Health Information Technology
HHS Is Pursuing Efforts to Advance Nationwide Implementation, but Has Not Yet Completed a National Strategy Gao ID: GAO-08-499T February 14, 2008Health information technology (IT) offers promise for improving patient safety and reducing inefficiencies. Given its role in providing health care in the United States, the federal government has been urged to take a leadership role to improve the quality and effectiveness of health care, 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 that established the position of the National Coordinator for Health Information Technology within the Department of Health and Human Services (HHS). The National Coordinator, appointed in May 2004, released a framework for strategic action two months later. In late 2005, HHS also awarded several contracts to address key areas of health IT. GAO has been reporting on the department's efforts toward nationwide implementation of health IT since 2005. In prior work, GAO recommended that HHS establish detailed plans and milestones for the development of a national health IT strategy and take steps to ensure that its plans are followed and milestones met. For this testimony, GAO was asked to describe HHS's efforts to advance the use of health IT. To do this, GAO reviewed prior reports and agency documents on the current status of relevant HHS activities.
HHS and the Office of the National Coordinator have been pursuing various activities in key areas associated with the President's goal for nationwide implementation of health IT. In 2005, the department established the American Health Information Community, a federal advisory committee, to help define the future direction of a national strategy for health IT and to make recommendations to the Secretary of Health and Human Services for implementing interoperable health IT. The community has made recommendations directed toward key areas of health IT, including the expansion of electronic health records, the identification of standards, the advancement of nationwide health information exchange, the protection of personal health information, and other related issues. Even though HHS is undertaking these various activities, it has not yet developed a national strategy that defines plans, milestones, and performance measures for reaching the President's goal of interoperable electronic health records by 2014. In 2006, the National Coordinator for Health Information Technology agreed with GAO's recommendation that HHS define such a strategy; however, the department has not yet done so. Without an integrated national strategy, HHS will be challenged to ensure that the outcomes of its various health IT initiatives effectively support the President's goal for widespread adoption of interoperable electronic health records.
GAO-08-499T, Health Information Technology: HHS Is Pursuing Efforts to Advance Nationwide Implementation, but Has Not Yet Completed a National Strategy
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United States Government Accountability Office:
GAO:
Testimony:
Before the Senate Committee on the Budget:
For Release on Delivery:
Expected at 10:00 a.m. EST:
February 14, 2008:
Health Information Technology:
HHS Is Pursuing Efforts to Advance Nationwide Implementation, but Has
Not Yet Completed a National Strategy:
GAO Highlights:
Highlights of GAO-08-499T, a testimony before the Committee on the
Budget, U.S. Senate.
Why GAO Did This Study:
Health information technology (IT) offers promise for improving patient
safety and reducing inefficiencies. Given its role in providing health
care in the United States, the federal government has been urged to
take a leadership role to improve the quality and effectiveness of
health care, 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 that established
the position of the National Coordinator for Health Information
Technology within the Department of Health and Human Services (HHS).
The National Coordinator, appointed in May 2004, released a framework
for strategic action two months later. In late 2005, HHS also awarded
several contracts to address key areas of health IT.
GAO has been reporting on the department‘s efforts toward nationwide
implementation of health IT since 2005. In prior work, GAO recommended
that HHS establish detailed plans and milestones for the development of
a national health IT strategy and take steps to ensure that its plans
are followed and milestones met. For this testimony, GAO was asked to
describe HHS‘s efforts to advance the use of health IT. To do this, GAO
reviewed prior reports and agency documents on the current status of
relevant HHS activities.
What GAO Found:
HHS and the Office of the National Coordinator have been pursuing
various activities in key areas associated with the President‘s goal
for nationwide implementation of health IT. In 2005, the department
established the American Health Information Community, a federal
advisory committee, to help define the future direction of a national
strategy for health IT and to make recommendations to the Secretary of
Health and Human Services for implementing interoperable health IT. The
community has made recommendations directed toward key areas of health
IT, including the expansion of electronic health records, the
identification of standards, the advancement of nationwide health
information exchange, the protection of personal health information,
and other related issues. The table shows recent HHS activities in
these areas.
Key Areas of Nationwide Health IT Activities:
Areas of health IT: Electronic health records; Activities: Defined
initial certification criteria for outpatient and inpatient electronic
health records and certified 100 products that offer electronic health
records.
Areas of health IT: Standardization;
Activities: Selected initial standards to address specific areas
identified by the American Health Information Community; federal
agencies that administer or sponsor federal health programs are to
implement the standards, as required by President Bush‘s August 2006
Executive Order.
Areas of health IT: Networking and information exchange; Activities:
Awarded contracts to nine regional and state health information
exchanges to begin trial implementations of the Nationwide Health
Information Network and to test their ability to work together and to
demonstrate real-time information exchange.
Areas of health IT: Health information privacy and security;
Activities: Reported the outcomes of a privacy and security solutions
contract in a final summary report that described variations among
organization-level business practices, policies, and laws for
protecting health information that could affect organizations‘
abilities to exchange data. Developed and made available to the public
a toolkit to guide health information exchange organizations in
conducting assessments of business practices, policies, and state laws
that govern the privacy and security of health information.
Source: GAO analysis of HHS data.
[End of table]
Even though HHS is undertaking these various activities, it has not yet
developed a national strategy that defines plans, milestones, and
performance measures for reaching the President‘s goal of interoperable
electronic health records by 2014. In 2006, the National Coordinator
for Health Information Technology agreed with GAO‘s recommendation that
HHS define such a strategy; however, the department has not yet done
so. Without an integrated national strategy, HHS will be challenged to
ensure that the outcomes of its various health IT initiatives
effectively support the President‘s goal for widespread adoption of
interoperable electronic health records.
To view the full product, including the scope and methodology, click on
[hyperlink, http://www.GAO-08-499T]. For more information, contact
Valerie Melvin at (202) 512-6304 or melvinv@gao.gov.
[End of section]
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. As we
and others have reported, the use of IT has great potential to help
improve the quality of health care and is critical to improving the
performance of the U.S. health care system.
Recognizing the potential value of IT in public and private health care
systems, the federal government has, for several years, been working to
promote the nationwide use of health IT.[Footnote 1] In April 2004,
President Bush called for widespread adoption of interoperable[Footnote
2] electronic health records within 10 years and issued an executive
order[Footnote 3] that established the position of the National
Coordinator for Health Information Technology within the Department of
Health and Human Services (HHS). The National Coordinator's
responsibilities include the development and implementation of a
strategic plan to guide the nationwide implementation of interoperable
health IT in both the public and private sectors.[Footnote 4]
Since 2005, we have been reporting on the efforts of the Office of the
National Coordinator to develop and implement a national health IT
strategy. At your request, my testimony today will describe HHS's
ongoing efforts to complete certain key health IT-related activities.
We conducted our work in support of this testimony during February
2008. To prepare this statement, we reviewed our prior reports and
analyzed agency documents on the current status of relevant HHS
activities. All work on which this testimony is based was performed in
accordance with generally accepted government auditing standards.
Results in Brief:
HHS and the Office of the National Coordinator have been pursuing
various actions in support of the President's goal for nationwide
implementation of health IT. In 2005, the Secretary of Health and Human
Services formed the American Health Information Community to help
define the future direction of a national strategy for health IT and to
make recommendations for key health IT areas, such as the advancement
of electronic health records, the identification of health IT
standards, the implementation of a nationwide health information
exchange, and the protection of personal health information. As a
result of these actions:
* The Office of the National Coordinator has taken steps to advance the
implementation of both outpatient and inpatient electronic health
records.
* The Secretary has recognized certain interoperability standards to be
implemented in federal health care programs.
* The Office of the National Coordinator has begun trial
implementations of a nationwide health information network at nine
health information exchange organizations across the country.
* The Office of the National Coordinator has released a summary report
and toolkit based on the results of its privacy and security solutions
contractor's work.
However, HHS has not yet completed a national strategy for health IT
that integrates the outcomes of these efforts and that includes key
elements needed to ensure that its goals are met. Given the amount of
work yet to be done and the complex task of integrating the outcomes of
HHS's various initiatives, it is essential that a national strategy for
health IT be defined that includes plans, milestones, and performance
measures for ensuring progress toward the President's goals. Without
such a strategy, it is difficult to effectively monitor progress toward
achieving national goals for health IT.
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 2006
reaching almost $2.1 trillion, or 16 percent of the gross domestic
product, concerns about the costs of health care continue, and many
policy makers, industry experts, and medical practitioners contend that
the U.S. health care system is in a crisis.[Footnote 5]
Health IT offers promise for improving patient safety and reducing
inefficiencies. The expanded use of health IT has great potential to
improve the quality of care, bolster the preparedness of our public
health infrastructure, and save money on administrative costs. For
example, as we reported in 2003, a 1,951-bed teaching hospital reported
that it had realized about $8.6 million in annual savings by replacing
outpatient paper medical charts with electronic medical records. This
hospital also reported saving more than $2.8 million annually by
replacing its manual process for managing medical records with an
electronic process to provide access to laboratory results and reports.
Technologies such as electronic health records and bar coding of
certain human drug and biological product labels have been shown to
save money and reduce medical errors.[Footnote 6] 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 due to significant financial, technical,
cultural, and legal barriers, such as 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, as a
regulator, purchaser, health care provider, and sponsor of research,
education, and training, has a central role in shaping nearly all
aspects of the health care industry. According to the Centers for
Medicare and Medicaid Services, several federal health care programs,
such as Medicare and Medicaid, spent almost $450 billion on health
services in 2006, accounting for 23 percent of the nation's health care
expenditures that year. Given the level of the federal government's
participation in providing health care, 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 an
expanded adoption of IT.
In an effort to leverage the federal government's role in health care,
the President called for the Secretary of Health and Human Services to
appoint a National Coordinator for Health Information Technology. The
Secretary appointed the first National Coordinator in May
2004.[Footnote 7] Two months later, HHS released a framework document
as the first step toward the development of a national
strategy;[Footnote 8] the framework described goals for achieving
nationwide interoperability of health IT and actions to be taken by
both the public and private sectors to implement a strategy for
reaching these goals.[Footnote 9]
In 2005, the Secretary formed the American Health Information
Community, a federally chartered commission,[Footnote 10] to advise the
department on achieving its goals in this area: in particular,
developing interoperable health information exchange through a future
Nationwide Health Information Network and providing most Americans with
access to secure electronic health records by 2014. The community is
made up of representatives from both the public and private health care
sectors. In 2005, it identified components of health care that could
potentially achieve measurable results in two to three years, including
electronic health records.[Footnote 11] The community makes
recommendations to the Secretary for advancing interoperability in
these areas, along with recommendations directed toward the
identification of health IT standards, the advancement of nationwide
health information exchange, the protection of personal health
information, and other related issues. Additionally, in furtherance of
the federal government's initiative to achieve expanded health IT
adoption, in August 2006 President Bush issued an executive order
calling for federal health care programs and their providers, plans,
and insurers to use IT interoperability standards recognized by
HHS.[Footnote 12]
From its establishment in 2004 through 2008, the Office of the National
Coordinator has received about $200 million in funding to support new
efforts to ensure the adoption of health IT nationwide through the
development of data standards and the implementation of projects on
priority areas identified by the American Health Information Community.
For the first 2 years of its operation (fiscal years 2004 and 2005),
funding was provided from departmental discretionary funds allocated by
the Secretary of Health and Human Services, and in fiscal year 2005 the
office received $20 million. In fiscal year 2006, the department began
submitting budget requests for the office. Table 1 shows the
department's requested and actual budget for the office for fiscal
years 2006 through 2008 and the amount requested for fiscal year 2009.
Table 1: Requested and Actual Budget for the Office of the National
Coordinator (Fiscal Years 2006 through 2009) (Dollars in millions):
Fiscal year 2006:
Request: $78;
Actual: $61;
Fiscal year 2007:
Request: $118;
Actual: $61;
Fiscal year 2008:
Request: $118;
Actual: $61;
Fiscal year 2009:
Request: $66.
[End of table]
HHS's overall departmental budget request for health IT for fiscal year
2009 is almost $115 million for various new and continuing initiatives
within multiple HHS divisions. Besides the $66 million for the
initiatives of the Office of the National Coordinator, this amount
includes:
* $3.8 million to fund the second year of a project at the Centers for
Medicare and Medicaid Services that provides financial incentives to
physician practices to adopt certified electronic health record
systems, and:
* $45 million for the Agency for Healthcare Research and Quality to
fund health IT investments aimed at enhancing patient safety.
The budget request also supports the continuation of an electronic
health record system for all direct health care sites of the Indian
Health Service.
Since the Office of the National Coordinator has been funded,
congressional interest in the expansion of health IT has increased.
According to the Healthcare Information Management Systems
Society,[Footnote 13] 41 pieces of legislation related to health IT
were introduced by the 109TH Congress, and, so far, the 110TH Congress
has introduced about 12 bills, reports, and resolutions; subjects
addressed include grants and financial assistance to help support the
implementation of health IT, provisions for incentives to health care
providers for IT implementation, standards for exchanging health
information, and protection of privacy and security of electronic
health information. Additionally, in his 2008 State of the Union
address, President Bush called for the 110TH Congress to expand the use
of health IT.
Our Past Work Has Reviewed HHS's Efforts to Define a National Strategy
and Expand the Implementation of Health IT:
Since 2005, we have reported and testified on HHS's efforts to define a
national strategy for achieving widespread implementation of health IT,
including an approach for ensuring the protection of electronic
personal health information. We reported that through the Office of the
National Coordinator for Health IT, HHS has taken a number of actions
to promote the acceleration of the use of IT in the health care
industry.[Footnote 14] For example, in late 2005 the National
Coordinator's Office awarded several contracts to address a range of
activities important for expanding the implementation of health IT;
these activities include:
* defining criteria and a process for certifying the interoperability
of electronic health records to help increase the number of health care
providers adopting electronic health records,
* defining health information standards needed to ensure the
interoperability of electronic health records and health IT systems,
* defining requirements for exchanging health information throughout a
nationwide health information network, and:
* defining privacy and security policies to ensure the protection of
electronic personal health information.
In our previous work, we reported that although HHS had made progress
in these areas, it still lacked an overall implementation strategy,
including the detailed plans, milestones, and performance measures
needed to ensure that the outcomes of its efforts are integrated and
that the President's goals for the implementation of nationwide health
IT are met. In May 2005, we recommended that HHS establish detailed
plans and milestones for the development of a national health IT
strategy and take steps to ensure that its plans are followed and
milestones are met. We reiterated this recommendation in March 2006 and
again in September 2006.
We have also reported on HHS's efforts to ensure the privacy of
personal health information exchanged within health information
exchange networks.[Footnote 15] According to our work, although HHS had
initiated several activities to help ensure the protection of health
information, it had not defined an overall approach for health
information privacy or an implementation strategy that included key
elements such as timelines and milestones for completing its privacy-
related initiatives. We recommended that HHS define and implement an
overall privacy approach that identifies milestones for integrating the
outcomes of its initiatives, ensures that key privacy principles are
fully addressed, and addresses challenges associated with the
nationwide exchange of health information.
HHS Is Pursuing Efforts to Advance the Nationwide Implementation of
Health IT, but It Has Not Yet Completed a National Strategy:
HHS and the Office of the National Coordinator have been pursuing
various efforts to implement health IT solutions. Among other
activities, the department has been relying on recommendations of the
American Health Information Community to assist the office's health IT
initiatives in several key areas aimed at the expansion of electronic
health records, identification of health IT standards, advancement of
nationwide health information exchange, protection of personal health
information, and other related issues. In this regard, HHS and the
Office of the National Coordinator have taken actions in the areas of
electronic health records, standardization, networking and information
exchange, and health information privacy and security:
Electronic health records. To help expand the implementation of
electronic health records, among other actions, HHS issued a contract
for the Compliance Certification Process for Health IT. This contract,
awarded to the Certification Commission for Health IT, is to define
criteria and a certification process to ensure that various electronic
health records products can be exchanged among different systems in
health information exchange networks. In May 2006, HHS finalized a
process and criteria for certifying the interoperability of outpatient
electronic health records and described criteria for future
certification requirements. Certification criteria for inpatient
electronic health records were finalized in June 2007. To date, the
Certification Commission has certified about 100 products offering
electronic health records. The results of this effort are intended to
help encourage health care providers to implement electronic health
records by providing assurance that they will be able to use electronic
records effectively and exchange them with other health IT systems.
Standardization. Through a contract for the Standards Harmonization
Process for Health IT, HHS is promoting the implementation of standards
required to enable the exchange of electronic health information in
federal health care programs, as well as ensure the interoperability of
electronic health records and IT systems. Such standards are essential
for the development of a nationwide health information network.
The contractor, in collaboration with the National Institute for
Standards and Technology, selected initial standards to address
specific areas identified by the American Health Information Community.
These standards address, among other things, requirements for message
and document formats, along with technical network requirements.
According to the contractor, the Secretary announced the recognition of
these standards in January 2008 after a year-long period of review and
testing by healthcare providers, government agencies, consumers and
other stakeholders.
Federal agencies that administer or sponsor federal health programs are
now required to implement these standards, in accordance with President
Bush's August 2006 Executive Order.
Networking and information exchange. The Office of the National
Coordinator has taken steps to enable health care entities--such as
providers, hospitals, and clinical labs--to exchange electronic health
information on a nationwide basis. HHS has awarded Nationwide Health
Information Network contracts that were designed to provide prototypes
of national networks of health information exchanges. These exchanges
are intended to connect providers and patients from different regions
of the country and enable the sharing of electronic health information,
such as health records and laboratory results. Together, these
connections are intended to form the "network of networks" that is
envisioned to be the Nationwide Health Information Network.
According to HHS, in early 2007 its contractors delivered final
prototypes that could form the foundation of a nationwide network for
health information exchange. In October 2007, the Secretary of Health
and Human Services announced the award of contracts totaling $22.3
million to nine regional and state health information exchanges to
begin trial implementations of the Nationwide Health Information
Network.[Footnote 16] At the end of the first contract year--September
2008--HHS intends for the nine organizations and the federal agencies
that provide health care services to test their ability to work
together and to demonstrate real-time information exchange based upon
nationwide health information exchange specifications that they define.
HHS plans to place these specifications and related testing materials
in the public domain, so that they can be used by other health
information exchange organizations to guide their efforts to adopt
interoperable health IT.
Health information privacy and security. HHS has taken steps to further
address privacy and security issues associated with the nationwide
exchange of personal health information. In June 2007, HHS reported the
outcomes of its privacy and security solutions contract based on the
work of 34 states and territories that participated in the
contract.[Footnote 17] A final summary report described variations
among organization-level business practices, policies, and laws for
protecting health information that could affect organizations'
abilities to exchange data. As a result of this work, HHS developed and
made available to the public a toolkit to guide health information
exchange organizations in conducting assessments of business practices,
policies, and state laws that govern the privacy and security of health
information exchange.
Additionally, in discussions with us in June 2007, the National
Coordinator for Health IT agreed with the need for an overall approach
to protect health information and stated that the department was
initiating steps to address our recommendation that HHS define and
implement an overall privacy approach. Such an approach should be part
of a comprehensive national strategy for health IT and should include
milestones for integrating the outcomes of HHS's various privacy-
related initiatives, ensure that key privacy principles are fully
addressed, and address challenges associated with the nationwide
exchange of health information. However, our recommendation for
protecting health information has not yet been implemented.
Further, although HHS has initiated specific activities intended to
meet the goals of its framework for strategic action, and it is
continuing efforts to expand the nationwide implementation of health
IT, it is undertaking these activities without a comprehensive national
strategy that includes the detailed plans, milestones, and performance
measures needed to ensure that the outcomes of its various initiatives
are integrated and its goals are met. Given the many activities to be
coordinated, such a national strategy is essential.
The National Coordinator acknowledged in March 2006 that more detailed
plans were needed for the office's various initiatives and told us that
HHS intended to release a strategic plan with detailed plans and
milestones in late 2006. Nonetheless, today the office still lacks the
detailed plans, milestones, and performance measures that are needed.
According to its fiscal year 2009 performance plans, the Office of the
National Coordinator has prepared a draft health IT strategic plan,
which it intends to release in the second quarter of 2008. If properly
developed and implemented, this strategy should help ensure that HHS's
various health IT initiatives are integrated and effectively support
the goal of widespread adoption of interoperable electronic health
records.
In summary, Mr. Chairman, our work shows that the Office of the
National Coordinator for Health Information Technology has been
undertaking important work on specific activities supporting the goals
of its framework for strategic action. However, HHS has not yet defined
detailed plans and milestones for integrating the various initiatives,
nor has it developed performance measures for tracking progress toward
the President's goal for widespread adoption of interoperable
electronic health records by 2014. To its credit, the office has taken
steps to advance electronic health record adoption, identify
interoperability standards, enable nationwide health information
exchange, and protect personal health information. However, given the
amount of work yet to be done and the complex task of integrating the
outcomes of HHS's various initiatives, it is essential that a national
strategy for health IT be defined that includes plans, milestones, and
performance measures for ensuring progress toward the President's
goals. Without such a strategy, it is difficult to gauge the amount of
progress being made by HHS toward achieving widespread adoption of
interoperable electronic health records by 2014.
Mr. Chairman, this concludes my statement. I would be pleased to answer
any questions that you or other Members of the Committee may have.
Contacts and Acknowledgments:
If you should have any questions about this statement, please contact
me at (202) 512-6304 or by e-mail at melvinv@gao.gov. Other individuals
who made key contributions to this statement are Barbara S. Collier,
Amanda C. Gill, Nancy E. Glover, M. Saad Khan, and Teresa F. Tucker.
[End of section]
Footnotes:
[1] Health IT is the use of technology to electronically collect,
store, retrieve, and transfer clinical, administrative, and financial
health information.
[2] Interoperable means that different information systems, software
applications and networks are able to communicate and exchange
information in an accurate, effective, useable, and consistent manner.
[3] 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.: Apr. 27, 2004).
[4] The Office of the National Coordinator for Health Information
technology is under the Office of the Secretary.
[5] GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP (Washington, D.C.: February 2005).
[6] GAO, Information Technology: Benefits Realized for Selected Health
Care Functions, GAO-04-224 (Washington, D.C.: Oct. 31, 2003).
[7] This position was vacated by the first national coordinator in May
2006. This position was filled by an interim coordinator until the
Secretary appointed a new coordinator in April 2007.
[8] HHS, The Decade of Health Information Technology: Delivering
Consumer-centric and Information-rich Health Care--Framework for
Strategic Action (July 2004).
[9] Interoperability is important because it allows patients'
electronic health information to move with them from provider to
provider, regardless of where the information originated.
[10] The Community was formed in September 2005.
[11] Other components are consumer empowerment, chronic care, and
biosurveillance.
[12] Executive Order: Promoting Quality and Efficient Health Care in
Federal Government Administered or Sponsored Health Care Programs
(Washington, D.C.: Aug. 22, 2006).
[13] The Healthcare Information Management Systems Society is the
health care industry's membership organization exclusively focused on
providing leadership for the optimal use of health IT and management
systems to improve health care. Each year it maintains a list of health
IT legislation introduced in Congress, including the status of the
legislation.
[14] GAO, Health Information Technology: HHS Is Taking Steps to Develop
a National Strategy, GAO-05-628 (Washington, D.C.: May 27, 2005);
Health Information Technology: HHS Is Continuing Efforts to Define a
National Strategy, GAO-06-346T (Washington, D.C.: Mar. 15, 2006);
Health Information Technology: HHS Is Continuing Efforts to Define its
National Strategy, GAO-06-1071T (Washington, D.C.: Sept. 1, 2006).
[15] GAO, Health Information Technology: Early Efforts Initiated, but
Comprehensive Privacy Approach Needed for National Strategy, GAO-07-238
(Washington, D.C.: Jan. 10, 2007); Health Information Technology: Early
Efforts Initiated, but Comprehensive Privacy Approach Needed for
National Strategy, GAO-07-400T (Washington, D.C.: Feb. 1, 2007); Health
Information Technology: Efforts Continue, but Comprehensive Privacy
Approach Needed for National Strategy, GAO-07-988T (Washington, D.C.:
June 19, 2007).
[16] The nine health information exchanges are CareSpark, covering the
Tricities region of Eastern Tennessee and Southwestern Virginia;
Delaware Health Information Network, covering Delaware; Indiana
University, covering the Indianapolis metroplex; Long Beach Network for
Health, covering Long Beach and Los Angeles, California; Lovelace
Clinic Foundation, covering New Mexico; MedVirginia, covering Central
Virginia; New York eHealth Collaborative, covering New York; North
Carolina Healthcare Information and Communications Alliance, Inc.,
covering North Carolina; and West Virginia Health Information Network,
covering West Virginia.
[17] According to HHS, this project has now expanded to involve 45
states and territories.
[End of section]
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