Health Information Technology: HHS is Continuing Efforts to	 
Define a National Strategy (15-MAR-06, GAO-06-346T).		 
                                                                 
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  
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.			 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-06-346T					        
    ACCNO:   A49142						        
  TITLE:     Health Information Technology: HHS is Continuing Efforts 
to Define a National Strategy					 
     DATE:   03/15/2006 
  SUBJECT:   Electronic health records				 
	     Information systems				 
	     Information technology				 
	     Interagency relations				 
	     Interoperability					 
	     Medical information systems			 
	     Medical records					 
	     Strategic information systems planning		 
	     Strategic planning 				 
	     Standards (health care)				 

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GAO-06-346T

     

     * Results in Brief
     * Background
          * Federal Government's Role in Health Care
          * National Strategy and Greater Interoperability Still Needed
     * HHS Continuing Efforts to Define a National Health Informati
          * The National Coordinator is Continuing Efforts to Develop a
          * Other HHS Divisions Contribute to the Department's Efforts o
     * Other Federal Agencies Have Initiatives Related to the Natio
     * Contacts and Acknowledgements
     * PDF6-Ordering Information.pdf
          * Order by Mail or Phone

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.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.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.

1HHS'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).

                                   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.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 records4 and bar coding of certain
human drug and biological product labels have been shown to save money and
reduce medical errors.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.

2Electronic 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.

3GAO, 21st Century Challenges: Reexamining the Base of the Federal
Government, GAO-05-325SP (Washington, DC: February 2005).

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.

4There 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.

5GAO, Information Technology: Benefits Realized for Selected Health Care
Functions, GAO-04-224 (Washington, D.C.: Oct. 31, 2003).

Table 1: Beneficiaries and Expenditures in Major Federal Health Care
Programs for Fiscal Year 2004

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

a Based on FY 2003 data

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 order6 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.

6Executive 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).

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.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.

7These 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).

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.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.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.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.

8GAO, Health Care: National Strategy Needed to Accelerate the
Implementation of Information Technology, GAO-04-947T (Washington, D.C.:
July 14, 2004).

9GAO, Health Information Technology: HHS Is Taking Steps to Develop a
National Strategy, GAO-05-628 (Washington, D.C.: May 27, 2005).

10GAO, 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).

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.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 actions12 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.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. 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.

11GAO, 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.

13Rather 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.

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.

14GAO, 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).

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.

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.

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 areas15 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
Network16-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:

15Breakthrough areas are projects that can potentially achieve measurable
results in two to three years.

16The 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.

           - 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.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 Council, and the Federal Health
Architecture. In 2004, the Officethe 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 adthe Departments of Defense,
Veterans Affairs, and Commerce, othefederal agencies involved with the
Federal Health Architecture include the Departments of Agriculture,
Homeland Security, Jusand the Environmental Protection Agency.

17The 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.

and Veterans Affairs play critical roles in the advancement of electronic
health records. The experience of these agencies inimplementing electronic
health records and in health informatiexchange across organizational
boundaries offer important lessonslearned-both positive and negative-that
could be applied as health care delivery organizations adopt electronic
health recorsystems. According to HHS, the Department of Defense has a
lengthy history working in remote and medically underserved 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.

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 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 theEmployee Health Benefit program, such as adopting systems based on
generally accepted and certified standards. When the agency issued its
2005 annual call letter18 to carriers last April, it requestethat plans
describe their health IT initiatives, including any currentlyin 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 bwith the intention of measuring progress on
the use of health IT.

collaborating with HHS, largely by supporting the Office of the National
Coordinator and its contractors with technical expertisInitially, its
support had been focused on the standards developmenand 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
systedevelopers and other stakeholders.19 In addition, NIST is expleverage
its technical resources by assisting HHS with the national health
information network architecture and the certification process for health
IT.

In

care industry are continuing although much work remains. As we recommended
last May, HHS still needs to establish detailed plansand milestones as
part of the national strategy and take steps to ensure that those plans
are followed and milestones are met. TheNational Coordinator plans to
release a strategic plan later this yeathat 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
thafederal resources are leveraged appropriately.

19 The Website is http://hcsl.sdct.nist.gov .

                         Contacts and Acknowledgements

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 M. Yvonne Sanchez, Nancy E.
Glover, and Teresa F. Tucker.

310804

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Highlights of GAO-06-346T , a report to Subcommittee on Federal Workforce
and Agency Organization, Committee on Government Reform, House of
Representatives

March 15, 2006

HEALTH INFORMATION TECHNOLOGY

HHS is Continuing Efforts to Define a 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 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.

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.

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 sitetoassistinstandardsdevelopmentefforts.

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

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

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

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