Health Information Technology: HHS is Continuing Efforts to	 
Define Its National Strategy (01-SEP-06, GAO-06-1071T). 	 
                                                                 
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 role in  
providing health care in the U.S., it has been urged to take a	 
leadership role in driving change 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. A	 
National Coordinator within the Department of Health and Human	 
Services (HHS) 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 its	 
plans are followed and milestones are met. GAO was asked to	 
identify progress made by HHS toward the development and	 
implementation of a national health IT strategy. To do this, GAO 
reviewed prior reports and agency documents on the current status
of relevant HHS activities.					 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-1071T					        
    ACCNO:   A60104						        
  TITLE:     Health Information Technology: HHS is Continuing Efforts 
to Define Its National Strategy 				 
     DATE:   09/01/2006 
  SUBJECT:   Electronic health records				 
	     Health care programs				 
	     Health information architecture			 
	     Information technology				 
	     Interoperability					 
	     IT standards					 
	     Medical information systems			 
	     Performance measures				 
	     Program evaluation 				 
	     Strategic planning 				 
	     Quality of health care				 
	     Nationwide Health Information Network		 

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GAO-06-1071T

     

     * Results in Brief
     * Background
          * Federal Government's Role in Health Care
          * Need for a National Strategy and Greater Interoperability
     * HHS Is Continuing Efforts to Advance the Nationwide Implemen
          * HHS Is Advancing the Use of Electronic Health Records
          * HHS Has Initiated Steps to Establish Health IT Standards
          * HHS Has Begun to Define Requirements for the Development of
          * HHS Is Taking Steps to Incorporate Privacy and Security Poli
          * HHS Is Continuing to Address Public Health Integration
          * HHS Is Continuing Efforts to Complete and Implement a Nation
     * Contacts and Acknowledgments

Mr. Chairman and Members of the Subcommittee:

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.

Recognizing the potential value of IT in public and private health care
systems, the federal government has been working to promote the nationwide
use of health IT.1 In April 2004, President Bush called for widespread
adoption of interoperable electronic health records within 10 years and
issued an executive order2 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.

At your request, today we will discuss progress made by HHS and its Office
of the National Coordinator for Health IT toward the development and
implementation of a national health IT strategy. In preparing this
statement, we reviewed agency documents on the current status of HHS's
activities related to a national health IT strategy and supplemented our
analysis with interviews of agency officials. We also summarized prior GAO
reports. Our work was performed in accordance with generally accepted
auditing standards.

1 Health IT is the use of technology to electronically collect, store,
retrieve, and transfer clinical, administrative, and financial health
information.

2 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).

                                Results in Brief

HHS and its Office of the National Coordinator for Health IT have made
progress through the work of the American Health Information Community3
and several recently-awarded contracts4 in five major areas: (1) defining
certification criteria for and certifying electronic health records, (2)
identifying interoperability standards to facilitate the exchange of
patient data, (3) defining requirements for the development of prototypes
for the Nationwide Health Information Network, (4) addressing privacy and
security issues associated with the nationwide exchange of health
information, and (5) taking steps to integrate public health into a
nationwide health information exchange. Specifically, certification
criteria for ambulatory electronic health records5 have been defined and
22 electronic health records vendors have achieved certification for their
products. Additionally, 90 interoperability standards have been selected
for areas such as electronic health records and public health detection
and reporting, and functional requirements for a nationwide health
information network have been proposed. The American Health Information
Community has also formed a workgroup to specifically address
confidentiality and security issues relevant to a nationwide health
information exchange.

These activities and others are being used by the Office of the National
Coordinator for Health IT to continue its efforts to complete a national
strategy to guide the nationwide implementation of interoperable health
IT. Since the release of its initial framework in 2004, the office has
defined objectives and high-level strategies for accomplishing its goals.
However, while HHS has made progress in these areas, it still lacks
detailed plans, milestones, and performance measures for meeting the
President's goals.

3 The American Health Information Community is a federally-chartered
commission made up of representatives from both the public and private
health care sectors.

4 In late 2005, HHS awarded several contracts to address a range of issues
important for developing a health IT infrastructure, such as advancing the
use of electronic health records, selecting health IT standards,
developing prototypes of a national network, and defining privacy and
security policies.

5 Ambulatory electronic health records are records of medical care that
includes diagnosis, observation, treatment, and rehabilitation that is
provided on an outpatient basis. Ambulatory care is given to persons who
are able to ambulate, or walk about.

                                   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 policy makers,
industry experts, and medical practitioners contend that the U.S. health
care system is in a crisis.6

Health IT provides a promising solution to help improve patient safety and
reduce 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. As we
reported in 2003, 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.7 For example, a 1,951-bed
teaching hospital reported that it 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.
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.

6 GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP (Washington, D.C.: February 2005).

7 GAO, Information Technology: Benefits Realized for Selected Health Care
Functions, GAO-04-224 (Washington, D.C.: Oct. 31, 2003).

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 industry 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. According to HHS, federal agencies fund more than a
third of the nation's total health care costs. Table 1 summarizes the
programs and 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

Source: HHS, VA, DOD, and OPM budget documents.

aBased on fiscal year 2003 data.

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 April 2004, President Bush called for the widespread adoption of
interoperable electronic health records within 10 years and issued an
executive order8 that established the position of the National Coordinator
for Health Information Technology within 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. The first National Coordinator was
appointed in May 2004,9 and two months later HHS released The Decade of
Health Information Technology: Delivering Consumer-centric and
Information-rich Health Care-Framework for Strategic Action, the first
step toward the development of a national strategy. 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. Just last week, 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.10

8 Executive Order 13335.

Need for a National Strategy and Greater Interoperability

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.11
Last year, we reported that HHS, through the Office of the National
Coordinator for Health IT, had taken a number of actions toward
accelerating the use of IT to transform the health care industry. To
further accelerate the adoption of interoperable health information
systems, we recommended that HHS establish detailed plans and milestones
for meeting the goals of its framework for strategic action and take steps
to ensure that those plans are followed and milestones are met.12 The
department agreed with our recommendation.

9 This position was vacated by the first national coordinator in May 2006.
HHS is currently in the process of conducting a nationwide search for a
new national coordinator and a deputy national coordinator.

10 Executive Order: Promoting Quality and Efficient Health Care in Federal
Government Administered or Sponsored Health Care Programs (Washington,
D.C.: Aug. 22, 2006).

11 GAO, Health Care: National Strategy Needed to Accelerate the
Implementation of Information Technology, GAO-04-947T (Washington, D.C.:
July 14, 2004).

12 GAO, Health Information Technology: HHS is Taking Steps to Develop a
National Strategy, GAO-05-628 (Washington, D.C.: May 27, 2005).

We also reported in June 2005 that challenges associated with major public
health IT initiatives still need to be overcome to strengthen the IT that
supports the public health infrastructure.13 Federal agencies face many
challenges in their efforts to improve the public health infrastructure,
including (1) the integration of current initiatives into a national
health IT strategy and federal architecture to reduce the risk of
duplicative efforts, (2) development and adoption of consistent standards
to encourage interoperability, (3) coordination of initiatives with state
and local agencies to improve the public health infrastructure, and (4)
overcoming federal IT management weaknesses to improve progress on IT
initiatives. To address these challenges, we recommended that HHS align
federal public health initiatives with the national health IT strategy and
federal health architecture, coordinate with state and local public health
agencies, and continue federal actions to encourage the development and
adoption of data standards.

Last September, we testified about the importance of defining and
implementing data and communication standards to speed the adoption of
interoperable IT in the health care industry.14 Hurricane Katrina
highlighted the need for interoperable electronic health records as
thousands of people were separated from their health care providers and
their paper medical records were lost. As we have 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 actions15 were 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 medical information that is critical to
delivering care and responding to public health emergencies.

13 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).

14 GAO, Health Care: Continued Leadership Needed to Define and Implement
Information Technology Standards, GAO-05-1054T (Washington, D.C.: Sept.
29, 2005).

15 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.

In March 2006, we testified before this subcommittee16 on HHS's continued
efforts to move forward with its mission to guide the nationwide
implementation of interoperable health IT in the public and private health
care sectors. We identified several steps taken by the department, such as
the establishment of the organizational structure and management team for
the Office of the National Coordinator for Health IT under the Office of
the Secretary and the formation of a public-private advisory body-the
American Health Information Community-to advise HHS on achieving
interoperability for health information exchange. The community, which is
co-chaired by the Secretary of HHS and the former National Coordinator for
Health IT, identified four breakthrough areas17 -consumer empowerment,
chronic care, biosurveillance, and electronic health records-and formed
workgroups intended to make recommendations for actions in these areas
that will produce tangible results within a one-year period. Subsequently,
in May 2006 the workgroups presented 28 recommendations to the American
Health Information Community that address standards, privacy and security,
and data-sharing issues.

We also reported in March 200618 that HHS-through the Office of the
National Coordinator for Health IT- awarded $42 million in contracts that
address a range of issues important for developing a robust health IT
infrastructure, such as an increasing number of health care providers
adopting electronic health records, definitions of health information
standards being developed, architectural definitions for a national
network, and the development and implementation of privacy and security
policies. HHS intends to use the results of the contracts and
recommendations from the American Health Information Community proceedings
to define the future direction of a national strategy. In March, the
National Coordinator told us that he intended to release a strategic plan
with detailed plans and milestones later this year. The contracts are
described in table 2.

16 GAO, Health Information Technology: HHS is Continuing Efforts to Define
a National Strategy, GAO-06-346T (Washington, D.C.: Mar. 15, 2006).

17 Breakthrough areas are components of health care and public health that
can potentially achieve measurable results in 2 to 3 years.

18 GAO-06-346T.

Table 2: Health IT Contracts Awarded by HHS's Office of the National
Coordinator

Source: HHS Office of the National Coordinator for Health Information
Technology.

aJointly managed by the Agency for Healthcare Research and Quality and the
Office of the National Coordinator.

HHS Is Continuing Efforts to Advance the Nationwide Implementation of Health IT
                        and Complete a National Strategy

HHS and its Office of the National Coordinator for Health IT have made
progress through the work of the American Health Information Community and
several contracts in five major areas: (1) advancing the use of electronic
health records, (2) establishing standards to facilitate the exchange of
patient data, (3) defining requirements for the development of prototypes
of the Nationwide Health Information Network, (4) incorporating privacy
and security policy, practices, and standards into the national strategy,
and (5) integrating public health into nationwide health information
exchange.

These activities and others are being used by the Office of the National
Coordinator for Health IT to continue its efforts to complete a national
strategy to guide the nationwide implementation of interoperable health
IT. Since the release of its initial framework in 2004, the office has
taken additional steps to define a complete national strategy, building on
its earlier work. However, while HHS has made progress in these areas, it
still lacks detailed plans, milestones, and performance measures for
meeting the President's goals.

HHS Is Advancing the Use of Electronic Health Records

HHS has made progress toward advancing the adoption of electronic health
records by defining initial certification criteria for ambulatory
electronic health records. The Certification Committee for Health IT,19
which was awarded the Compliance Certification Process for Health IT
contract, finalized functionality, security, and reliability certification
criteria for ambulatory electronic health records in May 2006 and
described interoperability criteria for future certification requirements.
The committee subsequently certified 22 vendors' electronic health records
products in July. Its next phase is to define and recommend certification
criteria for inpatient electronic health records. The committee plans to
publish these criteria for public comment during the last quarter of 2006,
with certification beginning in the second quarter of 2007.

19 The Certification Committee for Health IT is a voluntary, private
sector organization that is working to certify health IT products in three
areas: ambulatory electronic health records for the office-based physician
or provider, inpatient electronic health records for hospitals and health
systems, and the network components through which the electronic health
records operate and share information.

Additionally, the Nationwide Health Information Network contracts have
thus far resulted in the identification of draft functional requirements
for incorporating lab results and patient information, such as medical
history and insurance information, into electronic health records. The
requirements were presented to the Secretary of HHS in June 2006, and an
initial set of requirements for the Nationwide Health Information Network
are expected to be issued in September 2006.

In our March 2006 testimony, we described the Gulf Coast Electronic
Digital Health Recovery contract, which was awarded by HHS to promote the
use of electronic health records to rebuild medical records for patients
in the Gulf Coast region affected by hurricanes last year. The outcomes of
the contract are expected to coordinate planning for the recovery of
digital health information in cases of emergencies or disasters and to
develop a prototype of health information sharing and electronic health
records support. The contract established a task force of local and
national experts to help area providers turn to electronic medical records
as they rebuild medical records for their patients.

HHS Has Initiated Steps to Establish Health IT Standards

HHS awarded its Standards Harmonization Process for Health IT contract to
ANSI.20 The contract is supported by ANSI's Health IT Standards Panel, a
collaborative partnership between the public and private sector. This
effort integrates standards previously identified by the Consolidated
Health Informatics21 and other federal initiatives. To date, the panel has
selected 90 interoperability standards for areas such as electronic health
records and public health detection and reporting. The selected standards
specifically address components of the breakthrough areas defined by the
American Health Information Community and were produced by accepted
standards organizations. The Nationwide Health Information Network
functional requirements also incorporate standards defined through the
work of the Standards Harmonization Process for Health IT contract. The
selected standards are currently being reviewed for acceptance by the
Secretary.

20 The American National Standards Institute is a private, nonprofit
membership organization that coordinates the development and use of
voluntary standards in the United States.

HHS has also involved the Department of Commerce's National Institute for
Standards and Technology (NIST) with HHS's work to implement health IT
standards through its standards harmonization contract. HHS's standards
harmonization contractor is required to maximize the use of existing
processes and collaborate with NIST where appropriate, including
consideration of outputs from the standards harmonization process as
Federal Information Processing Standards22 relevant to federal agencies.
NIST's issuance of Federal Information Processing Standards for health IT
is to be aligned with recommendations from public and private sector
coordination efforts through the American Health Information Community, as
accepted by the Secretary of HHS. The Federal Information Processing
Standards are to be consistent with the standards adopted by the
harmonization contract to enable the alignment of federal and private
sector standards and widespread interoperability among health IT systems,
particularly electronic health records systems.

21 Consolidated Health Informatics was initiated in December 2001 as an
Office of Management and Budget e-government project to establish federal
health information standards to enable federal agencies to build
interoperable health data systems. The project was incorporated into the
Federal Health Architecture in September 2004.

22 Federal Information Processing Standards are developed by NIST in
collaboration with national and international standards committees, users,
industry groups, consortia, and research and trade organizations when
there are no existing voluntary industry standards to address federal
requirements for the interoperability of different systems, for the
portability of data and software, and for computer security.

HHS Has Begun to Define Requirements for the Development of Prototypes for the
Nationwide Health Information Network

HHS's Nationwide Health Information Network contracts are intended to
provide architectures and prototypes of national networks based on the
breakthrough areas defined by the American Health Information Community.
HHS awarded contracts for developing these architectures and prototypes to
four contractors. The contractors are to deliver final operating plans and
prototypes of a national network that demonstrates health information
exchange across multiple markets in November 2006.

In late June 2006, HHS held its first Nationwide Health Information
Network forum. More than 1000 functional requirements for a Nationwide
Health Information Network were presented for discussion and public input.
The requirements addressed general Nationwide Health Information Network
infrastructure needs and the breakthrough areas defined by the American
Health Information Community. The requirements are being reviewed by the
National Committee for Vital and Health Statistics,23 which is expected to
release its approved requirements by September 2006.

HHS Is Taking Steps to Incorporate Privacy and Security Policies, Practices, and
Standards into Its National Strategy

HHS, through its contracts and recommendations from the American Health
Information Community and the National Committee for Vital and Health
Statistics, has initiated several actions to address privacy and security
issues associated with the nationwide exchange of health information. In
May 2006, 22 states subcontracted under HHS's privacy and security
contract to perform assessments of the impact of organization-level
business policies and state laws on security and privacy practices and the
degree to which they pose challenges to interoperable health information
exchange. In August 2006, 11 more states and Puerto Rico were added to the
scope of the contract. The outcomes of the contract are to provide a
nationwide synthesis of information to inform privacy and security policy
making at federal, state, and local levels.

23 The National Committee on Vital and Health Statistics was established
in 1949 as a public advisory committee that is statutorily authorized to
advise the Secretary of HHS on health data, statistics, and national
health information policy, including the implementation of health IT
standards.

In addition, the standards selected through the standards harmonization
contract include those that are applicable to the consumer empowerment
breakthrough area, specifically privacy and confidentiality. Its initial
standards are intended to allow consumers the ability to establish and
manage permissions and access rights, along with informed consent for
authorized and secure exchange, viewing, and querying of their medical
information between designated caregivers and other health professionals.
Additionally, the proposed functional requirements for the Nationwide
Health Information Network include security requirements that are needed
for ensuring the privacy and confidentiality of health information.

In May 2006, several of the American Health Information Community
workgroups recommended the formation of an additional workgroup comprised
of privacy, security, clinical, and technology experts from each of the
other American Health Information Community workgroups. The
Confidentiality, Privacy, and Security Workgroup was formed in July to
frame the privacy and security policy issues relevant to all breakthrough
areas and solicit broad public input to identify viable options or
processes to address these issues. The recommendations developed by this
workgroup are intended to establish an initial policy framework and
address issues including methods of patient identification, methods of
authentication, mechanisms to ensure data integrity, methods for
controlling access to personal health information, policies for breaches
of personal health information confidentiality, guidelines and processes
to determine appropriate secondary uses of data, and a scope of work for a
long-term independent advisory body on privacy and security policies. The
workgroup convened last month.

In June 2006, the National Committee on Vital and Health Statistics
presented to the Secretary of HHS a report recommending actions regarding
privacy and confidentiality in the Nationwide Health Information Network.
The recommendations cover topics that are, according to the committee,
central to challenges for protecting health information privacy in a
national health information exchange environment. Specifically, they
address (1) the role of individuals in making decisions about the use of
their personal health information, (2) policies for controlling
disclosures across a national health information network, (3) regulatory
issues such as jurisdiction and enforcement, (4) use of information by
non-health care entities, and (5) establishing and maintaining the public
trust that is needed to ensure the success of a national health
information network. The recommendations are being evaluated by the
American Health Information Community workgroups, the Certification
Commission for Health IT, Health Information Technology Standards Panel,
and other HHS partners. The committee intends to continue to update and
refine its recommendations as the architecture and requirements of the
network advance.

HHS Is Continuing to Address Public Health Integration

To help promote the integration of public health data into a nationwide
health information exchange, the American Health Information Community's
biosurveillance workgroup made recommendations in May 2006 intended to
help the simultaneous flow of clinical care data to and among local,
state, and federal biosurveillance programs. The community recommended
that HHS develop sample data-use agreements and implementation guidance to
facilitate the sharing of data from health care providers to public health
agencies. The workgroup also recommended that HHS, in collaboration with
privacy experts, state and local governmental public health agencies, and
clinical care partners, develop materials to educate the public about the
information that is used for biosurveillance including the benefits to the
public's health, improved national security, and the protection of patient
confidentiality by September 30, 2006.

Information exchange standards for sharing clinical health information
(e.g., emergency department visit data and lab results) with public health
are included in the 90 standards recently recommended as a result of HHS's
standards harmonization contract. The standards are intended to enable the
transmission of essential ambulatory care and emergency department visit,
utilization, and lab result data from electronic health care delivery and
public health systems in standardized and anonymized24 format to
authorized public health agencies within less than one day. In addition to
advancing the use of electronic health records, the Gulf Coast contract is
intended to help support public health emergency response by fostering the
availability of field-level electronic health records to clinicians
responding to disasters.

HHS Is Continuing Efforts to Complete and Implement a National Strategy for
Health IT

As called for by the President's executive order in April 2004, the
national coordinator's office is continuing its efforts to complete a
national strategy for health IT. Since we testified in March 2006, the
office has worked to evolve the initial framework and, with guidance from
the American Health Information Community, has revised and refined the
goals and strategies identified in the initial framework. The new draft
framework-The Office of the National Coordinator: Goals, Objectives, and
Strategies-provides high-level strategies for meeting the President's goal
for the adoption of interoperable health IT and is to be used to develop
internal performance measures for the office's activities.

The framework identifies objectives for accomplishing each of four goals,
along with 32 high-level strategies for meeting the objectives. The Office
of the National Coordinator has identified and prioritized the 32
strategies for accomplishing the framework's goals and has initiated 10 of
them, which are supported by the contracts that HHS awarded in fall 2005.
Table 3 illustrates the framework's goals, objectives, and strategies and
identifies the 10 strategies that have been initiated.

The Office of the National Coordinator has prioritized the remaining 22
strategies defined in its framework. Six strategies are under active
consideration, and the remaining 16 require future discussion. According
to officials with the office, the strategies were prioritized based on
guidance and direction from the American Health Information Community. The
Office of the National Coordinator expects the framework to continue to
evolve through collaboration among the Office of the National Coordinator
and its partners, such as other federal agencies and the American Health
Information Community, and as additional activities are completed through
the contracts.

24 Anonymized data are data that have had personally identifying
information removed.

Table 3: Office of the National Coordinator's Goals and Initial Objectives
and Strategies

Source: HHS Office of the National Coordinator for Health IT

a Strategy has been initiated

b Strategy is under active consideration

c Strategy requires future discussion

While HHS has taken additional steps toward completing a national strategy
and has initiated specific activities defined by its strategic framework,
it still lacks the detailed plans, milestones, and performance measures
needed to ensure that its goals are met. While the National Coordinator
acknowledged the need for more detailed plans for its various initiatives
and told us in March that HHS intended to release a strategic plan with
detailed plans and milestones later this year, current officials with the
office could not tell us when detailed plans and milestones would be
defined. Given the complexity of the tasks at hand and the many activities
to be completed, a national strategy that defines detailed plans,
milestones, and performance measures is essential. Without it, HHS risks
not meeting the President's goal for health IT.

In summary, Mr. Chairman, our work shows that HHS is continuing its
efforts to help transform the use of IT in the health care industry.
However, much work remains. While HHS, through the Office of the National
Coordinator for Health IT and the American Health Information Community,
has initiated specific actions for supporting the goals of a national
strategy, detailed plans and milestones for completing the various
initiatives and performance measures for tracking progress have not been
developed. Until these plans, milestones, and performance measures are
completed, it remains unclear specifically how the President's goal will
be met and what the interim expectations are for 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 Subcommittee may have at
this time.

                          Contacts and Acknowledgments

If you should have any questions about this statement, please contact me
at (202) 512-9286 or by e-mail at [email protected]. Other individuals who
made key contributions to this statement are Amanda C. Gill, Nancy E.
Glover, M. Saad Khan, and Teresa F. Tucker.

310822

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 1:00 p.m. CDT Friday, September 1, 2006

HEALTH INFORMATION TECHNOLOGY

HHS is Continuing Efforts to Define Its National Strategy

Statement of David A. Powner Director, Information Technology Management
Issues

GAO-06-1071T

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www.gao.gov/cgi-bin/getrpt?GAO-06-1071T.

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For more information, contact David A. Powner at (202) 512-9286 or
[email protected].

Highlights of GAO-06-1071T, a testimony before the Subcommittee on Federal
Workforce and Agency Organization, Committee on Government Reform, House
of Representatives

September 1, 2006

HEALTH INFORMATION TECHNOLOGY

HHS is Continuing Efforts to Define Its National Strategy

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 role in providing health care in the U.S.,
it has been urged to take a leadership role in driving change 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. A National Coordinator within the
Department of Health and Human Services (HHS) 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 its plans are
followed and milestones are met.

GAO was asked to identify progress made by HHS toward the development and
implementation of a national health IT strategy. To do this, GAO reviewed
prior reports and agency documents on the current status of relevant HHS
activities.

In late 2005, to help define the future direction of a national strategy,
HHS awarded several health IT contracts and formed the American Health
Information Community, a federal advisory committee made up of health care
stakeholders from both the public and private sectors. Through the work of
the these contracts and the community, HHS and its Office of the National
Coordinator for Health IT have made progress in five major areas
associated with the President's goal of nationwide implementation of
health IT (see table).

Five Areas of Progress and Supporting Activities

Source: GAO analysis of HHS data

These activities and others are being used by the Office of the National
Coordinator for Health IT to continue its efforts to complete a national
strategy to guide the nationwide implementation of interoperable health
IT. Since the release of its initial framework in 2004, the office has
defined objectives and high-level strategies for accomplishing its goals.
Although HHS agreed with GAO's prior recommendations and has made progress
in these areas, it still lacks detailed plans, milestones, and performance
measures for meeting the President's goals.

Abbreviations

HHS Department of Health and Human Services

IT information technology

NIST National Institute for Standards and Technology

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