Health Information Technology: HHS Is Pursuing Efforts to Advance
Nationwide Implementation, but Has Not Yet Completed a National  
Strategy (14-FEB-08, GAO-08-499T).				 
                                                                 
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. 						 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-08-499T					        
    ACCNO:   A80809						        
  TITLE:     Health Information Technology: HHS Is Pursuing Efforts to
Advance Nationwide Implementation, but Has Not Yet Completed a	 
National Strategy						 
     DATE:   02/14/2008 
  SUBJECT:   Electronic health records				 
	     Electronic records management			 
	     Health care planning				 
	     Health care policies				 
	     Health care programs				 
	     Health care services				 
	     Information management				 
	     Information technology				 
	     Managed health care				 
	     Medical records					 
	     Preventive health care services			 
	     Quality assurance					 
	     Quality control					 
	     Quality improvement				 
	     Strategic planning 				 

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GAO-08-499T

   

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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 departmentï¿½s 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 HHSï¿½s 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 Presidentï¿½s 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 Bushï¿½s 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 organizationsï¿½ 
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 Presidentï¿½s goal of interoperable 
electronic health records by 2014. In 2006, the National Coordinator 
for Health Information Technology agreed with GAOï¿½s 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 Presidentï¿½s 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 [email protected]. 

[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 [email protected]. 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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