Footnote 4] and
bar coding of certain human drug and biological product labels have
been shown to save money and reduce medical errors.[Footnote 5] For
example, a 1,951-bed teaching hospital reported that it realized about
$8.6 million in annual savings by replacing paper medical charts with
electronic medical records for outpatients. This hospital also reported
saving more than $2.8 million annually by replacing its manual process
for handling medical records with electronic access to laboratory
results and reports. Health care organizations also reported that IT
contributed other benefits, such as shorter hospital stays, faster
communication of test results, improved management of chronic diseases,
and improved accuracy in capturing charges associated with diagnostic
and procedure codes.
However, according to HHS, only a small number of U.S. health care
providers have fully adopted health IT as there are significant
financial, technical, cultural, and legal barriers to its adoption.
These include a lack of access to capital, a lack of data standards,
and resistance from health care providers.
Federal Government's Role in Health Care:
According to the Institute of Medicine, the federal government has a
central role in shaping nearly all aspects of the health care sector as
a regulator, purchaser, health care provider, and sponsor of research,
education, and training. Seven major federal health care programs, such
as Medicare and Medicaid, provide health care services to approximately
115 million Americans. Table 1 summarizes the number of citizens who
receive health care services from the federal government and the cost
of these services.
Table 1: Beneficiaries and Expenditures in Major Federal Health Care
Programs for Fiscal Year 2004:
Federal Agency: HHS;
Program: Medicare;
Beneficiaries: 42 million elderly and disabled beneficiaries;
Expenditures: $309 billion.
Federal Agency: HHS;
Program: Medicaid;
Beneficiaries: 43.7 million low-income persons;
Expenditures: $276.8 billion (joint federal and state).
Federal Agency: HHS;
Program: State Children's Health Insurance Program;
Beneficiaries: 5.8 million children[A];
Expenditures: $6.6 billion (joint federal and state).
Federal Agency: HHS;
Program: Indian Health Service;
Beneficiaries: 1.8 million Native Americans and Alaska Natives;
Expenditures: $3.7 billion.
Federal Agency: VA;
Program: Veterans Health Administration;
Beneficiaries: 5 million veterans;
Expenditures: $29.1 billion.
Federal Agency: DOD;
Program: Tricare Program;
Beneficiaries: 9.2 million active-duty military personnel and their
families, and military retirees;
Expenditures: $24.4 billion.
Federal Agency: OPM;
Program: Federal Employees Health Benefit Program;
Beneficiaries: 8 million federal employees, retirees and dependents;
Expenditures: $27 billion.
Source: HHS, VA, DOD, and OPM budget documents.
[A] Based on FY 2003 data:
[End of table]
Given the federal government's influence in the health care industry,
it has been urged to take a leadership role in driving change to
improve the quality and effectiveness of medical care in the United
States, including the adoption of IT. In April 2004, President Bush
called for widespread adoption of interoperable electronic health
records within 10 years and issued an executive order[Footnote 6] that
established the position of the National Coordinator for Health
Information Technology, who was appointed in May 2004. The National
Coordinator is to develop and implement a strategic plan to guide the
nationwide implementation of interoperable health IT in both the public
and private sectors. Two months later, HHS released The Decade of
Health Information Technology: Delivering Consumer-centric and
Information-rich Health Care--Framework for Strategic Action.
The framework describes actions to be taken by the public and private
sectors to develop and implement a strategy that is built on already-
existing work in health IT. The framework defines goals and strategies
that are to be implemented in three phases.[Footnote 7] HHS is in the
initial phase of implementing activities of the framework by
coordinating federal health IT efforts across the government and
reaching out to private industry. The framework also introduced the
concept of regional health information organizations, which are
considered an essential element in the establishment of a national
health information network. Regional health information organizations-
-entities that enable the exchange and use of health information--are
expected to facilitate information exchange across different
jurisdictions and hospital systems.
Other federal agencies also play an important role in fostering the
adoption of health IT. The Department of Veterans Affairs--one of the
country's largest health care providers--has had an automated
information system in its medical facilities since 1985. The agency's
Veterans' Health Information Systems and Technology Architecture is an
integrated outpatient and inpatient system that includes its electronic
health record--the Computerized Patient Record System. The Department
of Defense has provided IT support to its hospitals and clinics since
1968. The Composite Health Care System (CHCS), deployed in 1993, is the
primary medical information system now used in all military health
system facilities worldwide. In 1997, the department initiated CHCS II
and is in the process of implementing the system in their facilities.
Now known as the Armed Forces Health Longitudinal Technology
Application, it will eventually replace CHCS. The Office of Personnel
Management (OPM) has responsibility for the Federal Employees Health
Benefit Program, which is one of the largest employer-based health
insurance programs in the country. The government pays on average about
72 percent of the cost of the coverage and enrollees pay the remainder
based on a formula set by law.
National Strategy and Greater Interoperability Still Needed:
In the summer of 2004, we testified on the benefits that effective
implementation of IT can bring to the health care industry and the need
for HHS to provide continued leadership, clear direction, and
mechanisms to monitor progress in order to bring about measurable
improvements.[Footnote 8] Last year, we reported that HHS, through the
Office of the National Coordinator for Health IT, and in conjunction
with other federal agencies, had taken a number of actions toward
accelerating the use of IT to transform the health care industry,
including the issuance of a framework for strategic action as a first
step toward defining a national strategy. To accelerate the adoption of
interoperable information systems, we recommended that HHS establish
detailed plans and milestones for each phase of the framework and take
steps to ensure that those plans are followed and milestones are
met.[Footnote 9] The department agreed with our recommendation.
We have also reported on major public health IT initiatives and
challenges that still need to be overcome to strengthen the IT that
supports the public health infrastructure.[Footnote 10] Federal
agencies face many challenges in improving the public health
infrastructure. These challenges include (1) integrating current
initiatives into a national health IT strategy and federal architecture
to reduce the risk of duplicative efforts, (2) developing and adopting
consistent standards to encourage interoperability, (3) coordinating
initiatives with states and local agencies to improve the public health
infrastructure, and (4) overcoming federal IT management weaknesses to
improve progress on IT initiatives. Until these agencies address all
these challenges, movement toward building a stronger public health
infrastructure will be limited, as will the ability to share essential
information concerning public health emergencies and bioterrorism. We
recommended that HHS coordinate with state and local public health
agencies, align federal public health initiatives with the national
health IT strategy and federal health architecture, and continue
federal actions to encourage the development and adoption of data
standards.
Last September, we testified before the full committee about the
importance of defining and implementing data and communication
standards to speed the adoption of interoperable IT in the health care
industry.[Footnote 11] Hurricane Katrina highlighted the need for
interoperable electronic health records as thousands of people were
separated from their health care providers and paper medical records
were lost. As we noted, standards are critical to enabling this
interoperability. Although federal leadership has been established to
accelerate the use of IT in health care, we testified that several
actions[Footnote 12] are still needed to position HHS to further define
and implement relevant standards. Otherwise, the health care industry
will continue to be plagued with incompatible systems that are
incapable of exchanging key data that are critical to delivering care
and responding to public health emergencies.
For the past seven years, the Departments of Defense (DOD) and Veterans
Affairs (VA) have been working to achieve the capability of sharing
medical information. However, they have been severely challenged in
their pursuit of the longer-term objective--providing a virtual medical
record in which data are computable.[Footnote 13] As we have noted, the
departments had achieved some success in sharing data through the one-
way transfer of health information from DOD to VA health care
facilities.[Footnote 14] According to the departments, the use of such
computable medical data contributes significantly to the usefulness of
electronic medical records. In the past year, VA and DOD have begun to
implement applications that exchange limited electronic medical
information between the departments' existing health information
systems. The agencies have implemented three recommendations that we
made in June 2004, such as developing an architecture for the
electronic interface and establishing a lead entity for the project,
but they have not developed a clearly defined project management plan
and they have experienced delays in exchanging computable patient
health data.
HHS Continuing Efforts to Define a National Health Information
Technology Strategy:
HHS--through the Office of the National Coordinator (ONC) for Health
IT--has continued efforts to define a national strategy, building on
the framework already established. HHS has established the
organizational structure of the Office of the National Coordinator. It
has also awarded about $42 million in contracts to address a range of
issues important in developing a robust IT infrastructure, such as
reviewing IT standards activities for gaps and duplication and
reviewing privacy and security laws across federal and state
governments. In order to obtain public and private sector input, the
Secretary of HHS has established an advisory body called the American
Health Information Community (Community). The Community began meeting
in October 2005 to advise the Secretary concerning efforts to develop
standards and achieve interoperability of health IT. HHS has other
important programs and initiatives such as the demonstration grants
awarded by the Agency for Healthcare Research and Quality and the
Centers for Disease Control and Prevention's Public Health Information
Network.
The National Coordinator is Continuing Efforts to Develop a National
Health Information Technology Strategy:
HHS's Office of the National Coordinator for Health IT (ONC) has
continued to move forward with its mission to guide the nationwide
implementation of interoperable health IT in the public and private
health care sectors. Building on the framework for strategic action,
last summer the National Coordinator announced the organizational
structure of his office and recently announced the appointment of his
management team. ONC is organized as follows:
* Immediate Office of the National Coordinator--provides executive
direction to the office and is responsible for carrying out the
office's mission and functions.
* Office of Health IT Adoption--works with all other ONC offices to
identify health IT strategies, implement plans, and monitor outcomes
toward meeting the President's goals.
* Office of Interoperability and Standards--provides leadership in
developing and implementing nationwide interoperable health IT
infrastructure and standards to support the secure and seamless
exchange of health information.
* Office of Programs and Coordination--ensures the integration of all
efforts across the ONC and supports the dissemination and adoption of
the federal government's policy on health IT.
* Office of Policy and Research--conducts studies in support of ongoing
health IT and coordinates efforts that inform policy decisions related
to health IT.
Since our May 2005 report, HHS has also awarded a series of contracts
that address the development of the infrastructure needed to support a
national health information network. These contracts, outlined in table
2, total about $42 million.
Table 2: Health IT Contracts Awarded by HHS's Office of the National
Coordinator.
American Health Information Community Program Support;
Date Awarded: September 2005;
Duration: 1 year;
Cost: $0.8 million;
Description: To provide assistance to the National Coordinator in
convening and managing the meetings and activities of the Community to
ensure that the health IT plan is seamlessly coordinated.
Standards Harmonization Process for Health IT;
Date Awarded: September 2005;
Duration: 1 year;
Cost: $3.2 million;
Description: To develop and test a process for identifying, assessing,
endorsing, and maintaining a set of standards required for
interoperable health information exchange.
Compliance Certification Process for Health IT;
Date Awarded: September 2005;
Duration: 1 year;
Cost: $2.7 million;
Description: To develop and evaluate a compliance certification process
for health IT, including the infrastructure components through which
these systems interoperate.
Privacy and Security [A];
Date Awarded: September; 2005;
Duration: 1½ years;
Cost: $11.5 million;
Description: To assess and develop plans to address variations in
organization-level business policies and state laws that affect privacy
and security practices, including those related to HIPAA, which may
pose challenges to interoperable health information exchange.
National Health Information Network Prototypes;
Date Awarded: November 2005;
Duration: 1 year;
Cost: $18.6 million; (4 contracts);
Description: To develop and evaluate prototypes for a nationwide health
information network architecture that maximize the use of existing
resources such as the Internet to achieve widespread interoperability
among software applications, particularly electronic health records.
These contracts are also intended to spur technical innovation for
nationwide electronic sharing of health information in patient care and
public health settings.
Measuring the Adoption of Electronic Health Records;
Date Awarded: September 2005;
Duration: 2 years;
Cost: $1.8 million;
Description: To develop a methodology to better characterize and
measure the state of electronic health records adoption and determine
the effectiveness of policies aimed at accelerating adoption of
electronic health records and interoperability.
Gulf Coast Electronic Digital Health Recovery;
Date Awarded: September 2005;
Duration: 1 year;
Cost: $3.7 million;
Description: To plan and promote the widespread use of electronic
health records in the Gulf Coast regions affected by recent hurricanes.
These agreements are expected to bring together local and national
resources, coordinate the planning for a digital health information
recovery, and develop a prototype of health information sharing and
electronic health record support that can be replicated throughout the
region.
Source: HHS Office of the National Coordinator for Health Information
Technology:
[A] Jointly managed by the Agency for Healthcare Research and Quality
and the Office of the National Coordinator.
[End of table]
As part of HHS's plans to include private sector involvement, the
Secretary of HHS established the American Health Information Community,
a public-private collaboration to advise HHS on how to make health
records digital and achieve interoperability for health information
exchange. The Community will also provide a forum for public and
private interests to recommend specific actions that will accelerate
the widespread application and adoption of electronic health records
and other health IT applications. Chartered for two years, with the
option to renew for no more than five years, HHS intends for the
Community to be succeeded by a private sector health information
initiative. (The first meeting of the Community was held in October
2005). To date, it has identified several potential breakthrough
areas[Footnote 15] and established four priority areas--consumer
empowerment, biosurveillance, electronic health records, and chronic
care management. Workgroups are in the process of being established,
each with a specific charge to be accomplished within one year (e.g.,
deploy a widely available pre-populated medication history linked to
the registration summary). Milestones have been established to present
findings and recommendations to the Community on a quarterly basis.
HHS intends to use the results of its contracts and the Community
workgroups to define future direction. The National Coordinator's
office intends to release a strategic plan later this year now that his
management team is in place. This plan is expected to guide the
nationwide implementation of interoperable health IT by providing
detailed plans and milestones, as we had recommended.
Other HHS Divisions Contribute to the Department's Efforts on the
National Health Information Technology Strategy:
As we have previously reported, the role of the National Coordinator
includes the coordination of programs and policies regarding health IT
across HHS. Building on ongoing agency initiatives--health IT
demonstration grants, the Federal Health Architecture, and the Public
Health Information Network[Footnote 16]--these activities address a
variety of issues important to accelerating and encouraging the
adoption of health IT across the health care industry. Key HHS
divisions, such as the Centers for Medicare and Medicaid and the Agency
for Healthcare Research and Quality, continue funding and supporting
the development of health IT initiatives that support the goals of the
framework for strategic action. The National Coordinator also plans to
form an HHS health IT committee for improving coordination within the
agency. Examples of health IT initiatives associated with the
framework, some that we have previously reported on, include:
* The Centers for Medicare and Medicaid Services (CMS), in conjunction
with VA, released a test version of VistA-Office EHR for evaluation by
a limited number of physician's practices. This system is targeted for
use in clinics and small physician offices and will be subject to the
same certification requirements as private sector products. CMS is
continuing with the Doctor's Office Quality Information Technology
initiative, a two-year demonstration designed to improve quality of
care and patient safety services provided to Medicare beneficiaries by
promoting the adoption of electronic health records in primary care
physician offices. Quality measures developed by the program will be
reported by participating practices to the Quality Improvement
Organization Clinical Warehouse. The warehouse will review and validate
electronically transmitted information regarding physician performance
and identify opportunities for improvement. CMS also awarded $6 million
for electronic prescribing pilot programs.
* The Agency for Healthcare Research and Quality is continuing its
support of demonstration and developmental projects to better
understand the connection between improved care and health IT. It
awarded more than $22.3 million in grant funds for the implementation
of 16 health IT demonstration projects in October 2005. In addition,
the agency created the National Resource Center for Health IT to
provide technical assistance and share new knowledge and findings from
the real-world experiences of its grantees.
* The Health Resources and Services Administration formed the Office of
Health IT in December 2005 to promote the adoption and effective use of
IT for improving the delivery of care in the safety net
community.[Footnote 17] It is also continuing its work with federal
community health centers to implement ambulatory electronic health
records, including the development of initial performance measures to
demonstrate the cost benefits of health IT. In addition, the Health
Resources and Services Administration has provided funds for telehealth
and other health IT projects through its Office for the Advancement of
Telehealth.
* The National Institutes of Health is continuing its efforts to
achieve interoperability as part of its standards development
initiative (i.e., Systemized Nomenclature of Medicine-Clinical Terms)
and development of a virtual infrastructure to allow research centers
to pool data, such as the Cancer Biomedical Informatics Grid and the
Rare Disease Clinical Research Network. It plans to host a joint
meeting with the Agency for Healthcare Research and Quality in May 2006
to look at how a national health information network can support
clinical studies and trials.
* The Centers for Disease Control and Prevention is continuing work on
the information systems that support the Public Health Information
Network. For example, data collection for BioSense is being expanded to
include emergency room data at selected cities and plans for the
National Electronic Disease Surveillance System call for it to move to
a Web-based data entry system.
Other Federal Agencies Have Initiatives Related to the National Health
Information Technology Strategy:
Several federal agencies collaborating with HHS --namely the
Departments of Veterans Affairs, Defense, and Commerce, as well as the
Office of Personnel Management--also have responsibility for their own
health IT initiatives related to the national health IT strategy. Many
of these agencies, as well as a representative from the Department of
the Treasury, participate in the American Health Information Community,
HHS's newly formed Health IT Policy Council, and the Federal Health
Architecture. In 2004, the Office of the National Coordinator for
Health IT was assigned responsibility for the Federal Health
Architecture. According to the National Coordinator, he is planning to
renew the Federal Health Architecture workgroups this spring in order
to improve coordination and collaboration on federal health IT. In
addition to the Departments of Defense, Veterans Affairs, and Commerce,
other federal agencies involved with the Federal Health Architecture
include the Departments of Agriculture, Homeland Security, Justice, and
the Environmental Protection Agency.
As major federal health care providers, the Departments of Defense and
Veterans Affairs play critical roles in the advancement of electronic
health records. The experience of these agencies in implementing
electronic health records and in health information exchange across
organizational boundaries offer important lessons learned--both
positive and negative--that could be applied as health care delivery
organizations adopt electronic health record systems. According to HHS,
the Department of Defense has a lengthy history working in remote and
medically underserved areas and has experience in using IT, such as
telehealth, to deliver care in isolated areas that can be compared to
the conditions in some rural environments.
According to the Office of Personnel Management, it is planning to use
its position as one of the largest purchasers of employee health care
benefits to contribute to the expansion and use of electronic health
records, electronic prescribing, and other health IT-related
provisions. The agency is represented on the American Health
Information Community and, according to agency officials, has been
holding informal discussions with staff from the Office of the National
Coordinator. In July 2004, the Office of Personnel Management outlined
various options for health plans in the Federal Employee Health Benefit
program, such as adopting systems based on generally accepted and
certified standards. When the agency issued its 2005 annual call
letter[Footnote 18] to carriers last April, it requested that plans
describe their health IT initiatives, including any currently in place
for doctors and pharmacies to use electronic prescribing. According to
an agency official, it received responses from participating health
plans and reviewed them to establish a baseline with the intention of
measuring progress on the use of health IT.
The National Institute for Standards and Technology (NIST) is also
collaborating with HHS, largely by supporting the Office of the
National Coordinator and its contractors with technical expertise.
Initially, its support had been focused on the standards development
and harmonization process. NIST supports a Website--the Health Care
Standards Landscape--to address the need for a Web-based repository of
information on health care standards, organizations, and resources that
can assist in standards development, coordination, implementation,
adoption, and use by system developers and other stakeholders.[Footnote
19] In addition, NIST is expected to leverage its technical resources
by assisting HHS with the national health information network
architecture and the certification process for health IT.
In summary, HHS's efforts to transform the use of IT in the health care
industry are continuing although much work remains. As we recommended
last May, HHS still needs to establish detailed plans and milestones as
part of the national strategy and take steps to ensure that those plans
are followed and milestones are met. The National Coordinator plans to
release a strategic plan later this year that establishes milestones.
Given the billions of dollars the federal government spends annually
towards health care and the potential of IT to save money and improve
quality, it is important that coordination continue across the federal
government and that federal resources are leveraged appropriately.
Contacts and Acknowledgements:
If you should have any questions about this statement, please contact
me at (202) 512-9286 or by e-mail at pownerd@gao.gov. Other individuals
who made key contributions to this statement are M. Yvonne Sanchez,
Nancy E. Glover, and Teresa F. Tucker.
FOOTNOTES
[1] HHS's Federal Health Architecture program is intended to define a
framework and methodology for establishing a target architecture and
standards for interoperability and communication. An architecture
describes an entity in both logical terms (e.g., interrelated
functions, information needs and flows, work locations, systems, and
applications) and technical terms (e.g., hardware, software, data,
communications, and security).
[2] Electronic prescribing enables a physician to transmit a
prescription electronically to a patient's pharmacy of choice. It
decreases prescription errors caused by hard-to-read handwriting and
automates the process of checking for drug interactions and allergies.
[3] GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP (Washington, DC: February 2005).
[4] There is a lack of consensus on what constitutes an electronic
health record (EHR), and thus multiple definitions and names exist for
EHRs, depending on the functions included. An EHR generally includes
(1) a longitudinal collection of electronic health information about
the health of an individual or the care provided, (2) immediate
electronic access to patient-and population-level information by
authorized users, (3) decision support to enhance the quality, safety,
and efficiency of patient care, and (4) support of efficient processes
for health care delivery.
[5] GAO, Information Technology: Benefits Realized for Selected Health
Care Functions, GAO-04-224 (Washington, D.C.: Oct. 31, 2003).
[6] Executive Order 13335, Incentives for the Use of Health Information
Technology and Establishing the Position of the National Health
Information Technology Coordinator (Washington, D.C.: April 27, 2004).
[7] These goals address the development of market institutions to lower
the risk of health IT procurement (phase I), investment in clinical
management tools and capabilities (phase II), and support for the
transition of the market to robust quality and performance
accountability (phase III).
[8] GAO, Health Care: National Strategy Needed to Accelerate the
Implementation of Information Technology, GAO-04-947T (Washington,
D.C.: July 14, 2004).
[9] GAO, Health Information Technology: HHS Is Taking Steps to Develop
a National Strategy, GAO-05-628 (Washington, D.C.: May 27, 2005).
[10] GAO, Bioterrorism: Information Technology Strategy Could
Strengthen Federal Agencies' Abilities to Respond to Public Health
Emergencies, GAO-03-139 (Washington, D.C.: May 30, 2003); GAO,
Information Technology: Federal Agencies Face Challenges in
Implementing Initiatives to Improve Public Health Infrastructure, GAO-
05-308 (Washington, D.C.: June 10, 2005).
[11] GAO, Health Care: Continued Leadership Needed to Define and
Implement Information Technology Standards, GAO-05-1054T (Washington,
D.C.: Sept. 29, 2005).
[12] These actions included the lack of mechanisms for better agency
coordination of the various standards efforts, incomplete milestones
associated with these efforts, and no mechanism to monitor the
implementation of standards across the health care industry.
[13] Rather than data being provided as text for viewing only, data
would be in a format that the health information application can act
on: for example, providing alerts to clinicians of such things as drug
allergies and plotting graphs of changes in vital signs such as blood
pressure.
[14] GAO, Computer-Based Patient Records: VA and DOD Made Progress, but
Much Work Remains to Fully Share Medical Information, GAO-05-1051T
(Washington, D.C.: September 28, 2005); GAO, Computer-Based Patient
Records: Improved Planning and Project Management Are Critical to
Achieving Two-Way VA-DOD Health Data Exchange, GAO-04-811T (Washington,
D.C.: May 19, 2004); and Computer-Based Patient Records: Short-Term
Progress Made, but Much Work Remains to Achieve a Two-Way Data Exchange
Between VA and DOD Health Systems, GAO-04-271T (Washington, D.C.: Nov.
19, 2003).
[15] Breakthrough areas are projects that can potentially achieve
measurable results in two to three years.
[16] The Public Health Information Network is a national initiative
intended to integrate and coordinate existing systems by serving as a
comprehensive architecture, information exchange network, and a set of
services that will integrate existing capabilities and advance the ways
in which IT can support public health.
[17] The safety net community is made up of providers that by mandate
or mission organize and deliver a significant level of health care and
other health-related services to the uninsured, Medicaid, and other
vulnerable patients.
[18] Call letters provide guidance for benefit and rate proposals from
FEHB program plans for the next contract term.
[19] The Website is http://hcsl.sdct.nist.gov.
