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Commission on Systemic Interoperability 

Ending theDocumentGame

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U.S. GOVERNMENT OFFICIAL EDITION NOTICE 
ii

NOTICE: This report was approved and produced by the Commission on Systemic 

Interoperability, whose members were appointed by the President of the United States of 

America and members of the United States Congress. Support for this report was provided 

by the National Library of Medicine and the Department of Health and Human Services. 

Any opinions, findings, conclusions, or recommendations expressed in this material are those 

of the authors and do not necessarily reflect the views of the sponsors. 

This is the Official U.S. Government edition of this publication and is herein identified to 

certify its authenticity. Use of the 0-16 ISBN prefix is for U.S. Government Printing Office 

Official Editions only. The Superintendent of Documents of the U.S. Government Printing 

Office requests that any reprinted edition clearly be labeled as a copy of the authentic work 

with a new ISBN. 

Additional copies of this report are available for sale from the U.S. Government Printing 

Office/Superintendent of Documents, 732 North Capitol Street, NW,Washington, DC 20401. 

Call (866) 512-1800 or (202) 512-1800 (in the Washington metropolitan area), or e-mail at 

ContactCenter@gpo.gov, or visit the GPO Access web page at http://bookstore.gpo.gov/ 

First published in 2005 

Printed in the United States of America 

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ISBN 0-16-072711-1 

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Ending the Document Game 
iii

COMMISSION MEMBERS 

Scott Wallace, J.D., M.B.A. 

Chair 

Donald A.B. Lindberg, M.D. 

Designated Federal Official 

Simon P. Cohn, M.D., M.P.H. Herbert Pardes, M.D. 

Don E. Detmer, M.D. 

Vicky B. Gregg, R.N. 

Thomas M. Priselac, M.P.H. 

C. Martin Harris, M.D., M.B.A. 

Connecting and Transforming Your Healthcare Through Information Technology 

Ivan Seidenberg, M.B.A. 

Fredrick Slunecka 

Gary A. Mecklenburg, M.B.A. William W. Stead, M.D. 
_____ 

iv

COMMISSION STAFF 

Dana Haza 

Director 

Michael Long 

Senior Writer 

Amanda Smith 

Senior Policy Analyst 

KaLea Kunkel 

Policy Analyst 

Raymond Sass 

Policy Analyst 

Carolyn Wise 

Policy Analyst 

Research Team 

Noah Frank

Steven Genson

Chelsea Phillips

Lauren Levy

Ending the Document Game 
v

Foreword 

Healthcare is a huge part of our economy, a dynamic topic of national debate, a focal point of 

enormous scientific and technical endeavor. But those large-scale issues don’t change the fact 

that much of healthcare has always been innately personal—one person seeking and receiving 

help from another person. 

Today the financial relationship between doctor and patient has grown complex, with a 

massive industry of professionals who negotiate prices, transfer reams of paperwork, and insulate 

individuals from the costs of their care. Politically, healthcare is volatile, encompassing issues 

spanning conception and birth to the ending of life and death. Major parts of our relationships with our doctors are not governed by us or our physicians, but by laws and regulations. 

Modern medical miracles have reduced many terminal diseases to chronic conditions and made 

multi-organ transplants a matter of routine. But delivering miracles is a complex undertaking 

that in many ways resembles a shuttle launch more than a house call, with teams of anonymous 

clinicians and technicians replacing the black bag-toting family doctor from across town. 

The shift from black bag to transplants has been gradual. Almost without notice, we have 

allowed the complexity of healthcare to blossom without developing and deploying tools to 

manage it. The structures we have built to create, pay for, and govern the medical miracles we 

seek have led to a depersonalization of care. We have, in many ways, disconnected ourselves 

from healthcare, from physicians, from those to whom we turn for help. But when a child is 

sick, or a parent’s health is failing, when we’ve taken ill or been injured, national issues fade into 

irrelevant obscurity, and we desire medicine to immediately become entirely personal again. 

In the face of robotic gamma knives and sophisticated medical imaging devices, it might 

seem that what is affecting healthcare is too much technology, not too little. But the reality 

is different. The only way to manage the complexity of healthcare is to start managing 

information using connected computer systems. 

We have the potential to ensure that all Americans get the healthcare they need. But to do 

so, we must put consumers in control of their care and allow them to make informed choices 

about what will be done to them and to those for whom they care. We must provide timely, 

accurate, and complete information to doctors and nurses, to public health officials, and to 

scientists. We must be efficient in the ways we use our healthcare dollars. 

This report is all about people and using computers to connect them and their healthcare 

information. It is a report about how we get consumers and clinicians to use these tools, how 

we pay for them, and what we want the computers to do. But computers are only a tool, a 

means to an end. We have focused this report on computers because they seem to be the best 

tool—and maybe the only tool—that will allow the nation to change the way healthcare works. 

Foreword 
vi

While this report is about computers and the information they manage, make no mistake: it is 

a report for people—for Americans who want and need better and more efficient care, for 

policy makers and political leaders who are seeking ways to help improve care delivery, and for 

providers and staff who want to give Americans the best healthcare possible. 

Healthcare’s Crisis. Despite medical miracles and dramatic increases in life expectancy in 

recent decades, healthcare in America has been diagnosed with a seemingly baffling, unconnected 

series of problems. Critics characterize the problems in simple terms: healthcare is unsafe, 

ineffective, inefficient, and inconvenient. They point to a staggering array of studies and 

commission reports—like this one—cataloguing the problems. 

In 1999, the Institute of Medicine shook the medical community—and the nation—when it 

reported that as many as 98,000 Americans are killed each year through preventable medical 

errors. A similarly shocking report by The Rand Corporation in 2004 concluded that the 

people they studied had received only 55 percent of recommended care. Estimates of the 

financial costs of healthcare’s inefficiency vary but run as high as $300 billion to $500 billion a 

year. While precision of the statistics continues to be hotly debated, the conclusions are clear. 

No one needs to be told healthcare is inconvenient. There is no other area of our economy 

where consumers are so consistently frustrated, their time so carelessly wasted. From scheduling 

appointments to waiting room delays, from waiting for test results to resolving billing problems, 

healthcare lags behind almost every other field in customer convenience. 

Systematic problems in healthcare waste consumers’ time and money, leave doctors and 

nurses without the critical information they need to deliver the right care, and sometimes cause 

well-meaning caregivers to inflict life-ending injuries on patients. 

An Information Problem. The problems of healthcare have many causes but they share a 

single characteristic—they result from a lack of information. Clinicians make mistakes not 

because they are careless, but most often because they lack information necessary to make 

better decisions. Critical information may exist somewhere in the system, but healthcare 

information isn’t connected and can’t move where it is needed to deliver safer and better care, 

or to reduce inefficiency and improve effectiveness. 

The lack of information about the care a patient receives creates additional costs for the 

people who create and who pay medical bills. The bureaucracies within healthcare translate 

information from medical records into billing records, then go back into those medical records 

to defend the bills before they are paid. 

Healthcare communicates by phone and by fax. Consumers spend interminable hours on 

phones to book appointments. Physicians and their staffs call other physicians’ offices to relay 

information or confirm the receipt or explain the fax. Doctors, whose poor handwriting has 

Ending the Document Game 
vii

been lampooned for generations on late night television, are responsible for much of what is 

written. It all takes time and it all wastes money. 

Creating the Solution. We need to do better. Healthcare must be safe; there is no excuse for 

a preventable death due to medical error. Healthcare must also be more effective, efficient, and 

convenient. The losses in suffering, time, and money are just too great. 

The solution is to connect healthcare information electronically. The concept is fairly simple: 

information relevant to a person’s healthcare should be available wherever and whenever it is 

needed and authorized. It’s not a pie in the sky technical dream. We have the ability to connect 

people’s information, to move it where they want it, to put it in the hands of trusted physicians 

and caregivers, and to guard it from prying eyes and accidental disclosures. 

We have the technical ability, but we haven’t taken the steps to make connectivity a reality. 

We have created a healthcare system that pays for visits and procedures, but doesn’t reward 

quality and therefore lacks incentives for quality improvement. We have created a patchwork 

of incomprehensibly complex state privacy laws making it almost impossible for our healthcare 

information to follow us as we travel. As a nation, we have fixated on concerns about our 

privacy without paying attention to the real costs—in lives, dollars, and time—that a lack of 

connected information imposes on us. 

This report articulates a vision of an information-connected healthcare system, where 

consumers’ privacy is protected and their convenience facilitated, where doctors and nurses 

have the information they need to efficiently deliver safe and effective care, where our public 

health and homeland security can be protected while still guarding each individual’s privacy. 

The report recommends specific actions and broader policy objectives, all with the goal of 

allowing healthcare to effectively use computers and information technology. If followed, 

the Commission’s recommendations will accelerate healthcare’s transformation. 

There is a great deal to be done. Consumers must understand and embrace the healthcare 

dimension of information technology, declaring not just a willingness for their clinicians to use 

computers, but a desire for the many benefits of connected healthcare information. Physicians 

and hospitals must embrace and adopt the technology as well, overcoming challenges inherent 

in changing the way things are done and seeking to improve the care given patients. Employers, 

insurance companies, and federal agencies paying for healthcare must recognize that the benefits 

of safer, more efficient, and more effective care will aid them as well, and they must step forward 

to help with the investment needed to transform care. 

While we have focused much of this report on consumers and clinicians, there are many 

other constituencies with an interest in and a commitment to improving healthcare. Each is 

critical to the successful transformation of healthcare. In particular, companies making 

Foreword 
viii

computer systems must recognize that the nation needs connected systems; standardized 

systems working seamlessly together are the only possible future. There are models of success 

around the world. Our everyday experience with banking, cell phones, and e-mail demonstrates 

that information can be connected, moved, and effectively protected. 

This Commission came together for the first time in January 2005 and its members have met 

and worked diligently over these past 10 months. In addition to echoing the acknowledgments 

on the following page, I am indebted to my fellow Commissioners who share a vision, one 

many of them have been contributing to their entire careers. I am grateful to each of them, 

for their selflessness, their openness, and their commitment to this project and to the country. 

I undertook this project as a memorial to my father,Thom Wallace, who suffered through a 

host of preventable medical errors that severely compromised the quality of his last years of life. 

What I learned is my father’s experience was all too typical, his unnecessary suffering all too 

common. Instead of a static memorial, I hope this report will guide, cajole, inspire, or compel 

action to transform care. We can transform healthcare, for ourselves and for those we love. 

We can, and we must. 

Scott Wallace 

Chair 

Ending the Document Game 
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Acknowledgments 

This Commission on Systemic Interoperability was authorized by the Medicare Modernization 

Act. The commissioners were appointed by the President, Senate Majority Leader Bill Frist, 

Former Senate Minority Leader Tom Daschle, Speaker of the House Dennis Hastert, and House 

Minority Leader Nancy Pelosi. We have sought to fulfill the promise of this Commission, 

to change and improve healthcare by offering concrete recommendations for connecting 

Americans’ health information. We are honored by and grateful for the trust of those who 

nominated us. 

Health and Human Services Secretary Mike Leavitt put our work at the top of his own 

priorities. His personal commitment to our deliberations helped guide our extensive 

examination of connectivity and interoperability. We are grateful to the Secretary and his 

staff for their support of our work and for keeping this issue a national priority. We are grateful 

as well to Secretary Leavitt’s predecessor, Secretary Tommy Thompson, who convened the 

Commission and launched our endeavors. 

Dr. Donald Lindberg, Director of the National Library of Medicine, contributed significantly 

to our understanding of the challenges of interoperability and its centrality in the wide range 

of issues confronting medicine. Dr. Lindberg, along with the Library’s Deputy Director, 

Betsy Humphreys, and the entire NLM staff have been gracious hosts, providing the 

Commission and its staff with office space and ready counsel. We thank them for their 

tireless efforts and flexibility. 

Dr. David Brailer, National Health Information Technology Coordinator, has made enormous 

strides in defining the framework for healthcare information technology in the United States 

and shared generously his insights and perspectives. Dr. Brailer consistently matched his sage 

advice with humor and creativity. We are grateful for his assistance and leadership on this issue, 

and to the Office of the National Coordinator’s staff for their assistance. 

The many patients, doctors, and experts who testified before the Commission and sat for 

interviews with Commissioners and staff provided us with firsthand knowledge of the 

real-world problems caused by the lack of connected health information and interoperability. 

We appreciate their willingness to share their stories of inconvenience and challenge, heartbreak, 

and tragedy caused by the lack of connecting health information technology. Healthcare is 

ultimately a personal experience, and credit for its transformation will go largely to those 

willing to share their personal stories and to insist on change. 

Acknowledgments 
x

Members and staff of the U.S. House of Representatives and Senate counseled us on how to 

create change. We are grateful for their guidance and hope that this report gives them the tools 

they need to make a difference. 

Finally, we offer a note of thanks to the Commission’s staff. Dana Haza, our Director, has 

mixed diligent project management with a constant infusion of new ideas, delivering it all 

with Southern charm and wit that is disarming and effective. In a remarkably short time, 

she assembled a staff and created the structure by which this Commission operated. We are all 

in her debt. The Commission’s staffers—Michael Long,Amanda Smith, Raymond Sass, Carolyn 

Wise, KaLea Kunkel, Chelsea Phillips, Steven Genson, Noah Frank, and Lauren Levy—are a 

remarkable group of professionals who personally invested themselves in gathering patient and 

provider stories and undertaking comprehensive research and writing. The energy, creativity, 

and enthusiasm each member of the team brought into this project helped bring the story 

of interoperability to life. Without a doubt, their dedication made this report a reality. 

Our appreciation for this team knows no bounds. 

Ending the Document Game 
xi

Ending the Document Game 

Department of Health and Human Services 

Secretary Mike Leavitt’s Remarks for the Commission on Systemic Interoperability 

August 29, 2005 

I recently had a surgical procedure that is recommended for men my age. I made my 

appointment four weeks in advance, talked with colleagues about what to expect, followed 

the instructions about what to eat and when, and then went dutifully to my local hospital, 

where I proceeded to fill out my contact and insurance information seven times. 

SEVEN times! 

I cannot imagine doing this in any other business, yet we do it in healthcare without a second 

thought. Just think of it: seven different people will enter my information into seven different 

and incompatible databases, seven different times. 

Making the medical clipboard a thing of the past is what Ending the Document Game is all about. 

It’s about moving away from filing cabinets and clipboards, and moving toward mouse clicks and 

memory sticks. It will mean higher quality, lower costs, and less hassle. 

During the same hospital visit, when the doctor asked me about my medical history, I nearly 

forgot to mention that I have sleep apnea—a condition that can be serious if not treated but 

that I’ve been managing, with the help of my doctor, for several years. Sleep apnea is not a 

big problem for me, but it is something a doctor should know about if you are going to be 

anesthetized, as I was. The omission was my fault; I simply forgot to tell the doctor. 

When our health practitioners do not have compatible data, they order tests and procedures 

we don’t need. This makes healthcare more expensive. Even worse, with incomplete data, 

practitioners can make medical errors that may cause complications, or even cost us our lives. 

We live in the digital age, and yet in healthcare we settle for the paper age, even though there 

is considerable evidence that interoperable electronic health records will reduce errors, 

improve quality, and save money. 

Up to a third of healthcare spending—more than half a trillion dollars every year—is wasted 

on wrong or redundant care or other problems. Even more serious, more people die each 

year in this country because of medical errors than from motor vehicle accidents, breast cancer, 

or AIDS. 

We can do better than this. 

Secretary Mike Leavitt’s Remarks 
xii

Our Nation has an economic and humanitarian imperative: get more efficient or face losing 

our economic prosperity and more human lives. Nothing short of the transformation of our 

healthcare system will do. 

President Bush is resolved to transform the healthcare system by putting information 

technology to work. He has set a national goal to have most Americans using electronic health 

records within 10 years. He has asked us to ensure that the privacy and security of those records 

are protected. 

The cornerstone of this effort is the American Health Information Community. The Community 

is a private/public collaboration to help develop standards and interoperability in a smooth, 

market-led way. 

I congratulate the Commission on Systemic Interoperability for its work and pledge to 

move forward with expedience. We will move our healthcare system to the plug-and-play 

world. As a result of this move, we will see fewer medical mistakes, lower costs, better care, 

and less hassle. 

Ending the Document Game 
xiii

Table of Contents

Tab I Recommendations

Tab II Executive Summary

Tab III The Problem and the Solution

Tab IV Consumers

Tab V The Healthcare Delivery System

Tab VI Existing Efforts

Tab VII Appendix

A. Commissioner Biographies 

B. American Health Information Community Charter 

C. Past Recommendations 

D. Bibliography 

E. Index 

Table of Contents 
xiv

Ending the Document Game 
1

Recommendations

There is no single step that, if taken, would create a connected nationwide system 

of health information. This Commission has organized the steps needed to create 

such a system into three categories: adoption, interoperability, and connectivity. 

These categories were formed acknowledging the obvious overlap, but recognizing 

a need to structure recommendations to facilitate understanding. 

Adoption focuses on the challenge of getting clinicians and consumers to use 

computer programs and information networks to maintain healthcare records, 

access relevant information about patient’s background and illness, and offer 

support for safer, better decisions. Adoption includes the need to train doctors 

and other caregivers to ensure they are able to adopt these technologies effectively 

in their practices, provide technical support so clinicians do not need to become 

computer technicians, and make clinicians and consumers aware of the benefits 

and the privacy safeguards of these systems. The issues of adoption also require 

addressing the difficult economic and regulatory issues slowing investment and 

use of connected computer systems and the growing gaps between communities’ 

access to these technologies. 

Information is valuable when it is available as needed. Interoperability focuses 

on the need for healthcare information to be connected so information is accessible whenever and wherever it is needed and authorized. Interoperability issues 

often become exceedingly technical, focusing on the rules for how information is 

created, stored, and moved among computer systems. 

Finally, there must be physical networks and operating rules for actually 

moving information around. Connectivity focuses on the networks providing 

the conduits for moving healthcare information seamlessly. A major obstacle 

to connectivity is creating a mechanism to connect an individual with his or 

her healthcare information. Connectivity also encompasses the major issue of 

consumer confidentiality—providing uniform privacy laws across the country 

and punishing those who seek to violate them. 

In crafting these recommendations, the Commission focused on providing 

actionable advice. While the recommendations will possibly provoke debate in 

Recommendations 
2 

some circles, the Commissioners, reflecting consensus and compromise, as well as 

a commitment toward action and the transformation of healthcare, present them 

with unanimous support. 

Ending the Document Game Ending the Document Game 

To advance progress of the adoption of health information technology, 

the following actions should be taken: 

1. Adoption Incentives. The Department of Health and Human Services 

(HHS) should implement, or seek authorization from Congress as necessary 

to implement, financial and other incentives for participation in a standardsbased healthcare information network. These incentives should be directed 

toward individuals and organizations including healthcare providers, medical 

institutions, purchasers, and health plans. Incentives should include broadbased approaches such as pay-for-performance, as well as targeted approaches 

that include grants directed at small, safety net, and financially challenged 

providers. These incentives should begin to be implemented within two 

years. Employers and other private sector healthcare payers who will benefit 

from the adoption of interoperable healthcare information systems should be 

encouraged to provide similar incentives. 

2. Regulatory Reform. The Secretary of HHS should act with urgency to 

revise or eliminate regulations that prevent healthcare entities, networks, hospitals, and clinicians from working together to create and adopt interoperable 

healthcare information systems, while promoting competition and maintaining 

reasonable protections against inurement and kickbacks. To ensure that 

healthcare providers can be confident in the legality of their actions, the Secretary should clearly state in the regulations those actions that are permissible 

and should direct the Centers for Medicare and Medicaid Services and the 

Office of the Inspector General to provide effective guidance to accelerate 

legally compliant activities that advance adoption of healthcare information 

technology. This effort should begin with 42 U.S.C. 1395nn, known as the 

Physician Self-Referral or Stark Law, and 42 U.S.C. 1320a-7b, known as the 

Federal Anti-Kickback Law, and regulations issued pursuant to those laws. 

3. Reporting on Adoption Gaps. To ensure that the benefits of healthcare 

information technology are equally available to all the nation’s citizens, HHS 

should monitor and annually issue a public report on gaps in the adoption 
3

and effective implementation of interoperable healthcare information technology systems across all sectors of the nation’s health system. The report 

should specifically identify types of gaps and should propose public and 

private sector policies to address and close those gaps. 

4. Workforce Needs and Impacts. The Departments of Labor and 

Commerce, in concert with HHS, should identify and quantify deficiencies 

in healthcare workforce knowledge and skills that must be addressed in 

order to secure maximum benefit from healthcare information technology. 

The effects of healthcare information technology on the use of labor and 

the upward mobility of workers in the healthcare system should also be 

considered. Based on these findings, these Departments should create a 

plan to meet such workforce needs and better estimate the financial impact 

of workforce changes that occur as a result of effectively adopting healthcare 

information technology. 

5. Public Awareness. HHS should develop and execute a public awareness 

campaign that helps educate consumers, providers, and other interested 

constituencies of the benefits of using interoperable health information 

technology and the steps they can take to realize those benefits. HHS 

should implement the campaign in conjunction with the Department of 

Commerce and other government and private-sector organizations. 

The adoption of healthcare information technology has been hindered by the 

economics of healthcare. The Commission’s recommendations seek to provide 

an incentive for adoption by rewarding the desired outcomes through pay-forperformance programs. In addition, direct financial and other support will be 

needed by small providers who get less direct benefit from use of the technology 

than larger providers and by safety net and other healthcare providers whose lack 

of financial resources have prevented their adoption of information technology. 

Much of existing provider-based healthcare information technology is found 

inside hospitals. However, existing laws and regulations prevent hospitals from 

sharing those resources with other clinicians in the community. While these 

laws serve to protect competition among healthcare providers and to prohibit 

inappropriate payments to doctors, changes should be made to facilitate the 

sharing of information technology systems. 

Recommendations
4 

Information technology promises to help bring about an extraordinary transformation in healthcare. The Commission recognizes three foundational areas 

where these changes are not being adequately addressed. The use of information 

technology adds another dimension to the gaps in both healthcare’s availability 

and quality. The first step in closing the gaps is to identify and quantify them. 

Using information technology effectively will require considerable changes in the 

way doctors, nurses, and other healthcare professionals practice medicine and 

approach their jobs. The Commission recommends a new focus on those 

changes, as well as on quantifying the benefits to healthcare workers from the 

implementation of information technology. 

The second step is to deal directly with workforce issues. A shift to connected 

health information requires changes in practice by caregivers. It enables shifts 

in roles within the care team resulting in increased effectiveness and efficiency. 

It creates new roles for informatics experts and technical support personnel. 

The Commission recommends planning for these changes so that work force 

availability does not block adoption. 

Finally, a critical dimension of this report is its focus on consumers. Consistent 

with the Commission charter, we recommend a concerted public education 

campaign to inform consumers and caregivers of the value and security of 

interoperable healthcare information systems. 

To advance progress of the interoperability of health information technology, 

the following actions should be taken: 

1. Product Certification. Purchasers of healthcare information technology 

products must have a reliable source of information about the interoperability, 

functionality, and security of these products; and vendors must be able to 

compete by differentiating their products beyond minimum standards. 

HHS should support a single, voluntary, private-public process to certify that 

products meet minimum standards. To ensure continual improvement in the 

products available to the healthcare community, the scope of certification 

activities should aggressively be expanded to include additional healthcare 

information technology products, and the minimum performance specifications should be augmented over time as technology and standards progress. 

Ending the Document Game Ending the Document Game 
5

2. Data Standards. HHS, advised by the American Health Information 

Community (AHIC) and in consultation with the National Committee for 

Vital and Health Statistics (NCVHS), should ensure broad acceptance, 

effective implementation, and ongoing maintenance of a complete set of 

interoperable, non-overlapping data standards that function to assure data in 

one part of the health system is, when authorized, available and meaningful across the complete range of clinical, administrative, payment system, 

public health, and research settings. Additionally,AHIC should build upon 

the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to 

develop national standards for authentication, authorization, and security that 

will permit the necessary infrastructure for consumers’ confident adoption of 

healthcare information technology. 

3. Standard Product Identifiers and Vocabulary. Standardizing data at the 

point of its creation will greatly accelerate the creation of an interoperable 

healthcare information network. HHS should work with manufacturers of 

drugs, devices, and test kits to achieve standardized identifiers and vocabulary 

in labels and packaging, and in all data outputs of devices and test kits. 

4. Drug Records. Interoperable healthcare information technology will 

ensure that all providers have access, when authorized, to their patients’ 

medication records and will establish a robust capability for post-marketing 

surveillance of drugs. AHIC should, in its early activities, take a phased 

approach to developing a fully interoperable drug record for every 

American by 2010. 

Interoperability of healthcare information can be achieved, but it will take more 

than good intentions or favorable marketing statements. Ensuring clinicians, 

hospitals, and other providers can purchase information technology systems 

enabling interoperability and appropriate functionality while protecting confidentiality requires an independent entity that can offer reliable product certifications. 

Certification depends upon the use of comprehensive, commonly accepted data, 

and technology standards—a critical infrastructure component not existing 

today but ready to be put into place rapidly through the work of AHIC. 

The Commission strongly endorses the creation of AHIC and the leadership 

demonstrated by HHS Secretary Mike Leavitt to chair and lead that entity. 

Recommendations
6 

Other industries have achieved interoperability by attaching computer readable 

information at the point of product manufacture. Manufacturers of retail products 

include a bar code with all the information needed to manage the product. 

Downstream participants in the supply chain use this information within their 

local systems. In healthcare, it is not yet practical to attach a physical tag to every 

drug or lab result with all the needed information. It is practical to identify the 

product with a standard identifier, to include that identifier in a national database, 

and to link it to all relevant information according to the appropriate terminology 

standard. The Commission recommends manufacturers of drugs, devices, and test 

instruments and kits identify the drug or result with standard identifiers and relay 

information in a standard vocabulary. The standardization of these items is the 

starting point to ensuring interoperability throughout the information 

supply chain. 

Finally, we recommend, and in the body of the report provide the framework 

for an interoperable drug record for all Americans. This roadmap provides a 

management dashboard and coordinates choices, shows what needs to be done, 

and when each step needs to be completed to achieve this goal in a reasonable 

time. While this Commission could not, in 10 months, complete a roadmap for 

every dimension of healthcare information technology, the specific roadmap 

recommended for drug records can serve as a model for the development of 

other interoperable healthcare modules, such as a laboratory record, in the 

coming months. 

Ending the Document Game Ending the Document Game 
7

To advance progress of the connectivity of health information technology, 

the following actions should be taken: 

1. Patient Authentication Standard. Correctly aggregating and exchanging 

information about a specific person is essential and requires a uniform 

mechanism for authenticating the patient’s identity. Congress should 

authorize HHS to develop a national standard for determining patient 

authentication and identity. 

2. Federal Privacy Standard. Congress should authorize the Secretary of 

HHS to develop a uniform federal health information privacy standard for 

the nation, based on HIPAA and pre-empting state privacy laws, which 

anticipates and enables data interoperability across the nation. 

3. Nationwide Health Information Network. A national healthcare 

information network is part of the critical infrastructure of national security. 

Therefore, HHS and its relevant agencies should coordinate and seek 

Congressional approval to coordinate, as necessary, with the Department of 

Homeland Security (DHS) and other cabinet Departments to ensure the 

nationwide health information network is created and receives funding 

commensurate with its contribution to the safety and security of the 

American public. 

4. Criminal Sanctions for Privacy Violations. To augment the protections 

provided by HIPAA, Congress should authorize Federal criminal sanctions 

against individuals who intentionally access protected data without 

authorization. 

5. Consumer Protections. Patients should be protected from the consequences of unauthorized access to or release of their healthcare information. 

Therefore HHS should study and recommend to Congress actions to prohibit 

discrimination based on data obtained in that way. 

Recommendations
8

A uniform national approach to patient authentication was part of HIPAA. 

Creating a single, unique patient identifier would be the most direct way to 

establish patient authentication, and this approach is used throughout Europe. 

However, no approach to personal authentication in computer systems is free of 

financial costs, management issues, and privacy concerns. A direct approach would 

involve an administrative infrastructure that may be unacceptable to some at this 

time for a variety of reasons, including privacy concerns. 

This approach could be modified to allow individuals to opt out of the 

uniform patient identifier. This compromise would let the nation provide a 

system benefiting individuals who recognize that their need for connected health 

information exceeds their privacy concerns while not penalizing those who find 

privacy more valuable. However, such a compromise would sharply reduce the 

administrative savings because the system would have to accommodate both sets 

of individuals. It would also present new liability challenges, specifically involving 

the potential liability of providers who lacked information in the treatment of a 

consumer whose information was not available. 

An alternative to creating unique personal identification for everyone is to 

define a national standard set of authenticating information required to receive 

healthcare. This set of data could be captured when an individual first enters the 

healthcare system. Such information could include a set of data such as date of 

birth, school, employment, and insurance policy number. 

Each of these approaches has strengths and weaknesses. The National Academies’ 

Computer Science and Telecommunications Board’s 2002 report,“IDs—Not That 

Easy,” is a learned, post-9/11 look at the options from the perspective of national 

security. For purposes of healthcare and of national security, the time has come to 

select an alternative and eliminate the unacceptable cost of unconnected healthcare. 

Much like the huge variety in patient authentication mechanisms, the variety and 

contradictions within the patchwork of state privacy laws also prevents the nation 

from connecting healthcare information. HIPAA set a minimum national privacy 

standard, but many states have augmented that standard. The resulting cacophony 

of state laws is fundamentally inconsistent: what is mandated in one state is 

prohibited in another. Congress must enact a uniform national privacy standard 

for the nation to realize the benefits of connected healthcare information. 

Ending the Document Game Ending the Document Game 
9

The networks that will allow connected healthcare information are a critical 

national infrastructure, promoting the safe, efficient, and effective delivery of care; 

the protection of public health; the defense of the nation; and the promotion of 

rapid medical advancement. Without a connected health information network, 

the nation is slower in detecting epidemics of natural or man-made viruses and 

compromised in its ability to detect and recall defective drugs or medical devices. 

The healthcare field alone cannot carry the full burden of establishing the networks 

and infrastructure to connect healthcare information, and the Commission calls 

on DHS and other appropriate Federal agencies to assist in this essential task. 

Finally, the Commission recognizes that no system of confidentiality and security 

protections will protect against all malicious attacks. To ensure the nation’s 

reliance on the confidentiality of connected healthcare information, the Commission 

calls upon Congress to enact stiff criminal sanctions against individuals who 

purposefully access protected data without authorization. We also recommend 

providing clear and comprehensive safeguards against discrimination to protect 

anyone whose personal data were improperly released. 

Recommendations
10 

Ending the Document Game Ending the Document Game 
11

Executive Summary

Addressing Healthcare Connectivity as a Matter of 

Life and Death 

Americans need a connected system of electronic healthcare information available 

to all doctors and patients whenever and wherever necessary. 

In 2000, the Institute of Medicine (IoM) estimated that between 44,000 and 

98,000 Americans die each year from preventable medical errors.1 Subsequent 

studies have estimated that the number may be twice as high.2 Medical errors 

are killing more people per year, in America, than breast cancer,AIDS, or motor 

vehicle accidents.3 This pain and suffering is compounded by the knowledge that 

many of these errors could have been avoided. 

The lack of immediate access to patient healthcare information is the source of 

one-fifth of these errors.4 

One of every seven primary care visits is affected by missing medical information.

5 

In a recent study, 80 percent of errors were initiated by miscommunication, 

including missed communication between physicians, misinformation in medical 

records, mishandling of patient requests and messages, inaccessible records, mislabeled 

specimens, misfiled or missing charts, and inadequate reminder systems.6 

Under the current paper-based system, patients and their doctors lack instant, 

constant access to medical information. As a result, when a patient sees more 

than one doctor, no doctor knows exactly what another doctor is doing, or even 

that another doctor is involved. The consequences range from inconvenient to 

critical or even fatal. Each time an individual encounters a new healthcare 

1 Kohn, L., J. Corrigan, and M. Donaldson. To Err Is Human: Building a Safer Health System. 

Committee of Health Care in America, Institute of Medicine. 2000. 2 HealthGrades. In-Hospital Deaths from Medical Errors at 195,000 perYear, HealthGrades Study Finds. 

July 27, 2004. 3 Institute of Medicine and Centers for Disease Control and Prevention. National Center for Health 

Statistics: Preliminary Data for 1998 and 1999. 2000. 4 Health Research Institute & GlobalTechnology Center. Reactive to Adaptive:Transforming Hospitals 

with DigitalTechnology, PriceWaterhouseCoopers. 2005. 5 Smith, Peter, et. al. “Missing Clinical Information During Primary Care Visits,” The Journal of the 

American Medical Association. February 2005. 

<http://murphy.house.gov/UploadedFiles/HealthCareFYI_5a.pdf> 6 Annals of Family Medicine. July/August 2004. 

<http://annalsfm.highwire.org/cgi/content/astract/2/4/317> 

Executive Summary
12 

provider, that patient must retell his or her medical history. Not only is this 

redundant, it can introduce error and imprecision, ensuring that no two copies 

of a personal medical record will be exactly alike. In an emergency, delay and a 

lack of information can be deadly. 

In the age of the Internet, this shortcoming is unacceptable. 

Many other problems stem from the lack of connectivity. Since doctors often 

work independently, the lack of shared knowledge can cause duplicate tests to 

be ordered, resulting in unnecessary expense and, occasionally, risk, and pain. 

The same problem exists for prescriptions, which can conflict with one another 

to create life-threatening drug interactions. 

Security and confidentiality are limited by the difficulty of tracking access to 

paper-based records. The paper-based system necessitates consultations via telephone 

calls, faxes, and e-mails without the benefit of complete medical records. Patients 

who want follow-up information on their conditions must schedule time with 

doctors, nurses, or staff, or conduct research independently—there is no 

networked access to supporting information. 

Handwritten records—most notoriously, prescriptions—are easily misread, 

causing potentially life-threatening mistakes. Similarly, analysis of large numbers 

of paper records is impossible, denying the public the benefits of early warnings 

of dangerous trends in disease or bioterrorism, and other research-driven efforts. 

The benefits of a connected system of 

healthcare information 

These problems and others are well addressed by a connected system of healthcare 

information, one that is referred to in this report as interoperable. The benefits of 

this interoperable system will extend to both patients and healthcare providers and 

may be categorized as promoting convenience, confidentiality, access, and quality 

of care. 

Interoperability creates convenience by allowing doctors and other healthcare 

providers to share medical history, lab results, and other pertinent information in 

a more timely and accurate way. It makes backups of data easier to maintain, so 

catastrophic data loss is more easily remedied. It provides improved support for 

Ending the Document Game Ending the Document Game 
13

adults who care for aging parents, especially from far away. Such systems 

enhance and ease post-diagnosis and post-treatment contact with doctors via 

on-line services. 

By more effectively limiting unauthorized access, and tracking who views 

personal healthcare information, interoperability provides patients with more 

security and confidentiality. 

Prescriptions and data are typed and stored electronically and not on paper, so 

they are always readable. Notification of drug or device recalls is faster and more 

thorough. And interoperability makes possible a powerful public-health resource 

against bioterrorism, the spread of disease, and other nationwide medical concerns 

by allowing national-level analysis of trends in disease and symptoms. 

In short, interoperable healthcare information enhances the quality of care for 

all Americans. 

The time patients and caregivers must spend filling out forms is dramatically 

reduced, affecting both cost and convenience. Similarly, the system improves 

continuity of care when treatment is ongoing and conducted among multiple 

healthcare providers, an especially important consideration for patients with 

chronic conditions. After patients move or when they travel, interoperable 

healthcare information helps ensure care consistent with treatment that is 

already under way. 

In the field of obstetrics, contact with multiple healthcare providers is an almost 

universal facet of pregnancy and childbirth. Interoperability allows physicians and 

others to share medical records and to provide additional medical information 

for expectant mothers. Similar effects benefit rural residents and those who rely 

on community health centers, who can receive more consistent treatment across 

multiple providers, a reduction in the number of office visits required, and access 

to personalized information that can help them live healthier lives. 

When all providers in the chain of healthcare are able to share information, it will 

be much more difficult to commit fraud and abuse. Connectivity will create new 

opportunities to ensure that prescriptions are valid and have not been duplicated, 

and the status of payment and reimbursement information will be better integrated 

and more frequently updated. 

Executive Summary
____________________ 

14

The first major manifestation of interoperability in people’s lives will be electronic 

prescribing, also known as e-prescribing. Doctors will be able to file prescriptions 

without paper, bringing an end to the age-old problems of illegibly written 

prescriptions, lost prescriptions, delays in taking prescriptions to a pharmacy, and 

doubts about whether prescriptions have been filled correctly. 

In addition to the recommendations made by the Commissioners, this report 

includes many other resources. There is a timeline in the chapter, The Problem and 

The Solution, that describes steps to create an electronic prescription drug record 

for every American. Patient and provider stories throughout the report document 

the challenges in a healthcare system without interoperability—and success stories 

of current implementations. The Existing Efforts chapter documents over 300 

interoperability projects under way nationwide. Recommendations of previous 

commissions, dating back to 1978, digitize the healthcare system and are listed 

in Appendix C. 

In order to make the information contained in this report available to the largest 

number of people, we have also chosen to make it electronically accessible, on-line 

(at www.EndingTheDocumentGame.gov) and on a CD-ROM (included with 

each hard copy of the report). The CD-ROM and Web versions will include 

such things as a video statement by Secretary Mike Leavitt of the Department of 

Health and Human Services, as well as interviews with the Commissioners and 

Dr. David Brailer (National Coordinator for Health Information Technology). 

There are also audio interviews that detail important ways in which connected 

health information and e-prescribing have helped save lives and improve the 

quality of life for patients and care providers. 

The quality of our healthcare, on both societal and individual levels, is suffering 

from the lack of a connected system of healthcare information. The cost comes in 

injury, wasted resources, and lost lives. Much of the technology for such a system 

is already being applied to infinitely less critical concerns such as making travel 

plans on-line and checking bank balances at any ATM. Much of the world has 

addressed this lack of medical connectivity to a far greater extent than the United 

States has. Our problem is not a lack of technology, but a lack of attention and a 

lack of will. 

Ending the Document Game Ending the Document Game 
15

This report describes what can be gained and what is required to achieve an 

interoperable system of electronic healthcare information. This goal can be 

reached, and its benefits are worth the effort that will be required. 

The evidence cited in this report compels action to achieve an interoperable 

health information technology system in the United States. 

Lives are in the balance. 

Executive Summary
16 

Ending the Document Game Ending the Document Game 
17

The Problem and the Solution

Table of Contents 

18 The Problem with the Paper System

18 The healthcare system: Did you know it could be better? 

19 The paper-based system is not good enough anymore 

20 The problems with paper 

20 The inconvenience of paper-based systems 

21 The lack of confidentiality in a paper-based system 

22 Lack of access in the paper-based world 

22 Possible compromises to quality of care from a paper-based system 

23 Barriers to connecting health information 

24 Legal considerations 

26 Connecting around the world 

28 Nations on their way to interoperability 

30 The Solution—Interoperability

30 Don’t reform! Transform instead 

31 The convenience of connecting 

32 Confidentiality is easier to preserve 

32 Easier and more secure access 

32 Improved quality of care 

34 Paving the Way to Interoperability

34 An interoperable medication record for every American 

34 2005: A portrait of today’s state-of-the-art electronic medical record system 

36 2006: Smart personal medication record 

37 2008: Electronic dispensing record 

38 2010 and beyond: Interoperable medication record 

40 Interoperability—Why Now?

40 People are dying 

40 The government is supporting this initiative right now 

41 The technology now exists and is continuously becoming easier to use 

41 Success stories show the system works 

42 People want interoperability 

The Problem and the Solution
18

The Problem and the Solution

“The day is not far off when we can walk into a medical clinic and not be handed 

a clipboard to enter the same information you’ve filled out a hundred times.” 

Mike Leavitt, Secretary, Department of Health and Human Services 

The Problem with the Paper System 

The healthcare system: Did you know it could be better?

Your life should not depend on your ability to memorize. Yet to some extent 

today, it does. 

On a business trip, you wake up with strange, painful symptoms in the middle of 

the night. You take a cab to the emergency room where doctors try to help you. 

They need to know your medical history. 

And you ... don’t know. Or can’t remember. Or never knew the details. 

Although your airline ticket confirmation number, your rental car record, and 

even your cellular phone bills and calling history are available 24/7 on-line, 

your medical records are locked away in filing cabinets somewhere, partially handwritten and partially typed, stored in paper folders, and stacked alphabetically. 

At four in the morning, that person with the key to your medical information is 

fast asleep and, in this case, a thousand miles away. How would you reach him or 

her? Would you call your doctor’s answering service and hope someone will go 

down to the office? Perhaps it can wait until morning—but wouldn’t it be better 

for the doctor treating you now to have that information now? 

Meanwhile, that emergency room doctor is asking you to remember as much of 

your history as you can ... while your stomach is in a knot ... or your head pounds 

... or the pain in your chest begins to creep into your jaw and down your arm. 

Scenes like this play out daily in America in emergency rooms, in the backs of 

ambulances, in doctors’ offices and hospitals, in walk-in clinics and neighborhood 

Ending the Document Game Ending the Document Game 
19

health centers. Sometimes it’s merely inconvenient, and a healthcare provider can 

contact another provider to get the necessary information—a few hours or days 

do not make a difference. But often there is no time for delay. Not after a serious 

car accident. Not during a stroke or heart attack. Not in a medical emergency far 

away from home. Not after a natural disaster or a terrorist attack. 

Interoperability or connectivity—constant, instant access to your medical information—is the only answer. Although such access is available for everything from 

shopping to helping with homework, it is not available for medical records. 

Yet it ought to be. And the technology to make it available already exists. 

The most basic information about your health—medicines you take, tests you’ve 

had, doctors you’ve seen, vaccinations you’ve received, illnesses you’ve had—ought 

to be available at your fingertips. And at your doctors’ fingertips. 

But it isn’t. Not for you. Not for your children. Not for your parents. Not for 

your wife, husband, partner, or best friend. 

Not unless you carry it around yourself—and who carries copies of their own 

x-rays and medical charts? And even if you did, could you possibly carry them 

around wherever you go on the chance you might be injured and need them? 

Individuals who rely on the medical system may find themselves in a dire 

situation: the most critical information about health and quality of life—the data 

that would and should guide future treatment—can’t be accessed in a timely 

manner by many healthcare providers. 

The cost comes in wasted time, diminished quality of care, duplicate testing, 

needless expense, unnecessary worry ... and, worst of all, in lives lost. 

The paper-based system is not good enough anymore

Consumers don’t realize how much benefit there is in having an interoperable 

system of medical information. Most people don’t even realize such a thing is 

possible. And not knowing the need for such a system, people certainly don’t 

know that the technological answer to the need is within reach. The public has 

accepted that medical records are kept in paper files in metal cabinets, and that’s 

the way it is. 

“The learning and knowledge 

that we have, is, at most, but 

little compared with that of 

which we are ignorant.

”

Plato, Greek Philosopher

The Problem and the Solution
20 

“We live in the 

Information Age, but our 

healthcare industry is stuck 

in the Stone Age.

”

Senate Majority Leader Bill Frist

Making the connection. ATMs and on-line banking provide universal access 

to your financial records. Oil service centers keep service records on your car 

accessible nationwide. Airlines keep track of your flight history, your seat 

preference, your payment history, and your frequent-flyer miles—and you can 

access them yourself on-line, too. 

This technology should be applied to healthcare immediately. It means more than 

convenience: this technology will save lives. 

The paper-based system of medical information currently in use has no connectivity, no ease of access for either patients or providers, and limited security 

and tracking of access. It is a barrier to improved treatment, and it diverts critical 

resources to bureaucracy and administration when they could be put to better use 

for direct patient care. 

The problems with paper

Problems with the paper-based system run the gamut. Some are just inconvenient: 

waiting for vaccination records before a parent can take a child to camp or enroll 

the child in school, or making a trip across town to take the child’s records to 

another doctor. Others are critical: for example, treating a patient with a 

chronic condition or who is in a life-threatening situation far from home, but 

unable to supply the healthcare provider with detailed medical information. 

The problems affect both healthcare providers and patients. For instance, doctors 

must be sure that access to paper records is limited to authorized personnel 

and must keep track of physical files that can be inconvenient to move around. 

Patients suffer because there are health benefits available that a paper-based system 

cannot support: post-visit interaction with a doctor by electronic communication; 

the ability to track one’s own health information and more closely follow detailed 

treatment plans; and, of course, the ability to provide a physician with instant 

access to critical information, especially in an emergency. 

The inconvenience of paper-based systems

• Difficulty sharing medical history and lab results with other doctors. 

When doctors do consultations, accept new patients, or review lab results, 

paper-based information is almost always involved. That means information is 

Ending the Document Game Ending the Document Game 
21

transmitted via fax machine, telephone conversation, courier, or mail. 

All these methods have the potential for misread or misheard data, lost 

information, delay, and breaches of security. 

• Inconvenience of securing vaccination records for camp and school 

enrollment. Almost every childhood activity outside the home requires 

proof of vaccination. That means a trip to the doctor’s office for the 

patient or the parent. A paper-based system costs your family time. 

• Recounting medical history for every new doctor. Nearly every 

new healthcare provider a patient sees will need to review his or her medical 

history. People move and travel more than ever, so this need is especially 

acute. No one can be expected to remember his or her entire medical 

history, and the record will be remembered even less accurately when a 

patient must see a new doctor in an emergency. 

• No support in caring for aging parents far away. Many adults find 

themselves taking care of their aging parents, and they often have to do so 

from far away. Medical information is almost always written down or 

conveyed in conversation, leaving long-distance caregivers with an additional 

burden. They have no convenient way to keep track of prescriptions, interact 

with a physician, review test results, or be sure that the parent is following 

the doctor’s treatment plan. 

• No easy way of getting quick answers to follow-up questions. 

Doctors want to help patients as much as they can, especially with matters 

such as following the treatment plan, providing more details about a condition, 

or finding general information about lifestyle choices. But the lack of 

connectivity means that patients have to wait by the phone or play 

“telephone tag” with their healthcare providers instead of using e-mail or 

accessing on-line articles that physicians and others have made available. 

The lack of confidentiality in a paper-based system

• Confidentiality is hard to preserve using paper. Patients do not want 

their sensitive, personal medical information stored in a way others can 

easily access. Doctors are committed to honoring the trust patients place in 

them, and they are bound by laws, regulations, and rules of ethics to protect 

confidentiality. But under today’s paper-based system, privacy is most often a 

“President Bush wants 

to maximize the benefits 

of information technology— 

electronic medical records— 

so that doctors and nurses 

can better monitor treatments 

and reduce errors and 

patients can go from doctor 

to doctor with their complete 

medical history.

”

First Lady Laura Bush

The Problem and the Solution
22 

matter of locks and keys: paper records are kept in file cabinets on the 

premises of a healthcare provider, and older records may be stored off-site. 

When records are being accessed—when doctors and nurses are referring 

to them during an office visit, for instance—privacy is often a matter of 

trust: notes regarding patients are kept in file folders that rest in plastic trays 

attached to an exam-room door, or on a billing clerk’s desk, or in a pile 

awaiting lab results. 

• No way to keep track of who sees paper records or to keep 

unauthorized people out. Unlike electronic records, paper records can 

be examined without any record of who looked at them, when a person 

looked at them—or copied them—and why. While security is always a 

priority for administrative staff and medical librarians, a record casually left 

out for even a few moments can easily be examined or even copied by 

unauthorized persons. 

“The single biggest problem 

in communication is the illusion Patients, especially those with serious illnesses or those who have confided 

that it has taken place.

” compromising secrets to their doctors, understand that if their information 

is exposed, they could be irreparably harmed. They fear the loss of a job, George Bernard Shaw, embarrassment at home or work, bias, and the inability to get insurance Winner of the Nobel Prize for 

Literature in 1925 coverage.

Lack of access in the paper-based world

• No instant, constant access to your healthcare information. 

Paper records have to be carried from place to place, faxed, or summarized 

in a phone call. The only way this transferred information is preserved is if it 

has successfully been received and placed in your medical file. 

• No guarantee for information backup. Your paper-based records could 

be destroyed by fire, flood, or other catastrophe, like Hurricane Katrina, or 

they could be damaged or stolen. Unless the doctor has made copies of every 

paper in the filing cabinet, that part of your medical history is lost. 

Possible compromises to quality of care from a paper-based system

• Illegible handwriting in records and prescriptions. Paper records are 

a mix of typed text and handwriting, and prescriptions are usually written 

completely by hand. Illegible handwriting in healthcare information can 

Ending the Document Game Ending the Document Game 
23

mean the loss of potentially important data when someone returns later to 

find that he or she cannot read the information written. In addition, 

pharmacists may make mistakes filling prescriptions because of illegible 

handwriting, or may have to spend extra time calling the doctor’s office to 

get clarification about a prescription. The Institute for Safe Medication 

Practices estimates that pharmacists make more than 150 million calls to 

physicians each year to clarify what was written on prescriptions.1 

• Patients with chronic conditions cannot easily get the information 

they need. Short of conducting their own research in a medical library, 

patients have no way of learning how to take better care of themselves or 

better understand their condition in light of details from their medical test 

results and treatment. 

• Recalls are slowed or may be incomplete. When medical devices and 

drugs are recalled, either by the Food and Drug Administration or by the 

companies that manufacture them, there is no system in place to quickly and 

efficiently contact physicians and their patients to advise them what to do. 

• We are missing out on powerful public health tools, especially 

against bioterrorism. Healthcare monitoring based on information 

technology is crucial in fighting bioterrorism, tracking disease, and supporting 

medical research. This information should be available quickly, on a day-today basis, and accessible at our nation’s hospitals and research facilities. 

Barriers to connecting health information

A connected healthcare system will overcome a lot of challenges, but implementing 

that system brings about challenges of its own: 

• Fear of change. Doctors’ methods and work habits are key to their ability 

to help patients. Doctors understand implicitly that changing those habits 

can affect the quality of care they deliver; but once a physician has embraced 

technology, he or she can help drive further interoperable efforts to 

improve healthcare. 

Americans EmbracingTechnology

People initially bought cell phones 

for emergencies only, but today 

they are in common use. We 

wonder how we got along without 

them. Consumers may initially 

demand connectivity because 

it seems like a vital element of 

a safe and efficient healthcare 

system—which it is. But once it 

is in place, the convenience and 

security it makes possible will 

make it hard for us to imagine 

what life was like before it. 

1 Institute for Safe Medication Practices. “Electronic Prescribing Can Reduce Medication Errors.” 

August 2005. <http://www.ismp.org/msaarticles/whitepaper.html> 

The Problem and the Solution
24 

• Cost. A question from every healthcare provider is: Where will the money 

come from to pay for this? The answer is that some will come in the form of 

direct savings and some in the form of governmental and private incentives. 

• Connecting vendors. Vendors—the companies that sell electronic healthcare systems—often try to protect their market share by making sure their 

systems will not interact with anybody else’s system. Vendors have financial 

incentives to work against each other, not with each other. But with the 

establishment of common standards, and as healthcare providers and the 

public realize that interoperable systems can save lives, pressure will grow for 

vendors to give their clients systems that can connect to one another. And, 

since the technology already exists, vendors will be able to provide connected 

systems faster and more easily than ever before. 

• Lack of standards. Besides allowing vendors to create systems that 

don’t “talk” to each other, the lack of standards discourages significant investment or effort toward an interoperable healthcare system. The Institute of 

Electrical and Electronics Engineers sets standards for computers and 

Underwriters Laboratories ensures that appliances meet safety specifications. 

Without an industry-recognized body for healthcare, the government will 

need to set those standards, coordinate their establishment among groups now 

pursuing them, or act as a catalyst for the creation of standards through some 

other method. 

Legal considerations

Legal considerations are of special concern, especially regarding those laws that 

make it illegal to set up business deals that would promote interoperability. 

The Inspector General for the Department of Health and Human Services has 

addressed the Federal “anti-kickback” law: 

On the books since 1972, the Federal anti-kickback law’s main purpose is 

to protect patients and the Federal healthcare programs from fraud and abuse 

by curtailing the corrupting influence of money on healthcare decisions. 

Straightforward but broad, the law states that anyone who knowingly and 

willfully receives or pays anything of value to influence the referral of Federal 

healthcare program business, including Medicare and Medicaid, can be held 

accountable for a felony. Violations of the law are punishable by up to five 

Ending the Document Game Ending the Document Game 
25

years in prison, criminal fines up to $25,000, administrative civil money 

penalties up to $50,000, and exclusion from participation in Federal healthcare programs.2 

Changes in the law created “safe harbors”: 

Because the law is broad on its face, concerns arose among healthcare providers 

that some relatively innocuous—and in some cases even beneficial—commercial arrangements are prohibited by the anti-kickback law. Responding 

to these concerns, Congress in 1987 authorized the Department to issue 

regulations designating specific “safe harbors” for various payment and 

business practices that, while potentially prohibited by the law, would not 

be prosecuted.... 

Safe harbors immunize certain payment and business practices that are 

implicated by the anti-kickback statute from criminal and civil prosecution 

under the statute.To be protected by a safe harbor, an arrangement must fit 

squarely in the safe harbor. Failure to comply with a safe harbor provision 

does not mean that an arrangement is per se illegal. Compliance with safe 

harbors is voluntary, and arrangements that do not comply with a safe harbor 

must be analyzed on a case-by-case basis for compliance with the anti-kickback statute.

3 

Safe harbors such as those addressing investments in large, publicly held healthcare 

companies or investments in small healthcare joint ventures, referral services, and 

certain settings in managed care need revisiting to remove roadblocks that discourage physicians, hospitals, other healthcare providers, and payers from working 

together to invest in interoperability.

4 

In addition, the “Stark Law” merits adjustment, either by statute or by regulatory 

clarification. By prohibiting referral of Medicare patients between physicians 

who have a financial relationship, the law not only cuts down on kickbacks— 

a desirable goal—but also makes it impossible for doctors and hospitals to join 

2 Office of Inspector General, Office of Public Affairs. Fact Sheet: Federal Anti-Kickback Law and 

Regulatory Safe Harbors. DHHS. November 1999. 3 Ibid. 4 Ibid. 

The Problem and the Solution
���

26

together to acquire interoperable systems at anything but considerable financial 

sacrifice.

5 Greater precision is needed. 

Connecting around the world

• The United States is far behind other countries. Several countries have 

already invested in electronic tools to reduce costs and improve healthcare. 

Many countries are now developing strategies and investing in interoperable tools to connect their health systems and reap even greater benefits from 

information technologies. Although the United States leads the world in 

healthcare spending per capita, our technology lags far behind other nations. 

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every dollar spent in America.6 

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Ending the Document Game Ending the Document Game 
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International Health Policy 

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“It may seem a strange 

principle to enunciate as the 

very first requirement in a 

hospital that it should do the 

sick no harm.

”

Florence Nightingale, Founded 

Modern Nursing and Helped 

Improve the Care Provided 

by Hospitals (1820 – 1910)

• Yet the United States is far behind the world in quality of care and 

has the highest death rate due to medical error. The Nation is behind 

the United Kingdom,Australia, Canada, and New Zealand in patient safety 

and efficiency of treatment.7 

7 2004 Commonwealth Fund International Health Policy Survey of Adults Experiences with Primary Care, 

conducted March through May 2004. 

<http://www.cmwf.org/surveys/surveys_show.htm?doc_id=24540> 

The Problem and the Solution
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• One reason for all the spending and the lack of success may be that 

the U.S. healthcare system lacks connectivity. Only 17 percent of physicians in America use electronic healthcare records, and only nine percent use 

electronic prescription systems (e-prescribing). Yet in the United Kingdom, 

nearly six out of 10 physicians use electronic health records, as do about half 

of the physicians in New Zealand and Australia.8 

Nations on their way to interoperability

• United Kingdom: The United Kingdom uses electronic healthcare 

records, but interoperability is limited. Successes in interoperability include 

exchanging pathology reports and sharing emergency information.9 The 

common care record enables all of England to link up health information 

and produce integrated information about a person’s state of well-being.10 

8 Information from the Harris Interactive Survey. 2001. 9 British Computer Society. “Comprehensive Computerised Primary Care Records Are an Essential 

Component of Any National Health Information Strategy: Report from an International Consensus 

Conference.” Informatics in Primary Care 12 (2004): 255–64. 10 United Kingdom Department of Health. “A Guide to the National Program for InformationTechnology.” 

NHS Connecting for Health <http://www.connectingforhealth.nhs.uk/> 

Ending the Document Game Ending the Document Game 
29

• New Zealand: New Zealand uses electronic healthcare records, but interoperability is limited. Yet “New Zealand has many of the ... components 

[necessary for interoperability]: secure health information networking ... a 

unique patient identifier, well-developed privacy and security legislation, and 

a national standards organization.”11 “The New Zealand health sector ...

 is second only to the United Kingdom in terms of primary care use of 

electronic healthcare records, double that achieved to date in Australia 

(25 percent) and triple that of the U.S. (17 percent).12

• Sweden: Sweden’s healthcare system is widely digitized, but not able to 

freely exchange information. Still, more than 90 percent of general 

practitioners use electronic healthcare records.13 

• Canada: Canada has committed over a billion dollars to the development 

and implementation of interoperable electronic health records, and aims 

to have infrastructure solutions in place in half of Canadian jurisdictions 

by 2010.14 

• Denmark: Demark has had an interoperable system since the late 1980s. 

Currently, the majority of general practitioners, laboratories, and hospitals are 

connected to one another, although patient referrals and a few other types of 

messages are still sent on paper.

15 

11 Karolyn Kerr. “The Electronic Health Record in New Zealand–Part 1.” Health Care and Informatics Review 

Online. 8, no. 1. March 2004. 

<http://www.enigma.co.nz/hcro/website/index.cfm?fuseaction=articledisplay&featureid=040304 > 12 Ibid. 13 “Increasing use of electronic prescriptions in Sweden.” European eGovernment News. April 27, 2005. 

<www.europa.eu.int/idabc/en/document/4221/353> 14 “About Infoway.” Canada Health Infoway, 2004. August 2005. 

<http://www.infoway-inforoute.ca/aboutinfoway/index.php?lang=en> 15 ACCA and Medcom, in collaboration with the European Commission Information Society DirectorateGeneral. The Cost of Electronic Patient Referrals in Denmark Summary Report. 2004. 

The Problem and the Solution
30 

A System for Biosecurity

The Center for Biosecurity at the 

University of Pittsburgh Medical 

Center (UPMC) is a model for 

preparing for outbreaks of disease. 

Its system is an inbound call center 

for medical information. The call 

center allows UPMC to know what 

hospitals within the network have 

open beds or other resources that 

can be shared. All 7,000 physicians 

in the UPMC system can call a 

number and speak to an expert 

within minutes. Such a system 

can also serve as a command 

and control center should a 

disaster occur, having been tested 

in emergencies including fires, 

floods, and breakdowns in hospital 

ventilation systems. Western 

Pennsylvania healthcare providers, 

public health officials, and law 

enforcement officers can access 

the system.

16 

The Solution—Interoperability 

“The first rule of any technology used in business is that automation applied to 

an efficient operation will magnify the efficiency.The second is that automation 

applied to an inefficient operation will magnify the inefficiency.” 

Bill Gates

Don’t reform! Transform instead

Healthcare must always be about people, not about a system. Even though people 

working in the healthcare system have great concern for patients, there are not 

always ways built into the system to encourage personalized attention and “second 

looks” at difficult choices. However, a connected system of health information 

would make that more possible by creating new and better ways to personalize 

information and interact with medical information. How? By making critical 

information more readily available for review on an individual basis. 

A connected system of healthcare information will be a major shift—but it will 

come about through incremental change. Those changes will be more than automated or more efficient versions of what we already do. There will be new ways 

to support and even provide healthcare: replacements and refinements for existing 

processes, procedures, and work habits that will improve outcomes. 

An interoperable system will enable faster and more efficient care by connecting 

the healthcare providers who take care of you with critical, personalized information. It will better integrate research, new best practices, and pharmaceutical 

information into the common practice of medicine. As new technology makes 

your health more a part of the decision of treatment, an interoperable system will 

make your information available in a timely way. And the concept of evidencebased care will become a more integral part of the practice of medicine. 

The push for making medical records systems “talk” to one another is focused on 

the needs of patients, doctors, nurses, and others involved in treatment, allowing 

for personalization, adaptability, and individual choice on all parts. 

16 Fred Baldwin. “NineTechTrends.” Healthcare Informatics Online (February 2005): 13. 

Ending the Document Game Ending the Document Game 
31

A system that works best for everyone will be built with allegiance to no particular method, program, or model, but with flexibility for the choices and needs of 

patients, doctors, nurses, and other healthcare providers. 

The convenience of connecting

• Allows doctors and other healthcare providers to share medical 

history, lab results, and other pertinent information. The ability to 

share information makes consultations easier and permits the consulting 

physician to review the complete picture of a patient’s healthcare as needed. 

Patients can follow up on the meaning of lab results; record comments about 

their diet, exercise, and other lifestyle choices; and address questions to their 

doctors without having to schedule an appointment or a phone call. 

• Easier to secure vaccination records for camp and school enrollment 

and provide records to other doctors. Schools and camps usually require 

confirmation of vaccinations. An interoperable system means the necessary 

records are available to any authorized person. Treatment while away from 

home or after a move no longer requires the physical transportation of 

records, just authorization by the patient for a new healthcare provider to 

access health information. 

• Better support for adults caring for aging parents. Adults caring for 

their aging parents—especially those doing so from far away—can more 

easily review material made available by their parent’s doctor, discuss medical 

choices, monitor the parent’s compliance with a course of treatment, 

check to see that prescriptions are filled, and stay in contact with on-site 

caregivers and nurses. 

• Easier to work with doctors after diagnosis and treatment. 

An interoperable system allows patients to more easily contact their doctors 

to confirm adherence to a treatment plan, to ask questions, and to learn more 

about their condition. 

“Information technology is 

a pivotal part of transforming 

our healthcare system. 

We are at a critical juncture. 

Working in close collaboration, 

the Federal government and 

private sector can drive 

changes that will lead to 

fewer medical errors, 

lower costs, less hassle, 

and better care.

”

Mike Leavitt, Secretary,

Department of Health and 

Human Services 

The Problem and the Solution
32 

Confidentiality is easier to preserve

• Easier to limit unauthorized access. Connected systems provide more 

consistent and measurable security than paper-based systems. Instead of 

filing cabinets, locks, and guards, electronic records are kept behind log-ins 

or biometric sensors. 

• Easier to track who views your medical information. Anyone who 

attempts to log-in to the system and review private healthcare information 

will have to provide authorization. Unlike paper records, which can be 

misplaced or copied, electronic records can be constantly monitored and 

their access tracked. Patients concerned about the unauthorized release of 

personal information will realize a level of security that is, in healthcare, 

thus far unknown—because even those who attempt unauthorized access 

will have left their electronic “fingerprints” in the system. 

Easier and more secure access

• Records are always available with instant access. Interoperable 

electronic health information systems provide constant access to data for 

authorized users. If a doctor or patient needs a medical history, lab results, 

or radiological images at any time, the information can be reviewed 

instantaneously. 

• Records less likely to be lost. Electronic healthcare information stored 

on an interoperable system will be preserved in backup copies, so it is highly 

unlikely that records would be lost. 

Improved quality of care

• Notes, prescriptions, and data are always readable. Paper records are 

written at least partly by hand, but electronic records are stored as digitized 

text, visual image files, and matrices of standard options. There will never be 

any doubt about text recorded in the electronic information. 

• Patients with chronic conditions can take better care of themselves. 

Those with chronic conditions such as diabetes can benefit from improved 

interaction with their healthcare providers and increased access to healthcare 

Ending the Document Game Ending the Document Game 
33

information. With an interoperable system, those patients will be able to 

more easily contact their healthcare providers, allowing those patients to more 

effectively manage issues of day-to-day care. When healthcare providers 

establish on-line links to articles and information about various conditions, 

their patients gain tools for maintaining their health. 

• Notification of recalls can be carried out faster. When the Federal 

Drug Administration, a manufacturer, or other authorized party issues recalls 

or advisories about medical devices and prescription drugs, an interoperable 

system can help identify and notify doctors and patients far more quickly than 

an individual search through medical files by healthcare providers. 

• Connectivity makes powerful public-health tools possible. 

With an interoperable system, authorized groups can conduct advanced 

biosurveillance—the acquisition and study of anonymously sourced data 

for trends, the appearance and movement of disease by geography and 

demography, the efficacy of treatment, early warnings of epidemic disease 

outbreak such as West Nile or avian influenza—and ascertain whether trends 

in data suggest the possibility of biological or chemical attack. 

The Problem and the Solution
34 

Paving the Way to Interoperability 

An interoperable medication record for every American

Having an electronic medication record for every American is a critical step 

toward achieving true interoperability in healthcare, giving treating physicians 

the information they need when they need it, allowing more effective care for 

their patients. It will bring all the medications an individual is currently taking to 

the doctor’s attention at the time important decisions about new prescriptions are 

being made. With tens of millions of Americans relying on so many different 

medications to manage everything from elevated blood pressure to high 

cholesterol, a physician needs a patient’s accurate and up-to-date medication 

list to prescribe the right medication at the right time for an individual’s specific 

health concern, while avoiding the potentially harmful effects of a negative 

drug interaction. 

Consider the following example of how one physician’s practice might benefit 

from a patient’s medication record. 

2005: A portrait of today’s state-of-the-art 

electronic medical record system 

No interoperability 

Dr.Vivian Schilling wants to provide her patients with important information 

about their health. She also wants to have access to information that can help her 

be a better doctor. She uses an electronic medical record system in her office that 

allows her to access patient information from her desktop computer, tablet personal computer, handheld computer, or from home. Dr. Schilling is one of the 10 

to 30 percent17 of more than 871,000 practicing physicians in the United States18 

who currently use a full version of an electronic medical record system. 

A unique user name and password securely connects Dr. Schilling to a patient’s 

electronic “chart” right in her office, during a visit. While she talks to her patient, 

she enters information directly into the electronic medical record, documenting 

every detail of the case as the patient describes symptoms and concerns. She can 

do so without the potential problem of illegible handwriting because, depending 

on the device she uses, she can speak, type, or have her writing converted to 

digitized text. 

17 Advanced Studies in Medicine 4, no. 8 (2004): 439. 18 American Medical Association. Physician Characteristics and Distribution in the U.S., 2005 Edition and 

Ending the Document Game Ending the Document Game prior editions. < http://www.ama-assn.org/ama/pub/category/12912.html> 
35

Each time Dr. Schilling sees a patient, she reviews and updates the information 

in the electronic medical record. She also uses the system to view the results of 

imaging studies and laboratory tests she has ordered to help guide her treatment 

decisions. And as she determines the best course of care for her patient, the system 

provides another layer of safety by automatically presenting a series of alerts— 

potential concerns for a patient that the physician might wish to consider—based 

on the patient’s age, sex, health condition, and medication. 

When Dr. Schilling chooses medication, she uses the system’s pharmaceutical 

database, which contains thorough information about each of the drugs she 

could prescribe. With this tool, she can determine the appropriate prescription 

and avoid allergic reactions, unnecessary side effects, and potentially harmful 

interactions between drugs. 

The electronic medical record system also gives Dr. Schilling the ability to 

review all the patients she treats as a single group, so whenever new medication 

information is released, she can quickly identify all the individuals taking a given 

medication and quickly provide them with important information that could 

impact their health. For example, when the U.S. Food and Drug Administration 

issued a public health advisory about the withdrawal of Vioxx® from the American 

market, each of Dr. Schilling’s patients who were takingVioxx® were identified 

through the system and notified within 24 hours to stop taking the medication. 

Dr. Schilling understands that patients who feel connected to her as their physician, and who are educated about their own individual health concerns, are more 

likely to be actively involved in maintaining their health over time. They make 

better lifestyle choices, tend to eat better, watch their weight, and avoid significant 

health risks by getting enough exercise and not smoking. 

For example, when patient Betsy Clemmons arrives for her first office visit, 

Dr. Schilling invites her to enroll in a personalized on-line service that provides 

tools for health management. Describing the system as an “on-line connection 

to her own electronic medical record,” Dr. Schilling tells Betsy about the things 

she will be able to do, such as viewing information the doctor has entered in 

the electronic medical record about Betsy’s health issues; reviewing information 

from past appointments, including any patient instructions the doctor recorded; 

receiving the results of tests almost as soon as they are released; requesting new 

The Problem and the Solution
36 

appointments and prescription renewals; and receiving reminders about when her 

next health screening or tetanus shot is due—and all this will be available from 

any Internet connection, any time, day or night. 

Perhaps most important, the tool contains links that provide Betsy with reliable 

information about the issues that matter most to her. For example, Betsy has 

a history of diabetes in her family. As Dr. Schilling is ordering a blood glucose 

screening at this first appointment, when Betsy gets home and logs in to the online tool, she can click on links to read in detail about diabetes, better understand 

how she might avoid it, and see how others manage the disease. Of course, Betsy’s 

personal information is encrypted and secure. No one but Betsy, Dr. Schilling, 

and the nursing and office staff directly involved in Betsy’s care can access it. 

Although the system significantly improves Dr. Schilling’s ability to provide 

superior medical care, its effectiveness is limited because the information in it is 

limited to Dr. Schilling’s practice. Ideally, a patient’s vital medical information 

should be accessible to any physician treating that patient, no matter where the 

patient may be when care is needed. Still, Dr. Schilling’s system is an important 

first step toward an interoperable medication record. 

2006: Smart personal medication record 

Stage 1: Limited interoperability 

In 2006, Betsy becomes interested in having her own personal medication 

record. She wants to include prescriptions from all her physicians, along with 

over-the-counter medicines she takes on her own—not just prescriptions from 

Dr. Schilling. 

Betsy finds a secure, password-protected on-line service that allows her to enter 

her medication history and access it at any time. She enters the medications she 

is currently taking, along with her known allergies, history of drug interactions, 

and other health conditions. All information will be entered manually by Betsy, 

but if she enters the Federal Drug Administration’s medication product code 

found on the label of her prescription bottles, official and complete drug 

information will be automatically linked to Betsy’s record. With this, she can 

be alerted automatically if any of the drugs she is taking are recalled, no matter 

who prescribed them. 

Ending the Document Game Ending the Document Game 
37

Betsy can grant access to her medication record to anyone she chooses, including 

physicians and family members. She can print out her medication history when 

going to a new physician or print out a copy to keep in her wallet in case of 

an emergency. 

The ability for consumers to have a personal medication record is a vital step 

toward an interoperable medication record. In this stage, anyone who has access 

to the Web will be able to access their own record 24 hours a day. 

2008: Electronic dispensing record

Stage 2: Increased interoperability 

In 2008, the medication record becomes more connected to other physicians 

and information. When Betsy buys medication, the dispensing information is 

forwarded by the claims adjudicator or pharmacy to a secure clearinghouse. 

Betsy (and any provider she authorizes) can access this aggregate record of 

medications via a secure Web site. This automated electronic dispensing 

record replaces the smart personal medication record of 2006, described in 

the previous section. 

Medicines are now recorded automatically in the record. Betsy doesn’t have to 

remember to do it. All of her providers automatically see what each of them 

has prescribed. Whenever a medicine is dispensed, it is checked for interactions 

with Betsy’s allergies and with her other medicines. Full information about each 

medication—including dosing, side effects, interactions, lab conflicts, allergy alerts, 

disease contraindications, pricing, and drug image identification—is only a click 

away with this electronic dispensing record. Notification about medication recalls 

is immediate and automatic. 

Betsy and each of her providers will be able to quickly and easily access all 

drug information in a single, aggregated record. However, the record is still not 

connected to practice-based e-prescribing systems. Dr. Schilling and any other 

healthcare provider must open a second display to manually check the aggregated 

record. During the prescribing process, automatic alerts are still limited to 

medications prescribed by that practice. 

“The only limit to our 

realization of tomorrow will be 

our doubts of today.

”

Franklin D. Roosevelt

The Problem and the Solution
38 

2010 and beyond: Interoperable medication record

Stage 3: Complete interoperability 

In 2010, Dr. Schilling’s office will have a fully interoperable medication record. 

The electronic medical record of 2005 has been retrofitted to use the standard 

drug names recognized by all systems. Over the last five years, all of Betsy’s 

other providers have adopted standards-based e-prescribing systems. Providers 

and pharmacies instantly update each other on every change in medication 

information and prescriptions in real time. Finally, e-prescribing and dispensing 

are connected. 

Dr. Schilling now has all the advantages of interoperability while maintaining the 

user-friendly electronic medical record interface of 2005. She can access patient 

records from home or in the office, allowing her to provide care for patients at any 

time. For example, when Betsy is admitted to the emergency room, Dr. Schilling, 

as her primary care physician, is able to connect to Betsy’s information from her 

home. She sees both her outpatient medications and the intravenous solutions 

being used in the emergency room, and she gives a well-informed opinion of the 

treatment that should be taken. 

Dr. Schilling’s electronic medical record allows her to select medications from a 

drug information database that is updated automatically, at least daily. It includes 

direct links to all information in the electronic drug label. 

With full interoperability now in place, Dr. Schilling can prescribe medications 

and treat her patients using evidence-based guidelines, concise and easy-to-use 

clinical care guidelines based on the most updated and accurate medical 

information available. 

For instance, Dr. Schilling often will use evidence-based guidelines in treating 

pneumonia, asthma, or sinusitis. Having this information available gives 

Dr. Schilling the information needed to achieve a diagnosis, estimate a prognosis, 

choose the best therapy, determine potential harm, and provide the highest quality 

of care in a timely and efficient manner. Information is automatically tailored to 

avoid drug interactions and comply with the formulary (i.e., the list of medicines 

qualified for coverage) from the patient’s insurer. With an interoperable medication record, the check for interactions is repeated at dispensing to catch changes 

in the patient’s medication list since the prescription was first written. 

Ending the Document Game Ending the Document Game 
___________ 

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39

By 2014, with Betsy’s permission, 

de-identified (i.e., anonymous) abstracts 

of her medication record, lab tests, and 

diagnoses are reported to a prescription 

reporting database for automated postmarket surveillance. Bioinformatics algorithms 

check regularly for unexpected patterns 

to help identify safety concerns that might 

be missed by premarketing trials. These 

trials often exclude patients who may be 

at greater risk of certain adverse effects 

but will likely receive a drug when it is on 

the market. Premarketing trials that assess 

safety or efficacy also do not always detect 

relatively rare adverse events. Through 

interoperable electronic prescription 

reporting, the public has the best available 

tools for storing and analyzing safety 

reports and possible adverse drug events. 

In 2010 and beyond, the benefits of a 

full interoperable medication record 

are realized. The building blocks of 

interoperability that were utilized in 

2006, 2008, and 2010 provided the 

interface, framework, and content for 

the interoperable medication record. 

Dr. Schilling and Betsy can now have a 

better doctor-patient relationship by 

using all available information technology 

tools in an interoperable framework. 

Timeline to an Interoperable Medication ���������������������������������������� Record for Every American

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The Problem and the Solution
40 

Interoperability—Why Now? 

“By computerizing health records, we can avoid dangerous medical mistakes, 

reduce costs, and improve care.” 

President George W. Bush

People are dying

In 2000, the Institute of Medicine released a landmark report estimating that 

44,000 to 98,000 people die each year from medical errors in this country,

19 

many of which can be caused by missing or incorrect information and delays in 

access. In a more recent study released by Health Grades, Inc. (a healthcare 

ratings, information, and advisory services company) the number was estimated 

to be 195,000 people killed by medical error annually.

20 There should be a widespread demand for a connected system, but neither the public nor the healthcare 

industry is calling for it. This is because many healthcare providers and even more 

members of the public are not aware that such a system is possible. Put simply, 

interoperability will save lives. 

The government is supporting this initiative right now

For the first time, the President has formally made a high priority of creating a 

national system of interoperable healthcare records.21 To support this goal, the 

Medicare Modernization Act included authorization for the Commission on 

Systemic Interoperability and a mandate for this report, which is a survey of 

interoperability and a guide to achieving it. In addition, the Office of the 

National Coordinator for Health Information Technology has been established 

to implement the President’s vision for widespread adoption of interoperable 

electronic health records within 10 years. 

19 L. Kohn, J. Corrigan, and M. Donaldson. To Err Is Human: Building a Safer Health System. Committee of 

Health Care in America, Institute of Medicine. 2000. 20 Ibid. 21 United States White House, Office of the Press Secretary. President Discusses Health Care Information 

Technology Benefits. January 27, 2005. 

<http://www.whitehouse.gov/news/releases/2005/01/20050127-7.html> 

Ending the Document Game Ending the Document Game 
41

The technology now exists and is continuously becoming 

easier to use

Interoperability relies on technologies that already exist: broadband, personal 

computers, wireless systems, e-prescribing platforms, biometric security devices, 

electronic imaging software and hardware, touch-sensitive screen input devices, 

advanced database programming and querying techniques, increased memory and 

data storage capacity, and simplified network administration software.

22 

Success stories show the system works

Successful implementations cited in this report include efforts in: 

• CareGroup, a six-hospital integrated system in Massachusetts; 

• Cummings, Georgia, clinics associated with Dr. James Morrow; 

• McLeod Regional Hospital, South Carolina; 

• Miami, Florida, pediatric cardiology practice of Dr. Evan Zahn; 

• New England Health EDI Network; 

• Sonoma County, California; 

• TheVeterans Administration; and 

• Wishard Memorial Hospital in Indianapolis, Indiana. 

Additionally, more than 300 other efforts and initiatives are identified in the 

chapter,“Existing Efforts: Connecting the Country.” 

22 Kenneth Adler. “Why It’sTime to Purchase an Electronic Health Record System.” American Academy of 

Family Physicians: News & Publications. November/December 2004. 

<http://www.aafp.org/fpm/20041100/43whyi.html> 

The Problem and the Solution
____________________ 

42

People want interoperability

When people learn about connected systems and their benefits, more than 70 

percent of the public say they would use one or more features of a personal health 

record. In particular: 

• Seventy-five percent say they would e-mail their doctor; 

• Sixty-nine percent would track immunizations; 

• Sixty-nine percent would monitor their record for mistakes; 

• Sixty-five percent would transfer information to new doctors; and 

• Sixty-three percent would look up and track their own test results.23 

The technology is ready, and the evidence for the value of connectivity is clear. 

For the last 27 years, both government and private industry have studied the 

problem and made hundreds of recommendations.24 There is still no system in 

place. It is time to end this aimless trek and implement an interoperable 

system of healthcare information. Healthcare without connectivity is extracting 

a price in resources, quality of life, and lost lives too high to continue to pay. 

It is time for healthcare providers to receive the tools they have been missing and 

for consumers to claim the benefits they need and deserve. 

23 Connecting for Health Collaborative. The Personal Health Working Group: Final Report. Markle 

Foundation. July 1, 2003. 24 See Appendix C for a complete list of past recommendations. 

Ending the Document Game 
Consumers

43

Table of Contents 

44 Introduction 

44 A personal story of “The Document Game” 

45 You deserve constant access to your personal health information 

47 Helps healthy people stay healthy 

47 Problems with the paper-based system 

48 Electronic medical records, interoperability, and the difference between the two 

48 If paper has so many drawbacks, what is the alternative? 

49 Benefits: Moral, intellectual, and practical 

50 Convenience

50 You can have constant access to your own information 

50 High-touch and low-touch 

51 Less time filling out forms 

51 Easier contact with your doctor means improved personal and family care 

53 Empowering Patients and Improving Care

53 Continuity of care 

53 Fewer errors and less wasted time 

54 Both doctors and patients are better informed 

54 Better management of chronic conditions 

54 Electronic prescribing (e-prescribing) 

55 Improved care for expectant mothers and their unborn babies 

55 Makes personalized care possible as future medical advances warrant 

56 Confidentiality, Privacy, and Security

56 The power of technology to create trust 

57 Why Americans (and the world) have so readily adopted technology 

58 People are growing more comfortable with using technology for healthcare 

59 The good news: Prevention and confidentiality are attainable goals 

61 Individuals want access to and control of their own records 

62 Confidentiality: The core of the doctor-patient relationship 

63 Health Issues for Individual Communities

63 Access for everyone, including the poor and indigent 

63 Better care in community health centers 

64 Issues in rural areas 

66 Tracking disease and nationwide medical concerns 

66 Military 

66 Veterans 

67 Reducing Medical Errors While Saving Patients’ Time and Money

67 The bottom line 

67 The scope of the problem: By the numbers 

68 Relative risk of healthcare 

69 The financial costs 

69 Financial advantages for patients 

70 Reduce duplication of tests 

70 Dramatically reduce drug interactions 

Consumers
44

Consumers

“A patient-centered system absolutely demands an electronic health record. 

To empower wired consumers with information, choice, and control, we need to 

harness the explosive power of information technology.” 

Senate Majority Leader Bill Frist

Introduction 

A personal story of “The Document Game”

Ashley Shaff was born with a chromosomal abnormality that has caused lifelong 

problems with her eyes, ears, and heart, and contributed to developmental delays, 

sleep apnea, lung disease, and a host of other conditions. Peggy Frank,Ashley’s 

mother, has had to take personal charge of Ashley’s medical records to ensure that 

complete and timely information reaches doctors and providers caring for Ashley. 

The sustained effort has been wrenching. Below is an excerpt from Peggy’s 

testimony before the Commission. 

[My daughter] Ashley has been seen by one dozen medical facilities, spanning 

3,000 miles—literally coast-to-coast. She has had approximately 35 hospitalizations. She has been seen by [at least 36 medical specialists and therapists].... 

I have had to be ... a “connector,” literally running interference between the 

various physicians and health care facilities to ensure that Ashley’s medical 

records physically get from place to place ... in a timely manner, often under 

extreme emotional conditions. 

Trust me, playing “the document game” is disturbing, especially at times of 

considerable duress. 

The same holds true for ... asking endless medical history questions [that have 

been asked and recorded by others many times before, but rarely shared with 

other doctors]. They ask everything that has happened during her entire 

life and seek great detail on absolutely every single medical procedure, 

hospitalization, etc., that has occurred over the span of Ashley’s life. 

I cannot tell you how many times I was reduced to tears. 

Ending the Document Game Ending the Document Game 
45

I remember in Northern California sitting at Ashley’s post-operative bedside, 

crying as I was trying to provide the medical history. I was just told, not 

minutes before, that she was terminally ill and had about five months to 

five years to live. This is wrong. It is unkind, and perhaps even a medical 

mistake waiting to happen. What if I make a mistake, an error or an 

omission, that has a grave impact on her care, then or in the future? 

There is a lot of talk about reducing medical costs by increasing patient safety. 

Where does having a medical record, easily accessible, fit into this picture? 

I believe it to be pivotal.1 

You deserve constant access to your personal health information 

Your personal medical information helps guide your medical treatment, but 

sometimes your complete information is hard to come by. 

Parts of the data may be easy to get, usually because you are standing in the office 

of the doctor who stores that record in the first place, or you are seeing a doctor 

who works in the same medical practice. Other parts of the information may 

be much less readily available, because separate information is stored in different 

doctors’ offices, hospitals, and labs. This lack of connection—lack of “interoperability”—among people and among sources of information can result in bad 

diagnoses, duplicate testing, conflicts in prescriptions, wasted time for doctors and 

patients, diminished quality of care, needless expense, unnecessary worry, and even 

the loss of lives. 

Problems that arise from a lack of information do not have to happen. 

The most basic information about your health—medicines you take, tests you’ve 

had, doctors you’ve seen, conditions you’ve had—ought to be available to any 

doctor you choose at any time. 

Once a patient has granted permission, healthcare providers should be able to 

access personal healthcare information when and where they need it, so they can 

provide the best care possible, whether the patient has a scheduled visit ... or has 

just fallen off a ladder. 

The Parallel to Cell Phone

Technology

No one knew the extent of what 

could be done with cell phone 

technology until the market got 

hold of it, and gave us the cell 

phone-address book combination, 

the camera phone, the Internetready phone, and more. We 

still do not know what new uses 

will be developed for cell phone 

technology. The same holds 

true for a connected system of 

medical information. 

1 Peggy Frank. Testimony before the Commission on Systemic Interoperability. March 15, 2005. 

Consumers
46

This document was provided by the Markle Foundation.

Ending the Document Game Ending the Document Game 
47

The U.S. healthcare system needs a connected electronic system of personal 

health information that allows doctors to share information and find critical data 

instantly. Systems that make the most of shared data and interaction are all 

around us: in banks, over the Internet, in libraries. Such a system for healthcare 

is possible. The technology exists and can be implemented—and no one can 

predict all the possible benefits that will arise from making it part of our lives. 

Helps healthy people stay healthy

Healthcare is episodic, but health is daily. You make decisions about your health 

every day, and the overall task of staying healthy is in your own hands. Healthy 

people stay healthy longer when they closely monitor their own health and seek 

out current information on how to stay well. Armed with information and 

knowledge, a patient not only gains new perspective on his or her choices, but 

also learns what the range of choices is. You choose what kinds of foods to eat, 

how much to eat, how much to exercise, whether or not to take vitamins, and a 

host of other things. Those living with chronic conditions usually monitor and 

maintain their health on a daily basis by, for instance, measuring blood sugar and 

blood pressure, or receiving outpatient therapy. 

A system of electronically connected medical information will help create a 

more active partnership between patients and healthcare providers and promote 

healthier lifestyles. Doctors will be able to more easily and frequently monitor 

the progress of their patients, and patients will be able to more easily contact their 

doctors—or access a doctor’s expertise through recommended articles and other 

material—to better follow a course of treatment. 

Problems with the paper-based system

The paper-based system of maintaining health information has critical shortcomings. 

There is no consistent and complete access, only limited control over access, 

no record of who has accessed the healthcare information, a risk of mistakes in 

care resulting from illegible handwriting and missing information, wasted time 

on tasks that could be streamlined, and no agreed-upon “language” for recording 

medical data. 

“In health there is freedom. 

Health is the first of all 

liberties.

”

Henri-Frederic Amiel,

Poet and Philosopher (1828 – 1881)

Seven “Rights”

According to Andy von Eschenbach, 

Director of the National Cancer 

Institute, there are seven “rights” to 

a high-quality system of healthcare: 

1. The right patient 

2. Receives the right treatment 

3. At the right time 

4. For the right reason 

5. In the right location 

6. With the right outcome 

in real time 

7. At the right price.

2 

2 Andrew C. von Eschenbach. “Director’s Update: ClinicalTrial System of Future.” NCI Cancer Bulletin 

(October 26, 2004): 2. 

Consumers
48

SevenWays to Know IfYour

Healthcare Provider Uses an

Interoperable System of

Healthcare Information

1. The patient and the healthcare 

provider can always see the 

information in the record of 

the patient’s healthcare. 

2. Neither the patient nor the 

healthcare provider ever has 

to reenter information that 

has not changed. 

3. The patient and the doctor can 

always obtain access through 

the system to all health studies, 

whether they were done in 

hospitals, clinics, laboratories, 

radiology facilities, rehabilitation 

centers, or nursing homes. 

4. The patient can grant access to 

his or her entire health record 

to a healthcare provider in any 

part of the United States.This is 

especially important in the case 

of emergencies during travel. 

5. The portions of the computerbased health record necessary 

for business processes 

(e.g., payments, insurance 

reimbursements) can be 

automatically and simply 

provided to appropriate parties. 

6. The portions of the record that 

are relevant to quality of care 

studies can be readily provided. 

7. The patient, doctor, and 

participating healthcare entities 

are protected from improper 

access to private medical 

records by any third party under 

severe penalty of Federal law. 

Electronic medical records, interoperability, and the difference 

between the two 

An electronic medical record is your current medical information and your 

patient history. It may include anything found in a typical paper-based file, 

including electronic imaging reports. 

While electronic medical records have the capacity to be interoperable, they are 

not naturally so. That is why most existing electronic medical records cannot be 

used in multiple clinical care environments. 

When interoperability exists, distant systems can exchange information. For 

instance, if you were on a trip to Los Angeles and ended up in the hospital, an 

interoperable system would allow your doctor there to view your entire medical 

history as recorded by your doctor back home, as well as any other information 

from any other time you had an encounter with the U.S. healthcare system. 

If paper has so many drawbacks, what is the alternative? 

The better answer is connected health information—interoperability. Part of this 

connected information for each patient is a personal medical history, maintained 

on a computer: an electronic “safe” where medical history is stored. Instead of 

having information written on sheets of paper in filing cabinets, medical records 

are accessible instantly by any healthcare provider who has received permission 

from the patient. 

What is in the interoperable electronic health record? The same things that are 

in a paper record: your x-rays, MRIs, prescriptions, treatment history, lab and 

other test results, physician’s notes, and anything else you or your doctors deem 

important to your health. 

Electronic medical information that is accessible by computer is easy for 

doctors to find in an emergency, because they can pull it up from wherever 

they are—there is no waiting for someone to rifle through a filing cabinet to 

find the needed information. 

Ending the Document Game Ending the Document Game 
49

Benefits: Moral, intellectual, and practical

The possible benefits of interoperability in healthcare fall into three categories: 

• The moral benefit. In 2000, the Institute of Medicine estimated that 

44,000 to 98,000 Americans are killed by preventable medical errors each 

year.

3 Since that time, follow-up studies have indicated that the number of 

preventable deaths is even higher. For example, Health Grades, Inc. reported 

in 2004 that as many as 195,000 Americans were killed in 2000, 2001, and 

2002 by medical mistakes in hospitals nationwide.

4 

• The intellectual benefit. In the 21st century, Americans should expect 

more from the healthcare system, a critical field that has less connectivity 

than many other parts of life: Kids are on-line in school, families care for 

grandparents through on-line services, and on-line shopping includes everything from shoes to stocks and bonds. The technology and skill exist but 

have yet to be purposefully applied. 

• The practical benefit. An end to the document game—the problems 

that result from delays and inefficiencies inherent in a paper-based system 

of records. It is time to eliminate the shuffling of papers and the wait for 

critical medical information to be sent to the right person or place via 

phone calls, faxes, or “snail mail.” An electronic system that connects 

caregivers and patients with information anytime and anywhere will: 

° Eliminate the need for repetitive, difficult, and often inaccurate retelling 

of medical history each time a patient sees a new caregiver; 

° Eliminate the one-size-fits-all approach that the lack of personal 

information forces on doctors and nurses as they diagnose and 

treat patients; and 

° Eliminate the problem of personal health information being scattered far 

and wide with no way to bring it together for basic healthcare, let alone 

emergency treatment. 

3 L. Kohn, J. Corrigan, and M. Donaldson. To Err Is Human: Building a Safer Health System. Committee of 

Health Care in America, Institute of Medicine. 2000. 4 HealthGrades. In-Hospital Deaths from Medical Errors at 195,000 perYear, HealthGrades’ Study Finds. 

July 27, 2004. <http://www.healthgrades.com/aboutus/index.cfm?fuseaction=mod&modtype=content&m 

odact=Media_PressRelease_Detail&&press_id=135> 

Consumers
50

Convenience 

“Never before in history has innovation offered promise of so much to so many 

in so short a time.” 

Bill Gates

You can have constant access to your own information

With an interoperable healthcare system, you will be able to review your personal 

medical information in private, at your leisure. You will also be able to add information as you see fit, such as family history, over-the-counter medicines you take, 

self-monitored data for blood sugar or blood pressure, and exercise history. 

High-touch and low-touch

With some services, you want human interaction. Other times, you just want to 

get what you came for and go. 

At the gas station, you want to get in and out. The trend toward self-service began 

when the price of gas got so high that few stations could afford to pay someone to 

pump the gas and still maintain a competitive price. Once people began pumping 

their own gas, they did not want to be bothered with having to go inside to pay, 

and “pay at the pump” systems emerged. In 2004, more than half the transactions 

at gas stations happened at the pump.

5 It has become a “low-touch” industry. 

But when you go to a nice restaurant on a special occasion, you expect personal 

service—“high-touch” attention. It is the same with any place where people want 

service tailored to their own needs. Hair salons, high-end clothing stores, auto 

repair shops—when people walk in, they want reassurance, handholding, 

and attention. 

In the healthcare world, high-touch attention is more than something nice to 

have. It is what most patients truly want, need, and expect. 

5 Jeff Lenard. Commission on Systemic Interoperability staff interview. May 2005. 

Ending the Document Game Ending the Document Game 
51

Healthcare is a hybrid—a high-touch activity that can benefit from low-touch 

support. It is easier to order prescriptions, make appointments, and keep up with 

medical records using an automated system—a low-touch approach. But when 

a person goes the doctor, it should be a high-attention, detail-oriented experience—a high-touch experience. However, according to the Health Resources 

and Services Administration, under the current system, physicians spend 38 

percent of their time writing up charts.6 For nurses, that figure is 50 percent.7 

Less time filling out forms

With connectivity, the first round of filling out forms can be the last round. 

Since all healthcare providers can share data, patients do not have to fill out 

a medical history or insurance form more than once. Wherever authorized 

providers are located (whether the patient has visited that provider before 

or not) the information will be readily available. 

Easier contact with your doctor means improved personal 

and family care

Interaction with the healthcare system is most often episodic. With an 

interoperable system in place, you can refer to your physician’s information network and find information you need to make a doctor’s appointment go more 

efficiently or reduce the number of follow-up visits you might have to make. 

Sometimes you need to ask your doctors detailed questions in person. At other 

times, e-mail would be a better medium. For many questions, doctors will be 

able to direct you to on-line resources such as MedlinePlus.8 Such a system 

could take into account the details of your medical condition and guide you to 

informative articles. 

6 Bill Finerfrock. “Presentation on Electronic Medical Records in Rural Health Clinics” (teleconference 

transcript). Health Resources and Services Administration. 2005. 

<http://ruralhealth.hrsa.gov/RHC/March16Transcript.htm> 7 Ibid. 8 URL: www.medlineplus.gov. MedlinePlus allows consumers to conduct free searches for up-to-date 

medical information, including extensive information about drugs, an illustrated medical encyclopedia, 

interactive patient tutorials, and the latest health news. MedlinePlus also provides access to medical 

journal articles. 

Avoid the Redundancy and

Possible Error of Retelling

Medical History

Nearly everyone has had the 

experience of going to a new 

doctor or hospital and having to 

fill out a huge pile of forms. Those 

forms usually include a request 

for medical history, something 

most people will have given to 

other healthcare providers several 

times before. When recounting 

that history, there is always the 

risk of forgetting something. 

People with many health 

problems cannot be expected to 

remember all the details of their 

treatment. 

Even the healthiest person can 

have a lengthy record, and 

the dates and details can be 

impossible to remember. In an 

emergency, a reliable recounting 

is even less likely and even more 

critical. For patients with chronic 

conditions, retelling a medical 

history is often quite emotional 

and painful and omissions can 

be deadly. 

An interoperable healthcare 

system will eliminate the need 

for retelling medical history by 

making that history available to 

every provider authorized by the 

patient and by allowing doctors 

and others to add to the history as 

treatment progresses. The system 

will minimize and ultimately 

eliminate the need to transmit 

medical records by phone, fax, 

courier, or mail. 

Consumers
52

A connected system makes it easier for parents to obtain copies of vaccination and 

other medical records for camp and school. It eases the task of caring for aging 

parents. It also provides a way for patients to get the information they need to 

ease their own health concerns. 

Millions of Adults Monitor Healthcare of a Loved One from a Distance

According to a survey conducted by the Family Caregiver Alliance,

9 over seven million Americans 

are managing care for a loved one over age 55 who lives at least an hour away. Caring for an 

aging parent is hard enough, and distance only increases the difficulty. 

According to the same survey, the average long-distance caregiver lives 450 miles away from the 

loved one he or she is caring for. Those polled reported spending an average of $392 a month for 

out-of-pocket expenses and travel, not counting missed job time and income. 

On-line Support: One Patient’s Experience

In 2003, Pat McGinley of Cleveland, Ohio, registered for an on-line program created to help patients monitor their health. She signed 

up at the request of her physician, but it never crossed her mind that she would actually use it. “I am not a real techie person,” she 

said. “I did it to appease my doctor.” A few weeks later, following routine blood work, the doctor’s nurse called to inform her that she 

had both high cholesterol and high triglyceride levels. Pat was upset at the news and resigned herself to living with her worries and 

unanswered questions until the follow-up visit in two weeks. 

Then something happened that Pat did not expect: She received an e-mail telling her that she should log on to her on-line healthcare 

program to review new information. She went from being worried to being relieved when the program directed her to comprehensive, easy-to-understand information about her test results and likely condition. She could compare her results with normal levels 

and click on embedded links for additional material. Pat began to feel more at ease, and at her next appointment she was prepared 

with important, informed questions for her doctor about her health and what she needed to change. 

The system “really empowered me to think about what was going on. It made me feel like I was part of the decision-making process,” 

she told President Bush at a public event at the Cleveland Clinic in January 2005. 

With the help of an interoperable healthcare system, Pat and her doctor were able to work together to make critical lifestyle 

changes. As a patient, Pat understood her medical situation better than she ever had before, and she credits that to her access to 

private, personalized information delivered electronically. “I went from feeling helpless to feeling completely in control of the 

situation,” she said.

10 

9 Michael Hill. “Moving Creates Boom in Long Distance Care,” Washington Post. March 17, 2005. 10 White House Office of the Press Secretary. President Discusses Health Care InformationTechnology 

Benefits. Press release. January 27, 2005. 

<http://www.whitehouse.gov/news/releases/2005/01/20050127-7.html> 

Ending the Document Game Ending the Document Game 
53

Empowering Patients and Improving Care 

“Health IT can enable transformation of healthcare by allowing a better way 

to care—consumer by consumer, physician by physician, disease by disease, and 

region by region.” 

David Brailer, M.D., Ph.D., National Coordinator for Health Information Technology

Continuity of care

With accessible personal health information, each new caregiver a patient sees 

can have access to that patient’s history as the patient sees fit. Doctors no 

longer have to worry that the medications and the course of treatment they 

prescribe may be in conflict with those prescribed by other providers. In short, 

an interoperable system of electronic health information allows not only doctors 

but also hospitals, pharmacies, insurance providers, labs, diagnostic centers, nursing 

facilities, assisted living centers, and hospices to see the big picture—to know and 

understand the courses of treatment in progress, the intentions and goals of other 

healthcare providers, and the details and general trends of a patient’s health and 

courses of treatment. 

In addition to helping patients who see multiple doctors, the system will help 

ensure continuity of care for people who have moved from one place to another, 

an important benefit in a mobile society. How frequently does this issue come 

up for people? A study by the Commonwealth Fund, a private foundation 

supporting research on medically underserved communities, shows that nearly 

two-thirds of adults change doctors at least once every five years.11 

Fewer errors and less wasted time

Since patients can give any provider access to their medical records any time, 

anywhere, they will no longer have to recount their medical histories every time 

they see a new doctor. That means that everyone saves time and there is no risk of 

forgetting a critical detail of treatment or condition. 

11 Harris Interactive. 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences 

with Primary Care, Commonwealth Fund. 2004 

<http://www.cmwf.org/surveys/surveys_show.htm?doc_id=245240> 

An Increasingly Mobile Society

Americans are refusing to stay 

put and today’s technology 

reflects that more and more. 

People travel greater distances 

frequently, whether for business 

or pleasure. 

Visiting family, moving around 

the country to find work, traveling 

on business... all of these realities 

create huge demand for new 

technologies and devices to 

accommodate busy lives and 

constant motion. Personal digital 

assistants, cell phones, laptop 

computers, wireless Internet 

access, portable DVD and MP3 

players, and Global Positioning 

Systems are just some of the 

gadgets that are available to the 

average consumer. 

Amazingly, though, our cars 

benefit from more connectivity 

than our bodies do. If your car 

breaks down, you can take it to 

almost any dealership service 

department where the mechanic 

can access a history of the work 

that has been performed on that 

car and make an appropriate 

decision on what to do next. 

Healthcare should be no 

different. In today’s economy 

and travel culture, even 

healthcare professionals are 

more mobile than they were just 

a few decades ago. Healthcare 

information should be mobile 

and available wherever patients 

and professionals happen to be. 

Your health information should be 

designed to travel with you, not 

limit your travel. 

Consumers
54

“All of a sudden, the more 

educated you become, the more 

comfortable you become, not 

only about figuring out what’s 

wrong, but, more importantly, 

figuring out how to cure the 

problem.

”

President George W. Bush 

(on patient-accessible electronic 

medical records) 

Both doctors and patients are better informed

Healthcare providers will also be able to monitor compliance to find out if 

patients are getting their prescriptions filled, following up with referred physicians, 

and getting tests as ordered. Patients will be able to access the details of their 

treatment on the network and read as much or as little about their condition 

as they like. When health information is made available by doctors for patient 

review, the patients will be more informed, better prepared to ask questions, and 

better able to find peace of mind. 

Better management of chronic conditions

Diabetes and other chronic conditions require frequent monitoring. Seven out 

of every 10 deaths in the United States each year are attributed to chronic diseases 

such as cancer, arthritis, muscular dystrophy, diabetes, and cardiovascular disease.

12 

These often are prolonged illnesses that decrease quality of life and cause critical 

physical limitations, and they affect 90 million Americans.13 When patients follow 

the treatments doctors prescribe and make lifestyle changes, such as getting more 

exercise, they can better manage chronic diseases. 

Communication between doctors and patients can improve the management 

of chronic diseases, because patients will have a better understanding of their 

condition, how to manage pain, and how to deal with personal limitations. 

Chronic diseases often manifest themselves in ways that appear minor but are 

in fact significant indicators of serious problems. With better communication, 

patients can learn to recognize these symptoms so they can properly manage 

their healthcare. 

Electronic prescribing (e-prescribing)

With an electronic healthcare system in place, doctors’ prescriptions will instantly 

be sent to a pharmacy for patients to pick up. The prescription will be signed 

with an electronic signature that is readable at the pharmacy, so the notoriously 

illegible handwriting of doctors will no longer be an issue. There will be no paper 

12 National Center for Chronic Disease Prevention and Health Promotion. <http://www.cdc.gov/nccdphp/> 13 Ibid. 

Ending the Document Game Ending the Document Game 
55

prescriptions to lose or to drop off at the pharmacy, so patients will save time, trips 

to the doctor, and phone calls. E-prescribing systems will be able to check for 

harmful drug interactions as the doctor writes the prescription, long before the 

patient picks it up at the pharmacy. 

Improved care for expectant mothers and their unborn babies

Obstetrics is an ideal place to introduce patients to connected healthcare 

information. On average, a pregnant patient will visit her provider’s office 14 

times during the pregnancy,

14 more than any other time in her life. Since prenatal 

exams may occur at many different locations, and different practitioners in a group 

may examine the same patient, interoperable records promote continuity of 

prenatal care. Expectant mothers may go into labor at unexpected times or places; 

accessible health information ensures that the mother’s history is always available, 

wherever and whenever the delivery takes place. 

Makes personalized care possible as future medical 

advances warrant

Medical advances such as DNA research might reveal that medicines will have 

different effects on people depending on their genetic makeup. Today a doctor 

may adjust a dosage on the basis of a patient’s weight. In the future, a doctor will 

be able to order medications with specific characteristics, probably down to the 

molecular level, depending on the genetic makeup of a patient. 

To take full advantage of these precise, customized medications, physicians will 

need access to voluminous and complex genetic information about a patient. 

These details will not be as simple as dates of treatment and names of conditions; 

that is, they cannot be memorized or easily carried around. These details will be 

stored in secure computer data files. For patients to benefit from new medicines, 

authorized healthcare providers will need to be able to review personal health 

information through an interoperable healthcare system. 

14 Donald Miller. “Prenatal Care: A Strategic First StepToward EMR Acceptance.” Journal of Healthcare 

Information Management 17, no. 2 (2003): 47–50. 

Consumers
56

Common ElectronicTransactions

ATMs. 371,000 ATMs processed 

10.8 billion transactions in 2003 in 

the United States. That is about 80 

transactions a day or about 29,000 

each year per ATM.

15 

Buying movie tickets on-line.

Nearly one in four moviegoers has 

purchased tickets on-line.

16 

Travel. 39 million people booked 

travel on-line in 2002, an increase of 

25 percent over 2001.

17 

Banking. The 29.6 million U.S. 

households banking on-line in 2003 

is forecast to increase to 56 million 

by 2008.

18 

Income taxes. Over half of all 

income tax forms in the 2005 tax 

season were filed on-line.

19 

Confidentiality, Privacy, and Security 

“We want to know that the record is secure and that it remains confidential. 

But information technology actually works perfectly to document that. If you 

left a medical record on paper in a room, how will you know who saw it? You 

can’t know. When it’s in electronic form, when anyone logs on to the system, 

we know. We know who they are, we know where they are, we know what they 

were looking at, and we can keep logs of all that information so that we can 

confirm for our patients that their information is secure.” 

Dr. C. Martin Harris, Cleveland Clinic

The power of technology to create trust

When it comes to using technology—actually making it a part of day-to-day 

life—attitudes have changed dramatically in a short period of time. Not so long 

ago, many people were intimidated by and distrustful of computers, but now most 

people welcome them and wonder how life went on without them: 

• Most people enjoy 24/7 access to cash through ATMs; 

• Fewer checks are used because of debit and credit card readers in stores; 

• Computers in your car tell you when you are due for maintenance, how 

much gas is left in the tank, how many miles you have traveled and how many 

you have to go, and even the temperature outside. Global Positioning Systems 

tell you exactly where you are, and how to get where you are going; 

15 Miller, Donald. “Prenatal Care: A Strategic First StepToward EMR Acceptance.” Journal of Healthcare 

Information Management 17.2 (2003): 47-50. 16 “This Summer’s Blockbuster Hit: The Internet.” FreelanceWriting. July 2004. 

<http://www.freelancewriting.com/survey-072004-01.html> 17 Mintel International Group Ltd. “InternetTravel: Abstract.” September 1, 2003. 

<http://www.marketresearch.com/product/print/default.asp?g=1&productid=931785> 18 Kim Komando. Online Banking’s Best Lure: Online Bill Paying. Microsoft: Small Business Center. 2005. 

<http://www.microsoft.com/smallbusiness/resources/technology/business_software/online_bankings_ 

best_lure_online_bill_paying.mspx> 19 Internal Revenue Service. 2005Tax Filing Season Sets Records. July 2005. 

<http://www.irs.gov/newsroom/article/0,,id=138112,00.html> 

Ending the Document Game Ending the Document Game 
57

• Cell phones are small, specialized computers. You can make calls wherever 

you are, and you are not limited by wires and cords. Some cell phones 

compete with desktop computers in their ability to accommodate e-mail, 

Internet access, word processing, and even photographs and video. 

Why Americans (and the world) have so readily 

adopted technology

Your most personal and important information is entrusted to secure electronic 

systems. That security is one key to quick and widespread acceptance of 

connected healthcare systems. 

It was not just convenience and fun that earned technology mainstream 

acceptance. A critical concern was first addressed: Would personal information 

such as tax returns and bank accounts be kept private? Had technology been 

introduced to the U.S. culture through government efforts, legislators could have 

simply mandated the use of interoperable systems, then improved the system after 

they were in place. 

But private investors in technology could take no such risks. Privacy and security 

issues had to be anticipated and resolved by the businesses creating the systems. 

The public had to accept a system’s security, then make their opinion known by 

using the system—or by turning it into a very expensive white elephant. 

For the ATM network, on-line banking, bill paying, and e-commerce to succeed, 

the system had to thoroughly protect privacy. And the public had to believe— 

correctly—that the system was reliable as advertised. This confidence in 

technology was acquired incrementally. The benefits were great enough for 

Americans to assume a relatively minor risk. 

“Information technology 

has radically changed business 

and so many other aspects of 

American life. It is time we use 

the power of the information 

age to improve health care. 

If we do, we can dramatically 

improve the quality of care, 

safety, efficiency and patient 

control over their health care 

decisions.

”

Statement by Senate Majority 

Leader Bill Frist and 

Senator Hillary Rodham Clinton 

Consumers
58

TrustingTechnology at the

Gas Pump

How often do you take a receipt 

after filling up your gas tank and 

paying with a card? When you do 

take the receipt, do you usually 

throw it away after looking at 

it? When the bill comes at the 

end of the month, do you just 

assume it is correct, or do you go 

through a stack of paper receipts 

to reconcile it? 

Most people discard the receipt 

if they take a look at it at all, 

and when the bill comes in they 

glance at the total to make sure 

the bill is in the normal price 

range. 

This example of trusting 

technology to consistently 

get important details right is a 

good indicator that people will 

eventually trust technology with 

other critical information—such as 

personal healthcare records. 

People are growing more comfortable with using technology 

for healthcare

Trust in technology’s ability to protect privacy is beginning to spread to its use for 

medical information: 

• Eight in 10 Internet users—about 95 million Americans over the age of 18— 

have looked on-line for health information.20 They are especially interested 

in diet, fitness, drugs, health insurance, experimental treatments, and particular 

information about doctors and hospitals.21 

• Fifty-nine percent of women who go on-line have read up on nutrition.22 

• Thirty-eight percent of parents on-line have checked for health insurance 

information.23 

• Forty-one percent of Internet users with broadband connection at home have 

looked up a doctor or hospital.24 

This is an encouraging start, but the level of American confidence needs to be 

much higher for an interoperable healthcare system to be accepted. Over 70 

percent of people want to see technology used to improve the quality of 

healthcare, but nearly as many (67 percent) are concerned about privacy.

25 

20 Susannah Fox. “Eight inTen Internet Users Have Looked for Health Information Online, with Increased 

Interest in Diet, Fitness, Drugs, Health Insurance, ExperimentalTreatments, and Particular Doctors and 

Hospitals.” Health Information Online. May 17, 2005. 

<www.pewinternet.org/PPF/r/95/report_display.asp> 21 Ibid. 22 Pew Internet. More Internet Users Do ‘Health Homework’ Online. Press release. May 17, 2005. 

<http://www.pewinternet.org/press_release.asp?r=106> 23 Susannah Fox. “Eight inTen Internet Users Have Looked for Health Information Online, with Increased 

Interest in Diet, Fitness, Drugs, Health Insurance, ExperimentalTreatments, and Particular Doctors and 

Hospitals.” Health Information Online. May 17, 2005. 

<http://www.pewinternet.org/PPF/r/95/report_display.asp> 24 Ibid. 25 Harris Interactive. “Many Nationwide Believe in the Potential Benefits of Electronic Medical Records and 

Are Interested in Online Communications with Physicians.” August 2005. 

<http://www.harrisinteractive.com/news/allnewsbydate.asp?NewsID=895> 

Ending the Document Game Ending the Document Game 
59

The good news: Prevention and confidentiality are 

attainable goals

No system can be perfect, but you can expect much higher quality outcomes 

from an electronic healthcare system than you receive from the current paperbased system. After all, most electronic information systems perform flawlessly 

every day. If they didn’t, bank accounts would be wrecked and bills would be 

inaccurate every month. 

That is not to pretend there are no problems in the world of electronic data 

exchange. But those problems are the exception, not the rule. For every incident 

of lost data, billions of transactions occur without incident every day. Still, recent 

events involving data loss deserve consideration. The following information was 

published by the Wall Street Journal in May 2005:27 

In February 2005, consumer-data compiler ChoicePoint announced the 

theft of data on about 145,000 consumers. Within two weeks of that 

incident, Bank of America announced the loss of up to 1.2 million credit 

card numbers belonging to the Federal government. In March, retailer 

DSW Shoe Warehouse announced the discovery of theft of data potentially affecting over a million people. In June, CardSystems Solutions Inc., 

a payment processing company, was infiltrated by hackers, exposing more 

than 40 million credit card and debit card accounts to potential fraud. 

Similar events followed at Lexis-Nexis, Boston College, Polo Ralph 

Lauren,Ameritrade, and Time-Warner. 

In some cases, fraud against consumers was discovered quickly. In other cases, 

customers were advised to closely check their credit card statements for several 

months to make certain fraudulent charges did not appear. In a few cases, the 

problem was not data theft but the loss of backup data media, such as reels of 

computer tape during shipping; this would have led to fraud only if the tapes 

had been found, identified, and translated. 

The LivingWill Registry:

An Application of Electronic

Connections in Healthcare

More and more Americans are 

writing “living wills”—instructions 

for medical care in the event that 

they become too incapacitated to 

communicate with their doctors. 

It’s a good idea, but the problem 

with a living will is that healthcare 

providers do not always know 

that their patient has one. 

That is why, in 1996, Joseph 

Barmakian, MD, created the U.S. 

Living Will Registry.

26 The registry 

is a way to provide instant access 

to physicians nationwide for 

patients who maintain a living 

will. In fact, healthcare providers 

are required by Federal law to 

check for a patient’s advance 

directive and place a copy of 

the will in the patient’s medical 

record. Access to the registry 

is password-protected, and a 

patient’s information is shared 

with no one other than his or her 

healthcare provider. This service 

is provided free to the public. 

26 United States Living Will Registry. “Living Will—Health Care Proxy.” July 2005. 

<http://www.uslivingwillregistry.com/info-english.shtm> 27 E. Perez and R. Brooks. “File Sharing: For BigVendor of Personal Data, ATheft Lays Bare the Downside.” 

Wall Street Journal. May 3, 2005. 

Consumers
60

The Limits of Security:

An Important Note

While a system of interoperable health information can be 

designed to carefully monitor the 

access and use of information, it’s 

not possible to ensure that there 

are absolutely no “prying eyes.” 

The limits of safeguards will be 

determined primarily by the state 

of technology. Today, unauthorized use is minimized by log-ins 

and passwords for authentication 

that limit access to medical information. In time, the system will 

be strengthened with biometrics. 

Improvements will also be made 

in encrypting data during storage 

and transfer. But even the most 

basic system of connected health 

information will provide more 

consistent security and improved 

tracking of access than any paper 

system can. 

While all data loss is potentially serious, these events are notable for their real-life 

impact relative to the number of records lost or stolen: 

• At ChoicePoint, only 750 cases of fraud appeared out of the records of 

145,000 consumers—about one-half of one percent.

• At Lexis-Nexis, only 59 incidents have been reported out of stolen 

information on 310,000 consumers—0.019 percent, or less than 

two-hundredths of one percent.

The organizational responses to these incidents are promising. In each case, 

the organization modified the way it handled consumer information to improve 

the systems of protection: 

• Bank of America is moving away from backup tapes to computer-tocomputer data transfers. In instances where backup tapes cannot be 

eliminated, encryption is being considered.

• Since the thieves posed as legitimate customers, ChoicePoint no longer 

sells sensitive personal data to clients outside government and accredited 

corporate entities.

• Lexis-Nexis reduced access to personal data.28 

All the companies worked with Federal authorities to find the culprits and to 

improve procedures for security. 

Public confidence in these companies has remained strong, as measured by the 

value of the companies’ stock and their sales. While stock prices for some of the 

companies took an immediate dip when the breaches were publicized, almost 

every firm has rebounded. Polo Ralph Lauren’s stock price dropped 55 cents 

(1.4 percent) the day it confirmed data theft;29 however, quotes bounced back to 

near 52-week highs in late June. DSW Shoe Warehouse’s sales actually saw a 

considerable increase; revenues grew more than 60 million dollars (not adjusted 

for inflation) for the first five months of 2005 compared with 2004.30 Other 

28 Lucas Mearian. “Data Snafus Spur IT Action: Bank Mishap Prompts Call for Network Backup.” 

COMPUTERWORLD. March 7, 2005. <http://www.computerworld.com/?source=nav_tab> 29 Associated Press. “Update 5: Polo Ralph Lauren Customers’ Data Stolen.” Forbes. June 2005. 

<http://www.forbes.com/business/feeds/ap/2005/04/14/ap1947570.html> 30 J. McGrady. “May Sales Report.” Retail Ventures (June 2005). 

<http://www.retailventuresinc.com/index.jsp> 

Ending the Document Game Ending the Document Game 
61

companies, such as Time-Warner and Bank of America, showed no significant 

fluctuation in stock prices. 

If consumer confidence was shaken, that confidence seemed to return quickly. 

Individuals want access to and control of their own records

Dr.Alan Westin is a retired professor at Columbia University and a widely 

recognized advocate for privacy rights. He has examined the task of winning 

public support for a system of electronic health records. 

Dr.Westin conducted a survey to see if people believe that the expected 

benefits of a system—whatever they think those benefits might be—outweigh 

the potential risks to privacy.

31 In his survey, Dr.Westin asked whether consumers 

think it is important to be able to track their own information and “exercise 

privacy rights.” The result was no surprise: More than 80 percent of the 

respondents rated availability of their medical records as important.32 

As a connected electronic healthcare system is integrated into the practice of 

healthcare, the system must be transparent—each element of an interoperable 

system must be fully known to the public, its function clearly understood, and 

its mechanisms available for inspection. Explanations to the public must use 

straightforward language to create confidence and must acknowledge—not 

dismiss—doubt. In particular, the system should allow individuals: 

• To access personal clinical data; 

• To make additions to the record; and 

• To review the audit trail of who accessed the records, what was viewed,

when, and for how long.

31 Alan Westin. How the Public Views Health Privacy: Survey Findings from 1978 to 2005. PrivacyExchange. 

February 23,2005. <http://privacyexchange.org/> 32 Ibid. 

Consumers
62

There is no more direct way for people to check the accuracy of their records 

than to simply review the information themselves. 

At the launch of the interoperable healthcare system, any particular piece of 

information will almost certainly be maintained at its source (e.g., lab reports 

at the lab or at the office of the requesting physician, treatment records at the 

doctor’s office, hospital records at the hospital). This may change as new 

technologies emerge and are implemented, but security, confidentiality, and 

transparency to patients must remain top priorities in deciding how and where 

data are stored. 

Confidentiality: The core of the doctor-patient relationship

The core of healthcare is the relationship between the patient and the provider. 

That relationship is built on trust—not an abstract notion of confidentiality 

or security, but a personal belief that what a patient tells a doctor or nurse 

remains confidential. 

In a healthcare relationship, individuals disclose highly confidential—sometimes 

embarrassing and definitely private—information about themselves, information 

they may not tell anyone else. 

Doctors need to know this information to better understand a patient’s problem 

and to better prescribe treatment. There is no other way to deliver the right care. 

Technology cannot be allowed to disrupt this relationship. Rather, technology 

must fit seamlessly into the existing “psychology of trust” found in the healthcare 

world. The trust a patient holds in a healthcare provider helps build trust in 

new elements added to the healthcare system, leading to an attitude of, “If my 

doctor trusts this new system, then I do, too.” Doctors will need concrete facts 

to tell their patients about the security and privacy of the system. Companies 

that provide systems will need to support physicians and hospitals in efforts to 

educate patients. 

Ending the Document Game Ending the Document Game 
63

Health Issues for Individual Communities 

“Information technology holds the promise of reducing healthcare disparities for 

those living in rural communities. We can measure our success in building an IT 

infrastructure by the provision of quality of care in these communities challenged 

by long distances and scarce medical resources.” 

Senator Chuck Grassley

Access for everyone, including the poor and indigent

The need for healthcare is universal and critical, and a system of accessible and 

accurate interoperable records can extend benefits to everyone. It would not 

merely equalize healthcare opportunities; it could raise the quality of healthcare 

for everyone. This is especially important for the indigent and the working poor 

populations, who often have the most challenging healthcare issues and the least 

continuity of care. 

Better care in community health centers

Thirty-six million Americans lack access to a regular source of healthcare—that 

is nearly one out of every eight people.

34 Twenty-six percent of all health center 

visits are for chronic diseases, including asthma, diabetes, hypertension, HIV/AIDS, 

mental health issues, and substance abuse.

35 These centers serve: 

• One in eight uninsured Americans; 

• One in five low-income uninsured Americans; 

• One in nine Medicaid beneficiaries; 

• One in seven members of minority groups; 

Connecting MigrantWorkers

The health problems of migrant 

workers are often compounded 

by constant travel, along with 

language and cultural barriers. 

But a new system in Sonoma 

County, California, is changing 

that. This interoperable healthcare 

network allows migrant workers 

and their families to enroll in 

a program that stores their 

health history, conditions, and 

treatments as an electronic 

health record. The records can be 

accessed by healthcare providers 

from clinics anywhere in the 

United States and Mexico.

33 

33 “Internet Medical Records for Migrant Workers.” Local Frontiers–Sonoma Medicine 55, no. 2 (Spring 

2004). <http://www.vwsvia.org/> 34 National Association of Community Health Centers. A Nation’s Health at Risk. 2004. 35 Ibid. 

Consumers
64

• One in ten Americans living in rural areas; and 

• One in five low-income children.36 

The following are among the benefits of an interoperable system to individuals 

who rely on these centers: 

• Preventing abuse by checking all medications taken and supplying only 

appropriate medications;

• Providing accurate records of immunizations for children; and 

• Preventing chronic disease with more effective primary care for patients 

through monitoring of conditions and adherence to treatment.37

Issues in rural areas

Four-fifths of the United States is rural,38 and in 29 states at least one-third of the 

population is classified as rural. Rural residents face serious healthcare issues not 

only in terms of illness but also in terms of lack of easily accessible services. 

For instance: 

• One in five Americans live in rural areas but only one in 10 physicians 

practice in rural areas;39

• Forty percent of the rural population lives in a medically underserved area;40 

• Fire departments are the primary provider of medical services in rural areas;41 

36 Ibid. 37 Ibid. 38 For practical purposes, “rural” can be considered areas of relatively low population outside cities and 

suburbs. “Urban” can be considered the cities and suburbs themselves. For purposes of analyzing 

statistics, consider the U.S. Census Bureau definitions: “urban” is “[a]ll territory, population and housing 

units in urban areas, which include urbanized areas and urban clusters. An urban area generally consists 

of a large central place and adjacent densely settled census blocks that together have a total population 

of at least 2,500 for urban clusters, or at least 50,000 for urbanized areas. Urban classification cuts 

across other hierarchies and can be in metropolitan or non-metropolitan areas.” “Rural” is “[t]erritory, 

population and housing units not classified as urban ... and can be in metropolitan or non-metropolitan 

areas.” Source: U.S. Census Bureau. “Urban and Rural Definitions.” October 1995. 39 Gary Erisman. “Rural Emergency Response–The Safety and Health Safety Net.” National Ag Safety 

Database. 2001. <http://www.cdc.gov/nasd/docs/d001701-d001800/d001781/d001781.pdf > 40 Ibid. 41 Bruce Evans. “Rural Health Care’s Missing Link.” Fire Chief. June 2002. 

Ending the Document Game Ending the Document Game 
65

• For motor vehicle accidents, the average response time of emergency medical 

services in rural areas is 18 minutes.42 This is eight minutes longer than the 

response time in urban areas.43 (The average response time from the point 

of injury to the arrival of medical assistance for transport during theVietnam 

War was eight to 10 minutes);44 

• Compared with patients in urban areas, patients in rural areas tend to be older, 

have higher rates of chronic illness, and exhibit poorer health behaviors such 

as smoking and obesity;45 and 

• Rural residents often have to travel great distances to reach medical care.

46 

With access to care an average of 30 miles away,

47 rural areas have much to gain 

from the ability to access healthcare information at a distance. In an emergency, 

interaction with a doctor may be limited to phone advice. For routine care, 

increased communication with healthcare providers will increase patients’ quality 

of life because they can better follow treatment guidelines and more easily receive 

feedback from healthcare providers. This is especially valuable for the many rural 

areas that offer few preventive services. 

The American Indian and Alaskan Native populations most often live in rural 

areas, and their healthcare problems mirror many of those of the rural population. 

Like the rural population, these individuals tend to have more serious and more 

frequent health problems than the general population, and they enjoy less access to 

the healthcare system. As a result, they tend to use health services less often than 

other groups. 

42 National Rural Health Association. What’s Different About Rural Health Care? July 2005. 

<http://www.nrharural.org/about/sub/different.html> 43 Ibid. 44 Gary Erisman. “Rural Emergency Response—The Safety and Health Safety Net.” National Ag Safety 

Database. 2001. <http://www.cdc.gov/nasd/docs/d001701-d001800/d001781/d001781.pdf > 45 American Society of Health-System Pharmacists. “IOM Sets Strategy for Improving Rural Health Care 

Quality.” December 15, 2004. <http://www.ashp.org/news/showArticle.cfm?cfid=19987294&CFToken=934 

16380&&id=8935> 46 National Rural Health Association. “What’s Different About Rural Health Care?” July 2005. 

<http://www.nrharural.org/about/sub/different.html> 47 Bruce Evans. “Rural Health Care’s Missing Link.” Fire Chief. June 2002. 

Consumers
66

“You won’t find a solution by 

saying there is no problem.

”

William Rotsler,

Author (1926 – 1997) 

An Institute of Medicine committee has recommended that the government 

develop a strategy for transitioning rural health clinics (along with community 

health centers, critical access hospitals, and other rural providers) from paper to 

electronic health records.48 

Tracking disease and nationwide medical concerns

A connected system of healthcare would allow the U.S. government to monitor 

health concerns such as vaccination rates, disease outbreaks, and disease trends 

nationwide. This kind of bio-surveillance would mean that West Nile virus, avian 

influenza, environmental health concerns, disease outbreaks from flooding due to 

hurricanes, such as Hurricane Katrina, and numerous other issues could be better 

targeted and monitored, allowing containment efforts to be established with more 

precision and efficiency. 

Military

The U.S. military service branches do not have an efficient way to transmit 

medical information in critical, time-sensitive situations. For soldiers extracted 

from the battlefield, injury notes, medical history, test results, and surgical history 

are not always communicated from one doctor to the next. This forces servicemen to undergo duplicate tests and surgeries, and to settle for less than the most 

efficient treatment. 

Veterans

The U. S. Department of Veterans Affairs (VA) currently provides medical care 

for over five million veterans.49 TheVA maintains electronic copies of all patient 

information—including information from doctor’s appointments, medications, 

and laboratory and imaging data—constituting a closed interoperable network 

of healthcare information for this specific population. Any of this information 

can be stored and transmitted among doctors within theVA medical system. 

The success of this system suggests that a nationwide system of connected 

health information is possible. 

48 American Society of Health-System Pharmacists. “IOM Sets Strategy for Improving Rural Health Care 

Quality.” December 15, 2004. <http://www.ashp.org/news/showArticle.cfm?cfid=19987294&CFToken=93 

416380&&id=8935> 49 United States Department of Veterans Affairs. Facts About the Department of Veterans Affairs. June 

2005. <http://www1.va.gov/opa/fact/vafacts.html > 

Ending the Document Game Ending the Document Game 
67

Reducing Medical Errors While Saving 

Patients’Time and Money 

“Today in America, thousands of patients are having unnecessary tests, 

undergoing surgeries they do not need, and taking harmful drugs due to our 

paper-based health care system, and the consequences are deadly and costly. 

Because of this, sadly, hundreds of patients will die today and thousands more 

will be put at risk. And all of this can be prevented. Simply put, paper kills.” 

Congressman Tim Murphy

The bottom line

Medical errors are killing more people each year than breast cancer,AIDS, or 

motor vehicle accidents.50 

The scope of the problem: by the numbers

• One of every seven primary care visits is affected by missing medical 

information, leading to duplication of, or delays in, care and testing,

along with unnecessary costs to the patient.51

• According to the Center for Information Technology Leadership, 

approximately one-fifth of medical errors are due to inadequate availability 

of patient information.52 

• In an article published in the July/August 2004 issue of Annals of Family 

Medicine,

53 medical errors were studied as a chain of events rather than 

isolated incidents. Two-thirds of all errors in treatment and diagnosis were 

found to begin with errors in communication. These included missed 

communication among physicians, misinformation in medical records, 

mishandling of patient requests and messages, inaccessible records, mislabeled 

specimens, misfiled or missing charts, and inadequate reminder systems. 

50 Institute of Medicine, Centers for Disease Control and Prevention; National Center for Health Statistics: 

Preliminary Data for 1998 and 1999. 2000. 51 Peter Smith. “Missing Clinical Information During Primary Care Visits,” Journal of the American Medical 

Association. 2005. 52 GlobalTechnology Centre. Reactive to Adaptive:Transforming Hospitals with DigitalTechnology. 2005. 53 Woolf, Steven H. A String of Mistakes:The Importance of Cascade Analysis in Describing, Counting, and 

Preventing Medical Errors. Annals of Family Medicine 2:317-326 (2004). 

<http://annalsfm.highwire.org/cgi/content/abstract/2/4/317> 

Consumers
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68

• According to a survey by Research America, 41 percent of Americans have 

been or know someone who has been the victim of a medical error.

54 

• According to the Institute of Medicine, over a half million people are injured 

each year because of adverse drug events, many of which could be avoided 

if healthcare providers had complete information about which drugs their 

patients were taking and why.

55 

Relative risk of healthcare

Of activities seen as potentially risky, travel by rail in Europe and commercial 

air travel are actually among the safest activities, with fewer than one in 100,000 

fatalities per personal encounter or trip. Driving is far more dangerous: about 

42,000 people die each year in automobile accidents. It is no surprise that, 

statistically, mountain climbing and bungee jumping are among the most 

dangerous activities. But the biggest surprise of all is there are more deaths 

per encounter with the healthcare system than for any of these other activities.56 

How Hazardous is Healthcare?

Source: Agency for Healthcare Research and Quality (AHRQ) 

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54 Wooley, Mary. Research for Health:The Power of Advocacy. January 14 2005. Research!America. 

PowerPoint. January 14, 2005. <http://www.nlm.nih.gov/csi/research_america_011405.pdf 55 Agency for Healthcare Research and Quality. “Reducing and Preventing Adverse Drug Events to 

Decrease Hospital Costs.” Research in Action: Issue 1. March 2001. 56 ScottYoung. The Role of Health IT in Reducing Medical Errors and Improving Healthcare Quality & 

Patient Safety. PowerPoint. Agency for Healthcare Research and Quality. August 2005. Ending the Document Game Ending the Document Game <http://www.ehealthinitiative.org/assets/documents/Capitol_Hill_Briefings/Young9-22-04.PPT> 
69

The financial costs

Total national costs (lost income, lost household production, disability, and 

healthcare costs) of preventable adverse events (medical errors resulting in injury) 

are estimated to be between $17 billion and $29 billion, of which healthcare costs 

represent over one-half.

57 According to a Markle Foundation report, the U.S. 

healthcare system spends $30 billion to as much as $293 billion annually on 

unnecessary paperwork.58 

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Financial advantages for patients

Because 90 percent of the financial benefits from health information technology 

goes to payers and purchasers,59 financial benefits to consumers will be indirect. 

In particular, patients will spend less time at the doctor’s office and miss fewer days 

at work while enjoying increased quality of care. 

57 L. Kohn, J. Corrigan, and M. Donaldson. To Err Is Human: Building a Safer Health System. Committee of 

Health Care in America, Institute of Medicine. 2000. 58 MedStar eHealth Initiative,Verizon. “At aTipping Point:Transforming Medicine with Health Information 

Technology, A Guide for Consumers.” MedStar eHealth Initiative, Verizon. April 1, 2005. 

<http://ccbh.ehealthinitiative.org/communities/community.aspx?Section=100&Category= 

211&Document=621> 59 N. Menachemi and R. Brooks. Exploring the Return on Investment Associated with Health Information 

Technologies, p. 36. Florida State University College of Medicine. February 2005. 

Consumers
70

Families Feeling the Pinch

In 2003, 43 million people 

reported financial problems 

related to paying medical bills.

60 

Reducing Fraud and Abuse

In 2003, Florida Medicaid 

implemented a voluntary 

medication management 

and e-prescribing program 

for physicians caring for 

Medicaid patients. Since its 

implementation, this program 

has saved Florida taxpayers an 

average of $700 per doctor each 

month. But there has been more 

than financial benefits: there 

has been a four percent drop in 

significant drug interactions since 

the program began.

64 

Some savings can be realized by giving providers updated and cost-effective 

information during the prescribing process. One e-prescribing system now in 

use alerts doctors to the most cost-effective treatments for patients, including 

generic medications, less expensive alternatives to medications in the same 

therapeutic class, and more appropriate drug utilization.61 The Center for 

Information Technology Leadership says this type of technology, which supports 

the ordering of medications, would save Americans about $27 billion annually 

in medication spending.62 

Reduce duplication of tests

Medical tests can be painful, and sometimes they involve great risk. In addition, 

tests can cost a lot of time and expense: up to $500 billion is spent on unneeded 

or duplicative care, which is nearly a third of our annual healthcare spending.63 

But under a system of connected medical data, a doctor can avoid unnecessary 

tests by accessing a patient’s record to see if another doctor has already 

completed the test. 

Dramatically reduce drug interactions

Patients will benefit from an extra layer of protection against drugs being 

prescribed that, when taken together, have adverse effects. This extra protection 

will come from the personal health information that is provided to physicians, 

nurse practitioners, and others who prescribe medicine. Today, providers have no 

way of knowing what other healthcare providers have prescribed for a patient. 

60 U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and 

Evaluation. Effects of Health Care Spending on the U.S. Economy 2005. August 2005. 

<http://aspe.hhs.gov/health/costgrowth/report.pdf> 61 Cap Gemini Ernst &Young. TouchScript Medication Management System: Financial Impact Analysis on 

Pharmacy Risk Pools. October 2000. 62 Center for InformationTechnology Leadership. The Value of Computerized Provider Order Entry in 

Ambulatory Settings. March 2003. 63 Statement of Mike Leavitt, Secretary of Department of Health and Human Services, before the 

Committee on the Budget, United States Senate, July 20, 2005. 64 Florida State. Agency for Health Care Administration. Florida Medicaid Nominated for National Award. 

Press release, August 3, 2004. 

<http://www.fdhc.state.fl.us/Executive/Communications/Press_Releases/archive/2004/08_03_2004.shtml> 

Ending the Document Game Ending the Document Game 
____________________ 

71

Most people try to do what they can to stay well—exercise and make healthy 

choices. When you get sick, you go to the doctor. It’s an age-old formula. 

Healthcare providers do what they’re supposed to do, patients do what they’re 

supposed to do, and everyone hopes that the outcome will be favorable. 

But much more is possible. An interoperable system of healthcare information 

will allow you to expand the healthcare relationship—to transform yourself from 

patient to partner. You can be better informed consumers, better able to make 

healthy choices, and better able to find treatment that reflects all your needs based 

on complete information, not just the information a single provider might know 

at any given time. 

Opportunities and responsibilities usually appear together; they represent the 

partnership that drives progress. You as consumers must also become partners in 

improving your healthcare and creating needed change. 

“Without continual growth 

and progress, such words as 

improvement, achievement, and 

success have no meaning.

”

Benjamin Franklin,

Inventor and Statesman 

(1706 – 1790) 

Consumers
72 

Ending the Document Game Ending the Document Game 
73

The Healthcare Delivery System

Table of Contents 

74 Information Saves Lives

77 Benefits to the Healthcare Delivery System

77 Classes of benefits 

78 Quality of care 

82 Administrative efficiencies 

84 Patient communication 

85 Public health and security 

86 Adoption and Implementation

86 Overcoming cultural barriers by phasing in the system slowly 

87 Making healthcare providers a part of the effort 

88 Financial barriers 

88 Good news: much of the technology already exists 

89 Conversion 

89 Certification 

90 Standards: definition and parameters 

91 Why we need standards right now 

93 Federal preemption 

93 Legacy systems 

94 Other challenges of implementation 

95 Interoperability costs and benefits 

96 Confidentiality

96 Patient consent 

97 Security authorization devices 

97 Punishment for violations 

98 Patient authentication 

98 Individual access 

The Healthcare Delivery System
74 

Digitizing the 

Healthcare Delivery System 

“In a digital healthcare system, providers can have the information they need 

right at the point of care. Computer algorithms can catch mistakes and prompt 

to ensure consideration of latest scientific developments. Public health officials 

can be alerted nearly immediately of unusual patterns that might indicate a 

natural or bioterror infectious outbreak, or to catch the next Vioxx® before tens 

of thousands are put at risk. Researchers would have vast new databases to 

learn more about what works.” 

Congressman Patrick Kennedy

Information Saves Lives 

For patients of Dr. Evan Zahn, immediate access to personal medical records can 

mean the difference between life and death. That is why, in 1995, he and his 

colleagues decided to “go digital.” 

“We make decisions [based on images],” said Dr. Zahn, a pediatric cardiologist 

in Miami, Florida. “We realized that there was virtually no information-sharing 

among members of our discipline. We were still running, looking for lab slips, 

and if I wanted to see an x-ray I had to go find it in its envelope. The kids we 

deal with are for the most part critically ill—we deal with little babies with very 

bad heart disease—and we needed detailed information quicker than that. Often 

when people relay things verbally, the details are left out. We needed a free exchange of information.” 

Today, Dr. Zahn and his colleagues can instantly share digital images of their patients’ hearts and other medical data with other doctors around the state. They use 

the system before, after, and even during surgery. 

“When I want to know something about the inside of the heart that I can’t see, 

and the child’s on bypass, and time is critical, the computer is in the operating 

Ending the Document Game Ending the Document Game 
75

room and one of the technicians can just punch it up. We’ve even been working 

on voice recognition so that ultimately I won’t even need a technician. I’ll just be 

able to say,‘Angiogram on John Smith, show frame 16,’ and it will do just that.” 

The system works over any Internet connection. “I can actually put up my laptop 

tonight when I’m watching the game in my living room and pull up all the same 

information that I can at work,” he said. “I could sit at my computer and go on 

the Internet anywhere in the world, and I have a database and a log-in and a 

password. It’s encrypted, and it’s HIPAA [Health Insurance Portability and 

Accountability Act] compliant. I can go in and I can work with any of my 

patients. I get digital images of their operation; I can even view a 30-second 

delay of their monitor in the intensive care unit, looking at their heart rate, 

respiration, oxygen saturation, and a number of other things. 

“In the bad old days, which still goes on in most places, the doctor performing 

a procedure would call me—provided I wasn’t out of town or unavailable—and 

I would pick up the phone and try to describe what I saw. We wanted a system 

where we would have instantaneous access to that type of data. 

“Today I was doing a case, and I wanted one of my partners in Orlando, about 

250 miles away, to render a second opinion. I just told him to go to the monitor 

and look at the case I was doing—it was almost in real time—and review with me 

the images of this little boy so we could make an accurate decision about where 

to go. 

“You only get one chance at it to make this right, and if you do it wrong, it’s potentially fatal. If you do it right, you’re going to save this baby an open-heart surgery and all the complications from that. This child had a very unusual anatomy, 

and it didn’t look quite right. I wasn’t comfortable taking my chances performing 

the procedure based on the information I had—even though this is all I do, and 

I’ve done it a lot for a long time. 

“I wanted somebody else’s opinion, but the only person I trusted with something 

like this was 250 miles away. It was as simple as ringing him up on our speakerphone from the lab. He was in his lab in Orlando. We have desktop computers, 

and we share a common network. My images immediately were uploaded to the 

network, and all he had to do was click on the patient and look at a few frames, 

and he basically agreed with where I was going to put it. We put it in and the 

baby did great. 

The Healthcare Delivery System
76 

“But I don’t know that I would have proceeded with it without a second opinion. 

That’s one of about a million examples I can give you. We rely on this type of 

image-sharing and information-sharing all the time. We share data about the 

patients, and not just images. 

“I think it will go down as 

one of those things that we 

can’t believe we ever lived 

without.

”

“I can look at all those things, including digital images of their operation as it 

is occurring. For every kid that comes in here, I know exactly who he or she is, 

exactly what he or she had done, I have pictures of everything, and I can talk to 

their physician and make a logical decision about what needs to be done. They 

don’t have to rely on me being able to fax a piece of paper, or the parent’s 

recollection. They just go in and they look at the whole hospitalization, 

everything you can think of—labs, progress notes, admission notes, operative 

notes, catheterization pictures, echocardiogram pictures—everything you would 

want to take care of a child with heart disease. 

Dr. Evan Zahn,

Pediatric Cardiologist

“Take a child with complicated heart disease. I get called to the emergency room 

to evaluate them. All their heart surgery was done eight miles away at another 

institution, but I can’t get any information from them: nobody knows what I’m 

talking about; it’s 11 o’clock at night. Without the information, their heart is a 

black box to me. It’s a terrible way to treat patients. 

“I understand people’s fear of this, and the privacy issue. But I think we’ll look 

back on this period in 20 years and not be able to imagine it having been any 

other way. 

“The value that our society and individuals will get from the ability of having 

their medical information viewed at multiple sites by multiple healthcare providers 

who are trying to help them is going to so far, far outweigh any problems, that 

I think it will go down as one of those things that we can’t believe we ever 

lived without.”1 

1 Evan Zahn. Commission on Systemic Interoperability staff interview. July 2005. 

Ending the Document Game Ending the Document Game 
77

Benefits to the Healthcare Delivery System 

“We have the most advanced medical system in the world, yet patient safety is 

compromised every day due to medical errors, duplication, and other inefficiencies. 

Harnessing the potential of information technology will help reduce errors and 

improve quality in our health system.” 

Senator Hillary Rodham Clinton

Classes of benefits

The bottom line for healthcare providers is to improve the quality of care for 

patients. An interoperable system helps achieve that: it reduces time spent on 

administrative tasks, phone calls, and office business, and provides immediate access 

to more complete information about patients. That means: 

• More complete information available for treatment decisions; 

• New and more efficient options for patient interaction; 

• Enhanced ability to demonstrate performance consistent with regulations and 

recognized professional standards; 

• Potential for reduced operational costs and more effective use of resources; 

• Reduced or streamlined management responsibilities; 

• Less paperwork; 

• Automation of repetitive tasks; and 

• Better efficiency in dealing with other providers and outside parties. 

Benefits Appear at All Levels,

from Emergencies to Routine

OfficeVisits

The benefits of interoperability 

will appear everywhere— 

because secure access will be 

available from any location that 

has an Internet connection. 

This means electronic healthcare 

information will be available in 

ambulances, emergency rooms, 

doctors’ offices, hospital rooms, 

staff rooms, nurses’ stations, 

and clinics. 

The Healthcare Delivery System
78 

“In medicine, seconds can 

mean the difference between life 

and death. If you have a heart 

attack tonight and are rushed to 

the hospital, your life depends 

on timely access to accurate and 

current information.That’s why 

it makes no sense that today’s 

healthcare is not advancing in 

the Information Age; it’s stuck 

in the Stone Age.

”

Senate Majority Leader Bill Frist

In fact, benefits to healthcare providers fall into four categories: 

• Quality of care; 

• Administrative efficiencies; 

• Patient communication; and 

• Public health and security. 

Quality of care

• Enhanced doctor-to-doctor communication. With an interoperable 

system of healthcare, physicians can instantly share test results with other 

doctors, healthcare providers, labs, pharmacies, and clinics. The system will 

also allow doctors to highlight particular parts of the record and “point” or 

“link” that information to other parts of the patient record—in practice, any 

physician authorized by the patient will be able to look at a patient’s chart 

with another physician who is far away. This will naturally streamline the 

process of consultation and improve healthcare delivery. 

• Available in any geographic location. Physicians and other healthcare 

providers will be able to review the complete medical history of a patient, 

regardless of the location of either the patient or the provider. An individual 

on vacation on the West Coast who lives on the East Coast could go to any 

doctor and have their information available instantly. At each visit, healthcare 

providers add to the record, so no matter where and when the record is 

examined, it will be up-to-date. 

• Available in any treatment setting. Access to medical histories will be 

available in any treatment environment: in an emergency room, in an exam 

room, in locations around a hospital, in a doctor’s home or office, in public 

and private clinics—anywhere an Internet connection is available. 

Ending the Document Game Ending the Document Game 
79

• Improved emergency room support. Doctors in emergency rooms 

(ERs) often have to work without any patient history at all. Treating an ER 

patient with no records can be like trying to navigate a country road in the 

dark with no headlights. However, interoperable tools can be physicians’ 

“high beams” that help them make the best decisions. Since many patients 

use the ER as their primary care facility, and ongoing and consistent treatment for such patients can be difficult, an interoperable system could reduce 

suffering and save lives. In addition, the consistency the system provides can 

help caregivers personalize the experience for the patient. That will help 

doctors and nurses to encourage patients to form relationships with healthcare 

practices and clinics, instead of waiting until a problem becomes so severe that 

it requires emergency treatment. 

• Immediate access to lab results. A connected, interactive system of 

healthcare will allow physicians to review test results as soon as they become 

available—no more waiting for a phone call or fax. Even the most basic 

system will provide doctors with the ability to “query the database”—to 

look for patterns that appear only under intense scrutiny and to find patterns 

and clusters of data that indicate other problems or treatments. By itself, 

the interconnectivity of lab information with drug information can provide 

more comprehensive data at the time of care. Today, such information is not 

available at the time of initial treatment, meaning that more refined treatment has to be postponed until the necessary data have been collected in one 

place—and that is just what an interoperable system is designed to do. 

• More evidence-based medicine. Interoperability will promote evidencebased medicine3

 by giving doctors access at any time to databases that offer 

updated clinical decision support. Interoperable systems will be equipped to 

provide protocols for various medical situations. Physicians will choose protocols as they see fit, and as outcomes are measured, the data can be used to 

revise best-practice standards. Interoperable health systems will improve this 

process in ways never before possible. 

2 P.C.Tang, D. Fafchaps, and E.H. Shortliffe. “Traditional Hospital Records as a Source of Clinical Data in 

the Outpatient Setting.” Eighteenth Annual Symposium on Computer Applications in Medical Care. 

Washington D.C. (1994): 575–79. 3 Also known as “best-practice guidelines.” 

A Lack of Information

In healthcare, having the correct 

information about a patient is 

crucial, and getting to medical 

information quickly can save 

lives. But one Stanford University 

study showed that 81 percent of 

the time, physicians lacked the 

necessary information to make 

informed medical decisions.

2 

The Healthcare Delivery System
80 

An Example from Emergency Care

When a 40-year-old female arrived at Indianapolis’s Wishard Memorial Hospital, all Dr. JohnT. Finnell knew was she had lost 

consciousness while waiting to see a doctor in an outpatient clinic. 

Dr. Finnell used her driver’s license number to pull up an electronic record listing the patient’s recent hospital visits. The listing 

showed the woman had been diagnosed with a seizure disorder, and she had not been taking her prescribed medication. With 

this information in hand, Dr. Finnell was able to treat the woman appropriately. 

If there had been no accessible medical record indicating the most likely cause of her unconsciousness, Dr. Finnell would have 

administered drugs to stop her breathing, then inserted a breathing tube and ordered tests. 

If the file had not been accessible via an electronic network, the delay in securing a paper file—which could have been any number 

of places—would have taken hours. 

“When you’re in an emergency and you can’t find information about a patient, everybody suffers,” said Dr. Finnell. 

If Dr. Finnell had not had access to crucial information about the 40-year-old woman who was rushed into his ER, would he still 

have been able to save her life? Would he have been able to avoid the potential negative effects of his treatment? Would he have 

been sued if he had not? 

Though it cannot be known for certain what would have happened without the electronic record, what happened when the record 

was available is a matter of fact. Dr. Finnell received the information he needed to come to the aid of an unconscious patient by 

sparing her redundant testing and risky emergency procedures. Access to her healthcare information helped him to save her life.

4 

In addition, digital systems are much easier to update than medical textbooks, 

which will speed the adoption of superior science into practice. Under the 

current system, the delay between new discoveries and their incorporation 

into common practice is, on average, 17 years.5 With some 10,000 clinical 

studies conducted each year, medical knowledge is doubled about every 

42 months.6 But medical studies are often duplicated because one researcher 

does not know what another is doing, and they may not learn of work 

similar to their own until a scholarly article is published. This delay in 

sharing information causes resources to be wasted and ultimately delays the 

delivery of new and better treatments to patients. 

• Enhanced support for management of chronic disease. The treatment 

of chronic conditions often involves multiple physicians and healthcare 

providers. The proportion of a typical medical practice focused on treatment 

of chronic conditions is growing every year, as our healthcare system is 

4 Susannah Patton. “Sharing Data, Saving Lives.” CIO Magazine. 2005. 5 Ruth Larson. “Medical Advances Can Outpace Doctors: Retraining Not Enforced, Critics Say.” 

WashingtonTimes, March 21, 1999. 6 Ibid. 

Ending the Document Game Ending the Document Game 
81

transformed from a base of infectious to chronic conditions.8 Already, half the 

U.S. population lives with chronic disease.

9 A connected healthcare system 

will make it easier for patients to find information to help them prevent such 

conditions, since many chronic illnesses are preventable. With patients and 

doctors in more frequent and casual contact—made possible by interoperability—patients can make better lifestyle choices to avoid chronic disease or 

improve their management of it. 

• Improved prescription writing and pharmacy interaction through 

e-prescribing. 

° When prescriptions are transmitted to a pharmacy through an 

interoperable system, there is no question about legibility or the loss 

of a paper prescription. 

° Doctors can find out whether or not a patient filled or refilled 

a prescription.

° There will be less opportunity for those who try to obtain multiple 

prescriptions from many doctors or commit other fraud. 

° Healthcare providers can rely on the same kind of safeguard as 

pharmacists to prevent drug interaction.

7 “Thedacare, Inc. –Touchpoint Health Plan”. 2005. Center for HealthTransformation. August 15 2005. 

<http://www.healthtransformation.net/Transforming_Examples/Transforming_Examples_Resource_ 

Center/139.cfm> 8 Ibid. 9 Ibid. 

Chronic Disease and Rural Health

Management

More than 125 million Americans 

suffer from at least one chronic 

medical condition.

7 Chronic 

conditions are a special problem 

for residents of rural America 

because of the typical distances 

separating patients from doctors’ 

offices, hospitals, and emergency 

responders. Compared to those 

of patients in cities and suburbs, 

office visits for rural residents 

require more coordination, 

planning, and time. 

Casual contact with healthcare 

providers is not as easy to make 

in rural areas as it is for patients 

in more-densely populated 

areas. This is important because 

seemingly minor symptoms for 

chronic-condition patients are often 

indicators of situations that need 

immediate attention to prevent 

long-term consequences. City- and 

suburb-dwellers can more easily 

contact their doctors about these 

“minor” symptoms and get early 

treatment. But the prohibitive 

distances and circumstances of 

many rural dwellers can cause them 

to put off seeking attention for such 

symptoms until the next scheduled 

doctor’s visit. Such delays can have 

serious health consequences. 

But a connected system would 

help to change that. Rural patients 

and their doctors would gain 

greater access to care because the 

distance from a doctor’s office and 

the formality of a doctor’s office 

visit would both be significantly 

decreased. 

The Healthcare Delivery System
82 

Administrative efficiencies

• Many outcomes. Connectivity leads to the creation of communication 

tools that were previously impossible. New ways to synthesize, share, and 

transmit data naturally suggest new applications to enhance administrative 

“... Draw from your errors efficiencies. 

the very lessons which may 

enable you to avoid their • Less duplication of work. Establishing files for patients and keeping 

repetition.

” them up-to-date can require significant time and effort from both staff and 

patients. Time to fill out forms has to be built into appointment time, even 

Sir William Osler, Canadian for returning patients. A connected system of healthcare information supports 

Physician (1849 – 1919) individual data that can be shared by all providers. If a patient’s psychiatrist 

orders a liver test, the general practitioner could review the results instead of 

ordering another test. A patient with a complete medical history on file with 

their doctor can make that record available to a new doctor for consultation 

or when the patient moves to a new town. 

Byproducts of Interoperability

1. Advancement of telemedicine 

2. Computerized physician 

order entry 

3. Disease registries 

4. Electronic health records 

5. E-prescribing 

6. Monitoring of chronic diseases 

7. Personal health records 

8. Secure e-mail messaging 

Financial Pressures

The financial pressures on physicians are severe. Reimbursements are more tightly controlled, 

the rate of inflation in the medical field is higher than the overall rate of inflation, and insurance 

costs are soaring. 

In 1999, total physicians’ administrative work and costs equaled $72.6 billion, $261 per capita or 

26.9 percent of physicians’ gross income.

10 

The New England Journal of Medicine reports that 31 cents of every healthcare dollar goes 

toward administrative costs and other expenses.

11 These expenses are from a variety of sources, 

but interoperability can contribute to reducing them. 

Up to $500 billion is spent on unneeded or duplicative care, which is nearly one-third of annual 

U.S. healthcare spending.

12 

10 S. Woolhandler,T. Campbell, and D. U. Himmelstein. “Costs of Health Care Administration in the United 

States and Canada.” New England Journal of Medicine 349 (2003): 768–75. 11 Ibid. 12 Statement of Mike Leavitt, Secretary of the Department of Health and Human Services, before the 

Committee on the Budget, United States Senate, July 20, 2005. 

Ending the Document Game Ending the Document Game 
83

• Improved workflow and streamlined processes. Electronic systems 

save time and money in standard business activities such as payroll, human 

resources tracking, attendance, billing, transcription, accounting, and inventory. 

When applied to healthcare, those benefits will expand to include: 

° Reduction of the number of documents lost in transmission,

especially via fax or postal mail;

° Reduction in spending on printing, transcription, faxing, mailing, 

scanning, duplicate data entry, and shredding; 

° Elimination of the problem of illegible handwriting and signatures; 

° Greater ease of sharing information with other providers; 

° Reuse of information instead of reentering; and 

° Flexible and instant reporting and tracking capabilities. 

• Easier accommodation to changes in paperwork requirements. 

An electronic and interoperable system accommodates changes in regulatory 

filing requirements with fewer changes to procedure—the system can 

incorporate new filing requirements. For instance, data may be requested 

automatically or mined from existing information. It is even possible that 

a vendor could make changes needed in the office or hospital software 

without any administrative effort on the part of the staff in the hospital or 

physician’s office. 

• More competitive practice benefits. “The reality of today’s healthcare 

environment is that providers are competing for every patient, every 

employee, and every dollar.”16 Healthcare providers can increase their 

ability to compete not only by offering benefits directly to patients, but by 

13 InterSystems Corporation. “CareGroup Healthcare System Expects System Projects Multi-million 

Dollar ROI from CareWeb Application Built on Caché e-DBMSTechnology.” Press release, April 10, 2000. 14 Ibid. 15 Hearing before the Subcommittee on Oversight and Investigations of the House Veterans’ Affairs 

Committee. 108th Congress, Second Session. March 17, 2004, 108-32. “Hearing VI on the Department of

Veterans’ Affairs InformationTechnology Programs.” Written testimony of John D Halamka, MD,

MS, 59–68. 16 Daniel Fell. “Seven Steps: Using Marketing in HealthcareTechnology Planning.” HealthLeaders News. 

May 23, 2005. 

Savings of Money andTime:

Real-world Examples

In Massachusetts, a paperbased insurance claim takes, on 

average, 100 days to process. 

New England Health EDI Network, 

connecting a large group of 

payers and providers in the 

region, projects that electronic 

data interchange could shorten 

this process to three to five days.

15 

Savings of Money andTime:

Real-world Examples

CareGroup, a six-hospital 

integrated delivery system, 

has saved more than $1 million 

annually from implementing a 

Web-based electronic medical 

record retrieval system that 

improves workflow processes. 

The group anticipates a 33 

percent annual increase in 

revenues from higher customer 

retention and attraction rates.

13 

CareGroup has seen cost and 

process time reductions in a range 

of hospital operations: clinicians 

need less time to find and retrieve 

records, the admittance process 

is quicker, and the average overall 

stay is shorter.

14 

The Healthcare Delivery System
84 

enhancing elements of the practice that will become apparent to patients over 

time. The return on investment in interoperable systems may appear not only 

as an increase in the number of patients, but also as better retention of doctors 

and other employees.17 

Patient communication

• Better interaction with patients. Electronic networks make it easier for 

doctors to review patient information, find patterns in patient history, provide 

patients with relevant information, monitor adherence to treatment, consider 

“The two words “information” patient questions and concerns in advance of visits, and prepare more thorand “communication” are often oughly for a patient visit. This results in a savings of time and trouble for 

used interchangeably, but they the provider and the patient, as well as a more focused and need-oriented 

signify quite different things. experience for the patient. 

Information is giving out; 

communication is getting • Better doctor-patient relationships. Electronic networks that operate over 

through.

” the Internet facilitate the frequent and relatively simple exchange of information without the need for expensive and time-consuming office visits or even 

Sydney J. Harris, phone calls. When doctors have electronic networks, they can closely moniAmerican Journalist (1917 – 1986) tor patient progress and more often form practical, effective partnerships with 

patients. Additionally, the ability of doctors to direct patients to reliable health 

information across such networks would provide patients with the opportunity to review important and detailed information about their condition and 

use that information to better care for themselves. The result can be a more 

engaged patient, working with a healthcare provider toward better health outcomes such as better care for chronic conditions, better initial diagnosis and 

A Lack of Information treatment, and interaction focused on specific problems and solutions toward 

“The proportion of physicians better health maintenance. saying they do not have enough

time to spend with patients rose

nearly 24 percent between 1997 • More time for contact with patients. In offices and hospitals where 

and 2001.”18

electronic systems are in place, doctors appear to have more time for patients 

and spend less time performing administrative duties and waiting for information. According to a physician interviewed by Commission staff, patient 

e-mails have relieved his practice of numerous phone call obligations. The 

doctor describes the telephone as the “most expensive piece of equipment in 

the office.” 

17 Ibid. 18 SallyTrude. So Much to Do, So LittleTime: Physician Capacity Constraints, 1997-2001. Center for 

Studying Health System Change, 2003. 

Ending the Document Game Ending the Document Game 
85

By using e-mail, he can answer the five to 18 messages he receives each day in 

about 10 minutes. Naturally, he recommends an office visit for patients whose 

complaint needs more attention; otherwise, an e-mail answer saves the patient 

the trouble of coming in.19 Doctors, and especially patients, believe that medical 

errors are prevented when physicians have more time to spend with patients.20 

This suggests that doctors who effectively use information technologies in their 

practices will have more time to spend with patients, both in the clinical setting 

and through nontraditional means of communications such as e-mail. This allows 

doctors to direct patients to reliable health information on the Internet so patients 

can take time to review important and detailed information at their leisure. 

Public health and security 

• Improved public health. Right now, there is no automated tracking in the 

United States for patterns and locations of patient diagnoses and treatment. If 

this information were available, it could support medical research and medical 

practice. Such data are even more important for activities such as biosurveillance, quick response to outbreaks of disease or to chemical or biological 

attacks, and improved monitoring of adverse drug effects.21 An electronic 

health information exchange would provide more thorough monitoring 

of adverse drug effects, and citizens could be automatically notified if their 

medication was no longer safe to take. 

• Tracking research and disease incidence. Without a connected system 

of healthcare information, there is no way to accurately track trends of disease 

and injury. Tracking how a disease spreads helps health officials understand 

the size of the threat. By looking at how quickly diseases spread through a 

particular area, officials can accurately determine the number of vaccinations 

needed to control the disease throughout the Nation. With interoperable 

tools at their fingertips, public health agencies can more efficiently and 

effectively control and contain the spread of diseases. 

19 Commission on Systemic Interoperability staff interview with James Morrow, MD, February 2005. 20 Robert J. Blendon. “Views of Practicing Physicians and the Public on Medical Errors.” New England 

Journal of Medicine 347, no. 24 (2002): 1933–40. 21T. Brewer and G. Colditz. “Postmarketing Surveillance and Adverse Drug Reactions: Current Perspectives 

and Future Needs.” Journal of the American Medical Association 281, no. 9 (1999): 824–29. 21 Connecting for Health Collaborative. Financial, Legal and Organizational Approaches to Achieving 

Electronic Connectivity in Healthcare. Markle Foundation, 2004. 23 Commission on Systemic Interoperability staff interview with James Morrow, MD, February 2005. 

“The health of the people 

is really the foundation upon 

which all their happiness and 

all their powers as a state 

depend.

”

Benjamin Disraeli,

Former Prime Minister of England

On-lineTools and Chronic Disease

Management

One study noted, on-line chronic 

disease management tools have 

been shown to significantly 

improve patient compliance 

with medication regimens, from 

compliance rates of 34 percent 

to 63 percent without the tool, 

compared with 93 percent to 

95 percent with the tool.

22 

Savings of Money andTime:

Real-world Examples

With the implementation of 

an interoperable electronic 

record system in his Cummings, 

Georgia, clinics, Dr. James 

Morrow calculates a savings 

of $33.15 per patient visit. This 

savings had been invested in 

widening the facilities’ services 

and medical capabilities. The 

result of the savings, the system, 

and the investment: the clinics’ 

patients do not need to come into 

the office as frequently and can 

now find all of their care—and 

all of their records—in one 

place. In addition, patients avoid 

unnecessary lost days of work 

and improve their interaction with 

their doctors, thus improving their 

healthcare.

23 

The Healthcare Delivery System
86 

• Better tools for first responders. A connected system would also support 

individual responders. Emergency workers would be able to get the most 

up-to-date information on vaccines and treatment for biological threats. They 

could more efficiently coordinate with hospitals and clinics, and all healthcare 

providers could more easily find up-to-the-minute information to provide 

care and to help contain a health crisis or epidemic. 

Adoption and Implementation 

“Knowing is not enough; we must apply. Willing is not enough; we must do.” 

Johann Wolfgang von Goethe,

German Poet, Dramatist, Novelist, and Scientist (1749 – 1832)

Overcoming cultural barriers by phasing in the system slowly

The key to successful adoption of an interoperable system is to gradually phase in 

functionality. The first features should be nondisruptive and prove to be time- or 

cost-saving—they should enable information access without requiring redesign 

of work procedures and data entry. For example, access to a browsable chart— 

transcribed reports, lab data, scanned paper—is a fundamental yet nondisruptive 

change that could be the main feature of the first implementation. The next step 

might be to add simple intrateam messaging, then e-prescribing, then structured 

notes and orders. 

In this way, users gain time and cost savings in the first steps, then give back 

some of the time in exchange for quality improvement in the latter steps. 

For instance, cost savings may come through improved reimbursement, either as 

a result of coding, participation in pay-for-performance programs, or through 

improved productivity. 

The Four Levels of Interoperability24 

Level 1: 

Nothing

Traditional data-sharing: 

Information is either 

physically mailed or 

communicated over 

the phone. 

Level 2: 

Basic

Very simple use of 

technology such as 

scanning paper 

documents and 

e-mailing or faxing 

them. No ability to 

update or amend 

electronic documents. 

Level 3: 

Interpreter

Information is 

structured, but data 

standards do not exist. 

As a result, computer 

programs (often called 

“middleware”) are 

used to interpret and 

translate data for 

processing. 

Level 4: 

Superior

All data are 

standardized and 

coded. All systems 

can send and receive 

information using a 

uniform format and 

vocabulary. 

24 E. Pan, D. Johnston, and J. Walker. The Value of Healthcare Information Exchange and Interoperability. 

Center for InformationTechnology Leadership, 2004. 

Ending the Document Game Ending the Document Game 
Making healthcare providers a part of the effort

Healthcare providers must realize that adopting interoperable electronic healthcare 

information is in their best interest in terms of time and professional convenience. 

In particular, the rollout of the system should engage doctors, nurses, and other 

healthcare providers in the identification of electronic healthcare implementation 

priorities that will allow better use of their time while directly caring for patients. 

Those in charge of implementing a system must remember that doctors currently 

are using procedures that work for them. Those procedures may not be particularly 

efficient procedures, but they get the job done; and for most managers, a proven 

system that is not quite perfect is worth much more than the promise of a more 

efficient system—especially when that system demands an intense conversion effort. 

87

Adoption Statistics

Reported rates of adoption vary widely, and not necessarily because the rates are actually different. At this early stage of 

interoperability, language and definitions are not universal, so the terms in survey questions mean different things to different 

respondents: one clinic’s “complete implementation” is another clinic’s “first step.” 

• Only about 10 to 30 percent

25 of the more than 871,000 practicing physicians26 in the United States use a “fully automated” 

system of electronic medical records. 

• In the 2003 National Hospital Ambulatory Care Survey, 22 percent of physician offices, 30 percent of outpatient departments, 

and 40 percent of emergency rooms had adopted electronic medical records.

27 

• In the 2002 HIMSS/AstraZeneca Clinician Wireless Survey, 72 percent of respondents had no electronic medical records 

deployed in their facilities, eight percent of respondents had some deployment, and 21 percent had complete deployment 

in all departments.

28 

• In the 2003 Commonwealth Fund National Survey of Physicians and Quality of Care, 35 percent of physician offices with 

10 to 49 physicians, and 57 percent of offices with 50 physicians or more had adopted electronic medical records.

29 

• In 2002, 13 percent of hospitals and 14 to 28 percent of physician’s practices had electronic health records.

30 

Although statistics are not consistently reliable for the reasons mentioned above, the trends noted by the Commission 

indicate that adoption and implementation exist in early stages. 

25 Advanced Studies in Medicine 4, no. 8 (2004): 439. 26 American Medical Association. Physician Characteristics and Distribution in the U.S., 2005 Edition and 

prior editions. <http://www.ama-assn.org/ama/pub/category/12912.html> 27 C. Burt and E. Hing. Use of Computerized Clinical Support Systems in Medical Settings: United States, 

2001–03. Division of Health Care Statistics of the National Center for Health Statistics, 2005. 28 2002 HIMSS/AstraZeneca Clinician Survey. Healthcare Information and Management Systems Society, 

AstraZeneca, 2002. <http://www.himss.org/content/files/surveyresults/Final%20Final%20Report.pdf > 29 The Commonwealth Fund 2003 National Survey of Physicians and Quality of Care. Harris Interactive, 

2003. <http://www.cmwf.org/surveys/surveys_show.htm?doc_id=278869> 30 2002 HIMSS/AstraZeneca Clinician Survey. Healthcare Information and Management Systems Society, 

AstraZeneca, 2002. <http://www.himss.org/content/files/surveyresults/Final%20Final%20Report.pdf > 

The Healthcare Delivery System
88 

“By creating national 

interoperability standards, 

we will give healthcare 

providers the confidence that 

an investment in health IT is an 

investment in the future.

”

Senator Hillary Rodham Clinton 

Doctors and their staffs deserve to have their concerns addressed with clear and 

simply stated information about benefits, potential delays, and realistic timetables. 

The more quantitative data available to make the case—in terms of saved money 

and especially increased time made available to care for patients—the more likely 

providers will support the switchover to an interoperable electronic healthcare 

system. 

Financial barriers 

Even for early adopters, the shift to a connected system will be an evolutionary 

process that will require updates, replacements, and changes in software, hardware, 

and procedures as standards and practices are refined. This alone is a discouraging 

truth, and it is compounded by the fact that healthcare providers face competing 

capital demands and have relatively limited resources. Financial incentives should 

be considered in various forms. 

Good news: much of the technology already exists

The necessary technology already exists and in some places is already in use. 

The Washington Post described the daily use of a system in a recent story: 

At 9 a.m., Dr. Julio Panza begins his rounds at [a] coronary care unit.... 

Residents and fellows review the status of the 14 patients in the unit. Panza 

takes notes and records his diagnoses and orders with a pen, as doctors have 

for centuries. 

Discussion turns to one particularly vexing case, a patient admitted the 

previous afternoon with chest pains. Panza turns to a computer screen and 

calls up the patient’s lab results, which have been transmitted by lab machines. 

Another click and he can see what medicines have been dispensed from the 

unit’s automated medicine cabinet. Yet another click and the group watches 

a video of what happened the day before as doctors threaded a thin wire 

through the patient’s arteries and installed three tiny stents to keep the passageways open. Panza clicks again to find details of previous hospital visits 

and learns that the patient was a heavy smoker and a diabetic. 

Ending the Document Game Ending the Document Game 
89

What the folks at the [facility] have discovered is that most of the makings of 

an electronic medical record are already available in digital form at most 

hospitals. By investing a relatively small amount of time and money, they’ve 

collected it all in one database and designed an easy-to-use interface that 

allows nurses, doctors, medical researchers, and finance staff to organize it in 

almost any way they want.31 

Conversion

The transition from a paper-based system to an electronic interoperable system 

will require changes in the way physicians and their staffs work. Procedures that 

are now carried out on paper will have to be translated and modified to fit the 

electronic system—although the expectation is that these new procedures will 

be faster and simpler. Conversion will therefore require physician and employee 

training. It will also require the establishment and adoption of standard terminology—that is, a common language for the description and exchange of data. 

While efficiency will drastically improve simply by automating much of what is 

painstakingly done by hand now, the full benefits of interoperability will not be 

realized if workflow patterns do not change with the introduction of technology. 

Certification

Healthcare accounts for nearly 16 percent of the U.S. economy,

32 and as the 

industry embraces information technology, more and more vendors will compete 

to sell their products to doctors, hospitals, and clinics. 

Given the complexity of the systems and the myriad choices that will be available, 

few if any people will be equipped to both practice medicine and study these 

systems well enough to make a completely informed decision best suited to 

their circumstances. 

Implementing Interoperability

Must Be Made as Simple

as Possible

The new procedures and systems 

that make interoperability 

possible must be straightforward 

in their adoption, transparent in 

their influence and benefit, and 

in line with the priorities of the 

business of being a healthcare 

provider. The new procedures 

and systems should also require 

as little adjustment in practice 

as possible. The concerns of 

healthcare providers should 

be respected as they are given 

the opportunity to adopt more 

efficient and resource-saving 

systems into their daily practice. 

American Health

Information Community

On June 6, 2005, Department 

of Health and Human Services 

Secretary Mike Leavitt announced 

the creation of the American 

Health Information Community 

(AHIC) that will serve as a 

standards and policy advisory 

board for the healthcare industry. 

It will focus on accelerating 

the work necessary to reach 

widespread implementation of 

health data standards.

33 

31 Steven Pearlstein. “Innovation Comes From Within.” The Washington Post, March 4, 2005. 32 Statement of Mike Leavitt, Secretary of Department of Health and Human Services, before the 

Committee on the Budget, United States Senate, July 20, 2005. 33 Office of the National Coordinator for Health InformationTechnology, Department of Health and 

Human Services. “American Health Information Community (the Community).” August 2005. 

<http://www.os.dhhs.gov/healthit/ahic.html > 

The Healthcare Delivery System
90 

If price difference is not a significant factor, purchasers will most often select those 

products that have the imprimatur, or certification, of a trusted entity. Product 

certification would allow doctors to purchase information technology systems 

knowing that they meet minimum standards of functionality and interoperability. 

Certification will increase purchasers’ confidence, encourage adoption, and ensure 

interoperability of systems with each other, as well as facilitate compliance with 

laws and regulations governing the exchange of healthcare information—much in 

the same way consumers feel more comfortable buying a car that got a favorable 

rating in Consumer Reports. 

Certification should be based on universally recognized standards. 

Standards: definition and parameters

Standards are agreed-upon specifications that allow independently manufactured 

products, whether physical or digital, to work together, or in other words, to be 

interoperable. Adherence to standards is the reason that any automobile gas tank 

can be filled at any gas pump, that any web browser can locate any public web 

page, and that an e-mail sent from an IBM-compatible PC can be read by people 

using Apple computers and vice-versa. 

Unfortunately the standards that support universal web browsing and e-mail exchange are important, but not close to sufficient for interoperable healthcare. True 

connectivity for healthcare requires standardization of the format and content of 

a wide range of health data elements so they can be understandable to computer 

programs as well as people. 

Systems must be able to read and write standard messages to request health data, 

such as lab test results or complete medical records, and to return data when 

legitimately requested by patients and authorized healthcare providers. Many key 

data elements in these messages, including a patient’s current problems, medications, allergies, and lab tests, must contain standard vocabulary if the full benefits of 

interoperability are to be realized. 

Over the past five years, considerable progress has been made in selecting the 

base set of messaging and vocabulary standards needed for efficient exchange of 

healthcare information. For example, some specific kinds of healthcare data, such 

Ending the Document Game Ending the Document Game 
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as lab tests results and radiology images, are routinely exchanged in standard electronic messages, but most do not yet use standardized terminology within them. 

Work has begun to ensure that the standard healthcare terminologies are properly 

aligned with the message standards and with standard code sets used in billing and 

statistical reporting. Vendors are beginning to incorporate standard vocabularies 

into new versions of their health information technology products. 

Despite these significant accomplishments, the standards selected have not yet 

been refined to work together efficiently to create a single coordinated, comprehensive, non-overlapping set. Lacking this single set, system developers have been 

unable to build the standards-compliant systems that can support all the functions 

required by the people who will use them. The standards retain gaps that must be 

filled and some duplication that needs to be eliminated. 

The selected standards will need to be tested in a wide range of healthcare settings 

in order to identify what changes must be made to ensure that these standards are 

helping patients and clinicians collaborate more efficiently, rather than slowing 

them down. One way to minimize the potential negative effects of the implementation of standards for doctors, nurses, and other health professionals is to 

standardize key healthcare data, such as medical devices, drug labels, and test kits at 

the point of manufacture. 

Why we need standards right now 

Until a practical and comprehensive set of standards is in place, the United States 

will never be able to trade the current patchwork of electronic health records 

and other systems for a system of interoperable healthcare. The lack of easily 

implemented, usable standards is the primary barrier to creating this system, but 

fortunately, this is a barrier that can be overcome with focused attention and 

action. Recent Federal actions to provide leadership for standards completion 

and implementation and to support robust regional testing of health information 

exchange will be critical in achieving workable standards. 

Healthcare Data Elements

What data elements need to be 

standardized? Another way to 

ask this question is, ‘What kinds 

of information do healthcare 

providers and payers need to 

know and computer systems 

need to interpret?’ These 

items will range from basic 

identifying information to specific 

information about a patient’s 

condition and history. Some 

examples will include: 

1. Name, birth date, and gender 

of patient; 

2. Family contacts; 

3. Presented conditions and dates; 

4. Records of allergies and 

reactions to medications; 

5. Physicians seen; and 

6. Lab test orders and results. 

The Healthcare Delivery System
92 

Standard Product Identifiers and Vocabulary. The standards and vendor 

products that enable the U.S. system of interoperable healthcare information must 

support these functions: 

• Physician access to patient information, including past diagnoses and 

treatment, lab results, prescriptions, MRI results, and x-rays;

• Access among providers in multiple care settings; 

• Systems that allow doctors to order medications and tests for patients 

in the hospital;

• Computerized decision-support systems, including best practices; 

• Tracking for compliance to support study and revision of best-practice 

definitions;

• Secure electronic communication among providers and patients; 

• Automated administration processes, such as scheduling; 

• Automated filing of insurance claims; 

• Patient access to health records, disease management tools, and health 

information resources; and 

• Data storage and reporting for patient safety and public-health 

monitoring efforts.

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Infrastructure Issue: Broadband Internet Access

Interoperability will require nationwide broadband connectivity—high-speed access to the Internet-among healthcare 

providers. This is because access to data for more than a trivial number of patients will call for significant bandwidth—the 

ability to accommodate many requests for large data files. Dial-up connections will be too slow to meet provider needs. 

(Patients, however, may be able to rely on dial-up, since they may only rarely need the bandwidth-driven ability to view 

detailed images and streaming audio or video.) 

The level of broadband adoption has surged in the last few years. A study by the Department of Commerce shows that the 

number of Americans with high-speed Internet connections doubled from 2001 to 2003. Another study by the Pew Project 

shows a 60 percent increase between March 2003 and March 2004.

34 However, many rural areas have no broadband access 

and it will be an essential ingredient in fostering the development of health information technology in already underserved 

areas. 

President Bush set a goal for universal affordable access to broadband technology by 2007. He said, “My Administration has 

long recognized the economic vitality that can result from broadband deployment and is working to create an environment to 

foster broadband deployment. All Americans should have affordable access to broadband technology by the year 2007.”35 

Federal, State, and private programs to promote the expansion of broadband may resolve this problem well before a 

connected healthcare system is fully deployed. 

Federal preemption

Today, States can—and do—create laws that differ substantially from each other on 

privacy, security, and the handling of personal information.36 In this environment, 

it is not possible to create a single set of procedures and systems that satisfies the 

regulations and statutes of all States. 

This means that two physicians authorized by a patient to share information may 

not be able to legally do so simply because they are located in different States. 

Therefore, Federal jurisdiction should be superior to State jurisdiction in matters 

of medical privacy related to healthcare interoperability. 

Legacy systems 

“Legacy” systems (usually electronic medical record systems with limited interoperability capabilities) are those systems implemented prior to the introduction of 

common national standards. These are the healthcare systems in use today. 

34 John Horrigan. “Pew Internet Project Data Memo.” Pew Internet & American Life Project. April 2004. 35 White House. “Broadband Rights-of-Way Memorandum.” Memo to the heads of executive departments 

and agencies, April 26, 2004. 36 Stephen A. Stuart. HIPAA/State Law Preemption Fact Sheet. State of California Office of HIPAA 

Implementation, January 9, 2003. 

The Healthcare Delivery System
94 

Their data storage, input, and even inventory of data items are unique and often 

proprietary. Legacy systems present a problem because each one is built for the 

needs of a particular task or even a particular facility, instead of for industry-wide 

flexibility. Moreover, many of these systems are designed to prevent interoperability with other vendors’ applications to protect market share and to encourage 

purchases by hospital or clinic chains. 

Legacy systems will be a part of the overall connected healthcare network, either 

temporarily or permanently. In either case, these legacy systems will require 

“middleware”—software and sometimes hardware—that translates the input and 

output of a system so it can interact with other connected healthcare systems. 

Because legacy systems are critical to the business side of medicine, they cannot be 

shut down while new interoperable systems are being implemented. If a legacy 

system is being replaced instead of adapted, it must run simultaneously with the 

new system for a time to ensure constant, reliable access. 

Other challenges of implementation

• Planning for the unexpected. The transition to a connected healthcare 

system may not be easy, but the problems on the way to conversion will be 

“If there is no struggle, there more readily accepted by providers if they understand, from the beginning, 

is no progress.

” that unexpected problems will occur, and if they understand, at least in 

general terms, what types of problems may arise. 

Frederick Douglass,

American Abolitionist and 

• The timeline for adoption. Providers are more likely to embrace an Author (1818 – 1895) 

interoperable system if they know how long it will take to get the system up 

and running. No one wants a promise of an early delivery if that promise is 

not likely to be kept. It is especially important to build in extra time to solve 

unexpected problems. 

• Education strategy. Healthcare providers will need to be taught how to 

use the connected system and why its use is important. If healthcare 

providers simply believe the system is a new way to fill out forms, they are 

less likely to acquire the technical skills and knowledge needed to make full 

use of the new system. When healthcare providers understand the potential 

for making their job easier, they are far more likely to apply serious effort 

toward using the tools of the new interoperable system. 

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Interoperability costs and benefits

Spending on interoperability is an investment, not just an expense, because it 

produces a return in the form of saved time, reduced paperwork, increased 

quality of care, reduced need for treatment, and saved lives. 

Since there is no complete implementation of a connected health information 

system yet, the exact financial savings are only speculation. However, the extent 

of these returns will depend on how thoroughly the interoperable system is 

integrated into the facility or practice and the extent to which patients participate. 

Ultimately, interoperability will enhance the “culture of care.” It changes the 

structure of an organization by redirecting resources, step by step, toward more 

patient-centered services. Tasks that once required a doctor or nurse to take 

time away from direct caregiving become automated at best and less 

time-consuming at least. 

Pay-for-Performance

Pay-for-performance is an 

initiative to promote quality 

care. This initiative realigns 

provider payment incentives to 

follow care guidelines based on 

scientific evidence about what 

actually helps to prevent or treat 

disease. Pay-for-performance is 

directly tied to the development 

of a national health information 

exchange because tools such 

as electronic prescribing and 

electronic information exchange 

help improve patient care and 

reduce medical errors. 

The Healthcare Delivery System
96 

Confidentiality 

“We need a better way to share information. We need a better system so that 

physicians have at their fingertips all the information they need to do their job— 

including patient history, the latest research, drug interactions, and everything else 

they need.... Information, in the hands of the right people, at the right time, 

drives quality and value. We need to empower patients and healthcare providers 

to make the right choices. And to do that, healthcare decision-makers— 

providers, payers, and patients—need to have access to the right information, 

where and when it is needed, securely and privately.” 

Senator Hillary Rodham Clinton

Patient consent

Before the interoperable system goes on-line, the rules on consent must be clear. 

Privacy and security policies should be considered as a part of design, not as an 

afterthought, and should be based on current law.

37 Legislation and regulation 

should be regularly considered to reevaluate emerging technologies and capabilities. Policies must be widely agreed to by patients and practitioners alike on the 

terms and conditions for access to and dissemination of patient data. 

The structure and rules of health information networks must support the exercise 

of patient rights under Federal privacy regulations. Although State privacy rules 

vary, Federal jurisdiction should be superior to State jurisdiction in matters of 

medical privacy related to connectivity. Health activities that are not directly covered by the Health Insurance Portability and Accountability Act (HIPAA) need to 

be associated with this or other privacy rules, by either regulation or statute. 

37 Some laws, such as the Health Information Portability and Accountability Act of 1996 (HIPAA) 

(Public Law 104-191), may need revision in light of the benefits and concerns that arise under an 

electronic and interoperable system. 

Ending the Document Game Ending the Document Game 
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According to HIPAA rules at the time of this writing, a patient’s consent is 

not required: 

• When emergency care is needed; 

• When a provider is required by law to administer treatment; 

• When substantial communication barriers exist and, in a professional’s 

judgment, the circumstances infer the individual’s consent;

• For a provider with an indirect treatment relationship to provide services 

(e.g., laboratories);

• For a health plan to use the information for treatment, payment, or healthcare 

operations; and 

• For a clearinghouse to use the information for treatment, payment, or 

healthcare operations.

Security authorization devices

Systems of passwords and biometric devices such as fingerprint readers and 

voice-scanning systems should be used to help ensure data and networks are 

secure. These security devices and procedures will vary from application to 

application. For instance, it should be physically easy (but not easier in terms 

of data protection) to enter authorization on devices to be used primarily in 

emergency applications. An emergency medical technician working an accident 

on the side of the road should be able to log in without using a large keyboard 

or numerous keystrokes. A retinal or fingerprint scan would save time and, 

therefore, speed treatment. 

Punishment for violations

The Federal government has passed laws to punish individuals guilty of identity 

theft.38 Electronic information breaches of any kind should be punished at least 

as severely as similar offenses such as fraud, theft, and forgery. Laws should be 

38 United States. Cong. Senate. The IdentityTheft and Assumption Deterrence Act. Public Law 105-318. 

The Healthcare Delivery System
98 

enacted with stiff criminal sanctions against individuals who purposefully access 

protected data without authorization. There should also be clear and comprehensive safeguards to protect anyone whose personal data was improperly accessed 

or released. 

Patient Authentication

Creating a unique number would be the most direct way to establish a patient’s 

identity and this approach is used throughout Europe. However, no approach to 

personal authentication in computer systems is free of financial costs, management 

issues, and privacy concerns. A direct approach would involve an administrative 

infrastructure that may be unacceptable to some at this time for a variety of 

reasons, including privacy concerns. 

This approach could be modified to allow individuals to opt out of the uniform 

patient identifier. This compromise would let the nation provide a system 

benefiting individuals who recognize that their need for connected health 

information exceeds their privacy concerns, while not penalizing those who 

find privacy more valuable. However, such a compromise would sharply reduce 

the administrative savings because the system would have to accommodate both 

sets of individuals. It would also present new liability challenges, specifically 

involving the potential liability of providers who lacked information in the 

treatment of a consumer whose information was not available. 

An alternative to creating unique personal identification for everyone is to 

define a national standard set of authenticating information required to receive 

healthcare. This set of data could be captured when an individual first enters the 

healthcare system. Such information could include a set of data such as date of 

birth, school, employment, and insurance policy number. 

Individual Access

Medical records should be like money in a bank account: the money belongs 

to you, while the task of accounting belongs to the bank. By further allowing 

patients to add comments to specific areas within the record, they can take a 

proactive role in maintaining their health record while the information remains 

clear to the healthcare provider. 

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99

In healthcare, changes most often enter the practice of medicine in the form 

of new drugs and procedures for a single illness or disease. But interoperability 

or connectivity—the notion of a national or even global electronic health 

information system—is a change that will affect the overall practice of medicine. 

Its legion of benefits—better-educated patients, complete physician access to 

medical histories, and easier consultations, just to name a few—enhance patient 

care and provider support in all healthcare circumstances. This is a rare thing. 

As the Internet affected all facets of daily life, connectivity will enhance all 

facets of healthcare. At last, healthcare providers will gain tools to support healthy 

lifestyles of patients. The information gap for providers seeing new patients will 

be closed. And the costly and time-consuming paperwork that burdens everyone 

in this field will be significantly diminished—a light at the end of the tunnel that 

few doctors ever imagined they would see. 

The Healthcare Delivery System
100 

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Existing Efforts: 

Connecting the Country 

Many efforts are underway to connect the country’s healthcare delivery systems 

electronically. These efforts are important steps to a better equipped, more reliable, 

and more efficient healthcare system that will save lives and money. 

The focus of these efforts is on making critical connections between patients 

and doctors, doctors and doctors, doctors and pharmacies, healthcare providers and 

payors, and healthcare providers and the government. These efforts to improve 

communication and increase safety in the healthcare system are parts of a step-bystep process involving legislation, government programs and departments, 

and public and private projects. 

Following is a summary of existing efforts included in this section: 

• Existing Federal Legislation 

Many members of the 109th Congress have introduced legislation that 

impacts electronic information exchange and healthcare. The legislation 

section includes a list of proposed bills organized by subject matter: electronic healthcare information exchange, prescription electronic reporting, 

emergency communications for first responders, and homeland security and 

emergency response. 

• Government Programs and Departments 

The US government is the largest single purchaser and provider of healthcare 

in the country and is a leader in health IT initiatives. In 2003 government 

funding was nearly 46% of all the dollars spent on healthcare in the United 

States.1 These organizations are leaders in implementing tools that will enable 

information exchange, and their efforts are described in this section. 

• Public and Private Projects 

The section on public and private projects provides a national overview of 

public and private efforts taking place around the country to connect health 

information. 

1

“Effects of Health Care Spending in the U.S. Economy.” Ed. Health and Human Services, 2005. 

Existing Efforts
102 

This is not an exhaustive list, as work is ongoing to advance healthcare delivery 

systems. Each description lists a point of contact as well as Web resources where 

more detailed information may be found. The information provided comes 

directly from the organizations listed and has not been independently verified by 

the Commission. 

Existing Federal Legislation: 

Summary of Bills from the 109th Congress 

that Apply to Healthcare Interoperability 

Electronic Healthcare Information Exchange: 

1. Bill Number: S.544 

Patient Safety and Quality Improvement Act of 2005 

Introduced by: Senator James M. Jeffords (VT) 

The Patient Safety and Quality Improvement Act of 2005 promotes the interoperability of healthcare information technology systems not later than 36 months 

after the date of enactment of this bill; the Secretary shall develop or adopt 

voluntary standards and provide for the ongoing review and periodic updating 

of the standards developed. The Secretary shall provide for the dissemination of 

the standards developed and updated under this section. It amends the Public 

Health Service Act to designate patient safety data as privileged and confidential. 

It permits certain disclosures of patient safety data by a provider or patient safety 

organization (PSO), including (1) voluntary disclosures of non-identifiable data; 

(2) disclosures of data containing evidence of a wanton and criminal act to directly 

harm the patient; (3) disclosures necessary to carry out PSO or research activities; 

and (4) voluntary disclosures for public health surveillance. 

The Patient Safety and Quality Improvement Act of 2005 prohibits an accrediting 

body from (1) taking any accrediting action against a provider based on the 

provider’s good faith participation in collecting, developing, reporting, or maintaining patient safety data; or (2) requiring a provider to reveal its communications 

with any PSO. It prevents a provider from taking an adverse employment action 

against an individual based upon the good faith reporting of information. 

This bill also requires the Secretary to (1) maintain a patient safety network of 

databases that has the capacity to accept, aggregate, and analyze non-identifiable 

Ending the Document Game Ending the Document Game 
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patient safety data voluntarily reported and that provides an interactive resource 

for providers and PSOs; (2) develop or adopt voluntary national standards to 

promote the electronic exchange of healthcare information; and (3) contract with 

a research organization to study the impact of medical technologies and therapies 

on healthcare. 

2. Bill Number: S.1223 

Information Technology for Health Care Quality Act 

Introduced by: Senator Christopher J. Dodd (CT) 

The Information Technology for Health Care Quality Act established the Office 

of the National Coordinator for Health IT (ONCHIT) within the Office of the 

President to direct all health IT activities within the Federal government and 

facilitate interaction between the Federal government and the private sector. It 

establishes specific duties and responsibilities for ONCHIT. 

This bill shall provide for the adoption by the Federal government of national data 

and communication health IT standards. Standards adopted shall be voluntary 

for the private sector and shall be adopted at the conclusion of a collaborative 

process that includes consultation between the Federal government and private 

sector/IT stakeholders. To the extent practical, the Secretary shall pilot test health 

IT standards developed under this Act. The Secretary may license standards or 

use of other means to facilitate dissemination and implementation one year after 

adoption of standards. 

The Information Technology for Health Care Quality Act shall guarantee loans 

to independent consortiums—community stakeholders—to implement LHII, 

facilitate the development of interoperability, or to facilitate the purchase and 

adoption of health IT. Special consideration will be given to specified entities. 

It states that within six months of enactment, ONCHIT shall make recommendations on changes to Federal reimbursement and payment structures that would 

encourage the adoption of health IT. This bill also states that Health Insurance 

Portability and Accountability Act of 1996 (HIPAA) privacy, confidentiality, and 

security regulations shall apply to the implementation of programs and activities 

under this Act. 

It states that a collaboration of DHHS, DoD, andVA—in consultation with 

Quality Interagency Coordination Taskforce—IoM, JCAHO, NCVHS,AHQA, 

Existing Efforts
104 

NQF, MedPAC, and others shall develop uniform healthcare quality measures for 

each of the 20 priority areas identified by IoM within 18 months of enactment. 

Each federally supported health delivery program may conduct pilot tests of quality 

measures and establish ongoing reporting and evaluations of quality measures. 

3. Bill Number: S.1227 

Health Information Technology Act of 2005 

Introduced by: Senator Debbie Stabenow (MI) 

The Health Information Technology Act of 2005 states that within two years 

of enactment, the Secretary shall provide for the development and adoption of 

national data and communication health IT standards. No later than Jan. 1, 2008, 

the Secretary shall implement procedures to enable DHHS to accept the optional 

submission of data derived from reporting requirements established after enactment using standards adopted under this section. Not later than Jan. 1, 2010, the 

Secretary shall implement procedures to enable DHHS to accept the optional 

submission of data derived from all healthcare reporting requirements using 

standards adopted. 

This bill states that the Secretary shall develop a grant program to offset costs incurred related to clinical healthcare informatics systems and services from 

Jan. 1, 2005, through Sept. 29, 2010, and it states that priority in awarding grants 

will be given to specified entities. At least 20% of funds must be given to entities 

in shortage areas or rural areas. This bill states that the Secretary shall establish 

a methodology for making adjustments in Medicare payments to providers and 

suppliers who use health IT and technology services that the Secretary determines improve the quality and accuracy of clinical decision-making, compliance, 

healthcare delivery, and efficiency—such as EMRs, e-prescribing, clinical decision 

support tools, and CPOE. 

The Health Information Technology Act of 2005 states that the Secretary 

shall conduct studies and demonstration projects to evaluate the use of clinical 

healthcare informatics systems and services to measure and report on quality 

data and demonstrate impact on improving patient care, reducing costs, and 

increasing efficiencies. 

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4. Bill Number: S.1418 

The Wired for Healthcare Quality Act 

Introduced by: Senator Michael B. Enzi (WY) 

The Wired for Healthcare Quality Act establishes the Office of National Health 

Information Technology to ensure that patient health information is secure and 

to improve overall healthcare. It states that the DHHS Secretary shall establish a 

public-private cooperative American Health Information Collaborative, and 

asks the Secretary to advise achievable actions for the collaborative, such as 

recommending standards. One year after enactment, and annually, the Secretary 

is to recommend national policies for adoption and the collaborative shall review 

adoption efforts as consistent with HIPAA regulations. This bill states that standards 

adoption in private entities should be voluntary, but private entities with contracts 

with the Federal government must comply with the standards. The Secretary 

must then submit an annual report to the Senate Finance Committee and the 

HELP Committee and the House of Representatives Committee on Energy and 

Commerce and Committee on Ways and Means. 

The Wired for Healthcare Quality Act states that the Secretary shall develop 

criteria for implementation and certification of a health information exchange. 

The Secretary may award competitive grants to eligible entities to facilitate the 

purchase and enhance utilization of health information technology systems, but 

the entities must match the grant $1 for each $3. Preference can be awarded to 

entities in rural, frontier, and other underserved areas. Competitive grants may 

also be awarded to States for development of State loan programs for health IT 

adoption, which must be matched by non-Federal contributions $1 for each 

$1. Competitive grants may also be awarded to eligible entities to implement a 

regional or local health information exchange or to carry out demonstration 

projects to develop academic curricula for clinical education of health 

professionals. These grants may not be used for the purchase of hardware, 

software, or services. 

It states that the Secretary shall contract a private entity to conduct a study that 

examines the variation between State laws regarding licensure, registration, and 

certification of medical professionals and how these laws impact electronic health 

information exchange. This bill states that relevant Secretaries and government 

agencies shall develop or adopt a quality measurement system for patient care. 

The Wired for Healthcare Quality Act states that the Secretary shall provide an 

Existing Efforts
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analysis of quality measures collected and the dissemination of recommendations 

and best practices derived from such analysis. S.1418 states that the Public Health 

Service Act shall be amended by added language for a Center for Best Practices. 

5. Bill Number: H.R.747 

National Health Information Incentive Act of 2005 

Introduced by: Representative Charles A. Gonzalez (TX-20) 

The National Health Information Incentive Act of 2005 states that the Secretary 

shall develop or adopt standards for transactions and data elements for transactions 

that lead to the creation of NHII. The Secretary will act through ONCHIT and 

CSI and recommendations from NCVHS. The Secretary shall adopt trial standards 

two years (or subsequent date) after enactment. Entities that voluntarily use 

electronic health record (EHR) systems shall comply with standards adopted or 

modified within 24 months of adoption or modification, and the standards shall 

supersede any State law or regulations relating to electronic transmission of patient 

history, eligibility benefit, or other information. 

National Health Information Incentive Act of 2005 provides for optional financial 

incentives to small healthcare providers and entities to implement a national health 

information infrastructure. It states that the Secretary shall include additional 

Medicare incentives to small healthcare providers to move toward NHII by 

acquiring EHR systems. Types of reimbursement include add-on payments for 

evaluation and management services; care management fees; payments for structured e-mail consults; and other methods deemed appropriate by the Secretary. 

This bill amends the Internal Revenue Code to provide for a refundable credit for 

a portion of the expenses of or for establishing a healthcare IT system. 

6. Bill Number: H.R.2234 

21st Century Health Information Act of 2005 

Introduced by: Representative Tim Murphy (PA-18) 

The 21st Century Health Information Act of 2005 authorizes the DHHS 

Secretary to make grants to regional health information organizations (RHIOs) 

to develop and implement regional health information technology plans. This 

bill requires the Director of AHRQ to establish and maintain a national technical 

assistance center to provide assistance to physicians to facilitate adoption of health 

information technologies and participation in such regional plans. It requires the 

Secretary to establish a program of accrediting health information networks. 

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This bill requires the Comptroller General to report to Congress on the progress 

of RHIOs in realizing the purposes of this Act. The 21st Century Health 

Information Act of 2005 prohibits Federal funds available under this Act from 

being used for the purchase of a health information technology product unless 

such product has been certified as incorporating interoperability data standards 

and compliance criteria. 

It allows the Secretary to make loans to any accredited RHIOs to finance 

investments in network infrastructure and technology acquisition, training, and 

workflow engineering for physicians. The 21st Century Health Information Act 

of 2005 amends the Social Security Act to exclude the provision of equipment 

or services for the development of such a regional plan from illegal remuneration 

provisions and limitations on physician compensation arrangements. It requires 

the Secretary to (1) establish a methodology for making adjustments in Medicare 

payments to providers participating in an accredited network; and (2) make 

matching Medicaid payments to States for the development and implementation 

of a regional plan under certain circumstances. This bill states that no Federal 

funds may be made for the purposes of this Act for the purchase of health IT 

unless the product is certified by the CCHIT and must be approved by ANSI or 

the Secretary if the CCHIT is not approved by ANSI or the Secretary, the 

Secretary shall adopt interoperability standards and compliance criteria or 

designate a private entity to do so. 

7. Bill Number: H.R.3010 

Department of Labor, Health and Human Services, and Education, 

and Related Agencies Appropriations Act, 2006 

Sponsor: Representative Ralph Regula (OH-16) 

The Department of Labor, Health and Human Services, and Education, and 

Related Agencies Appropriations Act, 2006, makes appropriations for FY 2006 

to the Department of Health and Human Services (DHHS) for the Office of the 

National Coordinator for Health Information Technology; and the public health 

and social services emergency fund, for activities related to countering potential 

biological, disease, and chemical threats to civilian populations, and to developing 

and implementing rapidly expandable influenza vaccine production technologies 

and purchasing influenza vaccine as necessary. 

It authorizes, for expenses necessary for the Office of the National Coordinator 

for Health Information Technology, including grants, contracts, and cooperative 

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agreements for the development and advancement of an interoperable national 

health IT infrastructure, $58,100,000 (reduced by $12,000,000): provided, that 

in addition to amounts provided herein, $16,900,000 (increased by $12,000,000) 

shall be available from amounts under section 241 of the Public Health Service 

Act to carry out health IT network development. 

8. Bill Number: Yet to be Introduced 

Sponsor: Representative Nancy Johnson (CT-5) 

This bill states that the National Coordinator for Health Information Technology 

at the Department of Health and Human Services (DHHS) shall serve as the 

coordinator of Federal government activities relating to health information 

technology. It states that the National Coordinator shall harmonize standards, 

provide for certification and inspection of health IT products, provide for the 

evaluation of variations in business policies and Federal and State laws that 

affect confidentiality, and provide for the development of prototypes for a 

national health information network. 

This bill states that the Secretary shall conduct a study to determine the impact of 

safe harbor laws, and shall submit a report to Congress recommending changes in 

the safe harbors. 

This bill states that the Secretary shall conduct a study of State laws and regulations relating to the security and confidentiality of health information and submit 

a report to Congress. This bill also includes language for Federal preemption of 

State laws for confidentiality and security of health information. 

This bill includes language for the Secretary to issue notice for rulemaking for 

the adoption of updated ICD codes for HIPAA standards and Medicare. The 

Secretary must also provide Congress with a report on the work conducted by 

the American Health Information Community. 

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Prescription Electronic Reporting: 

1. Bill Number: S.16 Affordable Health Care Act 

Introduced by: Senator Edward M. Kennedy (MA) 

The Affordable Health Care Act allows the DHHS Secretary to require the sponsor 

of an approved drug to conduct one or more studies that confirm or refute a 

credible hypothesis of a significant safety issue. It amends the Public Health 

Service Act to establish the Office of Health Information Technology to improve 

the quality and efficiency of healthcare delivery through the use of health 

information technology. 

The Affordable Health Care Act requires that the DHHS Secretary, the DoD 

Secretary, and theVA Secretary establish uniform healthcare quality measures 

and public reporting requirements across all federally supported health 

delivery programs. 

2. Bill Number: S.518 

National All Schedules Prescription Electronic Reporting Act of 2005 

Introduced by: Senator Jeff Sessions (AL) 

The National All Schedules Prescription Electronic Reporting Act of 2005 

amends the Public Health Service Act to require the DHHS Secretary to award 

grants for terms of 18 months to each approved State to establish or improve a 

State controlled-substance monitoring program. It requires the Secretary to develop 

minimum standards for States to ensure the security of information collected and 

to recommend penalties for the provision or use of information in violation of 

applicable laws or regulations. 

This bill requires each approved State to (1) require dispensers to report to the 

State within one week of each dispensing of a controlled substance to an ultimate 

user; and (2) establish and maintain an electronic searchable database containing 

the information reported. It allows a State to provide information from the 

database in response to certain requests by practitioners; law enforcement, 

narcotics control, licensure, disciplinary, or program authorities; the controlled 

substance monitoring program of another State; and agents of DHHS, State 

Medicaid programs, State health departments, or DEA. 

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It requires the Secretary to (1) specify a uniform electronic format for the 

reporting, sharing, and provision of information under this Act; and (2) study 

and report to Congress on such programs, including on interoperability between 

programs, the feasibility of a real-time electronic controlled substance monitoring 

program, privacy protections, and technological alternatives to centralized 

data storage. 

3. Bill Number: H.R.1132 National All Schedules Prescription 

Electronic Reporting Act of 2005 

Introduced by: Representative Ed Whitfield (KY-1) 

The National All Schedules Prescription Electronic Reporting Act of 2005 

amends the Public Health Service Act to require the DHHS Secretary to award 

one-year grants to each approved State to establish or improve a State controlledsubstance monitoring program. It requires the Secretary to develop minimum 

standards for States to ensure security of information collected and to recommend 

penalties for the provision or use of information in violation of applicable laws 

or regulations. 

It requires each approved State to (1) require dispensers to report to the State 

within one week of each dispensing of a controlled substance to an ultimate 

user or research subject; and (2) establish and maintain an electronic searchable 

database containing the information reported. It allows a State to provide 

information from the database in response to certain requests by practitioners; 

law enforcement, narcotics control, licensure, disciplinary, or program authorities; 

the controlled-substance monitoring program of another State; and agents of 

DHHS, State Medicaid programs, State health departments, or DEA. 

This bill requires the Secretary to (1) specify a uniform electronic format for the 

reporting, sharing, and provision of information under this Act; (2) give preference 

to approved States in awarding any grants related to drug abuse; and (3) study 

and report to Congress on such programs, including on interoperability between 

programs, the feasibility of a real-time electronic controlled substance monitoring 

program, privacy protections, and technological alternatives to centralized 

data storage. 

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Emergency Communications for First Responders: 

1. Bill Number: S.1274 

Improve Interoperable Communications for First Responders 

Act of 2005 

Introduced by: Senator Joseph I. Lieberman (CT) 

Improve Interoperable Communications for First Responders Act of 2005 

establishes an Office for Interoperability and Compatibility (OIC), headed by a 

Director, within the Directorate of Science and Technology of DHS. S.1274 

requires the OIC Director to (1) assist the Secretary in developing and implementing the program to enhance public safety interoperable communications 

at all levels of government; (2) carry out DHS responsibilities and authorities 

relating to the SAFECOM Program; and (3) conduct extensive, nationwide 

outreach and foster the development of interoperable communications systems 

by State, local, and tribal governments and public safety agencies, and by regional 

consortia thereof. 

It requires the Secretary to (1) establish a comprehensive research and development 

program to promote communications interoperability among first responders; 

and (2) make grants to States and eligible regions for initiatives necessary to 

achieve short-term or long-term solutions to Statewide, regional, national, and, 

where appropriate, international interoperability. 

2. Bill Number: H.R.1251 

The Connecting the Operations of National Networks of Emergency 

Communications Technologies for First Responders Act of 2005 

Introduced by: Representative Nita M. Lowey (NY-18) 

The Connecting the Operations of National Networks of Emergency 

Communications Technologies for First Responders Act of 2005 requires the 

DHS Secretary, in cooperation with State and local governments, Federal agencies, 

public safety agencies, and the private sector, to develop a national strategy to 

achieve communications interoperability and to report to Congress annually on 

progress toward achieving such interoperability. 

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3. Bill Number: H.R.1544 

Faster and Smarter Funding for First Responders Act of 2005 

Sponsor: Representative Christopher Cox (CA-48) 

The Faster and Smarter Funding for First Responders Act of 2005 amends the 

Homeland Security Act of 2002 to set forth provisions governing DHS grant 

funding for first responders pursuant to the State Homeland Security Grant 

Program, the Urban Area Security Initiative, and the Law Enforcement Terrorism 

Prevention Program. It directs the Secretary of Homeland Security to require any 

State applying for a covered grant to submit a three-year State homeland security 

plan, to be developed in consultation with local governments and first responders. 

This bill directs the Secretary, in consultation with specified officials and standards 

organizations, to promulgate national voluntary consensus standards for grantfunded first responder equipment and training. It requires the coordination of 

such activities that relate to health professionals with the DHHS Secretary, and 

also requires the Comptroller General to report to Congress on the overall 

inventory and status of first responder training programs of DHS and other 

Federal agencies and the extent to which such programs are coordinated. 

Homeland Security and Emergency Response: 

1. Bill Number: S.21 

Homeland Security Grant Enhancement Act of 2005 

Introduced by: Senator Susan M. Collins (ME) 

The Homeland Security Grant Enhancement Act of 2005 requires the Director 

of the Office for Domestic Preparedness to allow any State to request approval 

to reallocate funds received under the State Homeland Security Grant Program 

under specified Federal laws among the categories of equipment, training, 

exercises, and planning. 

This bill creates the position of Executive Director to head the DHS’s Office for 

State and Local Government Coordination and Preparedness (OSLGCP) and 

give it additional responsibility for managing the Homeland Security Information 

Clearinghouse. The Clearinghouse will provide States, local governments, and 

emergency response providers with information regarding (1) homeland security 

grants; (2) technical assistance; (3) best practices; and (4) the use of Federal funds. 

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It directs the DHS Secretary to support the development of, promulgate, and 

update as necessary national voluntary consensus standards for the performance, 

use, and validation of first responder equipment for purposes of assessing 

equipment-related grant applications. 

The Homeland Security Grant Enhancement Act of 2005 establishes in DHS an 

International Border Community Interoperable Communication Demonstration 

Project to (1) address the interoperable communication needs of police officers, 

firefighters, emergency medical technicians, the National Guard, and other 

emergency response providers; (2) foster interoperable communications among 

domestic government agencies and their counterparts in Canada or Mexico; 

(3) foster standardization of interoperable communications equipment; (4) ensure 

that emergency response providers can communicate with one another and the 

public at disaster sites or in the event of a terrorist attack or other catastrophic 

event; and (5) provide training and equipment to enable emergency response 

providers to deal with environmentally varied threats and contingencies. 

2. Bill Number: S.1013 

Homeland Security FORWARD Funding Act of 2005 

Introduced by: Senator Dianne Feinstein (CA) 

The Homeland Security FORWARD Funding Act of 2005 requires the DHS 

Secretary to establish clearly-defined essential capabilities for State and local 

government preparedness for terrorism (sets forth factors to address in establishing 

such capabilities and lists critical infrastructure sectors and types of threats to 

specifically consider). 

It directs the DHS Secretary to promulgate national voluntary consensus standards 

for grant-funded first responder equipment and training, and it expresses the 

sense of Congress regarding interoperable communications and Citizen Corps 

councils, and requires the Secretary to (1) ensure coordination of Federal efforts to 

prevent, prepare for, and respond to acts of terrorism and other major disasters and 

emergencies among DHS divisions; and (2) study the feasibility of implementing a 

nationwide emergency telephonic alert notification system. 

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3. Bill Number: H.R.796 

Domestic Preparedness Act of 2005 

Introduced by: Representative Carolyn McCarthy (NY-4) 

The Domestic Preparedness Act of 2005 authorizes the Secretary of Homeland 

Security to make grants to address homeland security preparedness shortcomings 

of units of municipal and county government. It specifies that each grant shall 

be made for one of the following categories: (1) equipment and training, or 

(2) improving interoperability among members of a consortium of municipal 

and county governments. It states that the Secretary may not make a grant 

under this Act unless the applicant conducts an assessment of the applicant’s risk 

and vulnerability to possible acts of terrorism, including conventional biological, 

nuclear, and chemical attacks. 

The Domestic Preparedness Act of 2005 provides that grant amounts may be 

distributed to fire departments, police departments, emergency services, and 

public health agencies of the grantee. 

4. Bill Number: H.R.1323 

The Public Safety Interoperability Implementation Act 

Introduced by: Representative Bart Stupak (MI-1) 

The Public Safety Interoperability Implementation Act amends the National 

Telecommunications and Information Administration Organization Act to 

establish in the Treasury the Public Safety Communications Trust Fund. It 

requires the Administrator to make grants to implement interoperability and 

modernization for the communication needs for public safety, fire, emergency, 

law enforcement, and crisis management by State and local government agencies 

and instrumentalities and nonprofit organizations. 

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Government Programs and Departments: 

American Health Information Community (AHIC) 

On June 6, 2005, the Department of Health and Human Services (DHHS) 

Secretary Mike Leavitt announced the formation of a national collaboration, the 

American Health Information Community (AHIC), which will advance health 

IT efforts across the public and private sectors to respond to the President’s call 

for a majority of Americans to have electronic health records within 10 years. 

AHIC will help the nationwide transition to electronic health records—including 

common standards and interoperability—to proceed in a smooth, market-led way. 

AHIC, which will be formed under the auspices of the Federal Advisory 

Committee Act, will provide input and recommendations to DHHS on how 

to make health records digital and interoperable, and it will ensure that the 

privacy and security of those records are protected. 

AHIC will be initially chartered for two years, with the potential to extend its 

charter. Secretary Leavitt intends for AHIC to be succeeded within five years by 

a private sector health information community initiative that, among other things, 

would set additional standards, certify new health information technology, and 

provide long-term governance for healthcare transformation. 

For more information, please contact:

The Office of the National Coordinator for Healthcare IT 

ONC c/o U.S. Dept of Health and Human Services 

200 Independence Avenue, S.W. 

Washington, DC 20201 

Phone: 866-505-3500 

E-mail: onchit.request@hhs.gov 

Web site: http://www.hhs.gov/healthit/ 

Agency for Healthcare Research and Quality (AHRQ) 

Originally created in 1989 as a Public Health Service agency in the Department 

of Health and Human Services (DHHS), the Agency for Healthcare Research 

and Quality (AHRQ) was reauthorized in 1999. AHRQ’s mission is to support 

research designed to improve the quality, safety, efficiency, and effectiveness of 

healthcare in America. It sponsors and conducts research and programs that 

provide evidence-based information on healthcare outcomes: quality as well as 

cost, use, and access. 

Existing Efforts
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AHRQ’s health IT initiative in fiscal year 2005 includes $139 million in 

multiyear funding for more than 100 projects and contracts across the country via 

its Transforming Healthcare Quality Through Information Technology (THQIT) 

grants and State and Regional Demonstration (SRD) contracts portfolio, which 

impact 40 million Americans. These initiatives are exploring and testing a wide 

range of health IT applications with the potential to transform everyday clinical 

practice and help build the 21st century health IT infrastructure. AHRQ’s health 

IT initiative encompasses three types of grants that: 

• Support planning for health IT projects; 

• Support implementation of health IT projects; and 

• Demonstrate the value of health IT applications. 

The goals of these projects are as follows: 

• Using IT to improve patient safety and reduce medical errors; 

• Identifying barriers and solutions to IT implementation; 

• Increasing satisfaction among patients and providers through health IT; 

• Making the business case for health IT by determining both the costs 

and the benefits; and

• Streamlining work for clinicians and enhancing efficiency. 

AHRQ also maintains the National Resource Center for HIT. The Center 

provides technical assistance, expert advice, and best practices to a variety of 

organizations and entities utilizing or contemplating the utilization of health 

IT. Currently, AHRQ is concentrating on the support of AHRQ and Health 

Resources and Services Administration (HRSA) HIT grantees and contractors. 

However, the Center has recently begun to provide support to local, State, and 

regional entities developing health information exchanges/networks. To date, 

they supported efforts in Florida, Montana,Wyoming, and NewYork. The 

center was established through a five-year, $18.5 million contract and is a 

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central component of AHRQ’s commitment to provide assistance, project and 

technical insight, and the dissemination of best practices. 

For more information, please contact:

Dr. Scott Young, Director for Health IT 

540 Gaither Road 

Rockville, MD 20850 

Phone: 301-427-1500 

E-mail: syoung@ahrq.gov 

Web site: http://www.ahrq.gov/ 

Centers for Medicare and Medicaid Services (CMS) 

The Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. 

Department of Health and Human Services (DHHS), administers the Medicare 

program for U.S. citizens age 65 and older, the disabled, and people with end 

stage renal disease (ESRD), and works in partnership with the States to administer 

Medicaid, the State Children’s Health Insurance Program (SCHIP), and health 

insurance portability standards. CMS also works on administrative simplification 

standards from the Health Insurance Portability and Accountability Act of 1996 

(HIPAA) quality standards in healthcare facilities through its survey and certification activity, and clinical laboratory quality standards. Currently, about 83 million 

beneficiaries, or more than one in four Americans, receive healthcare coverage 

through Medicare, Medicaid, and SCHIP. In fiscal year 2005, CMS will spend 

about $519 billion. 

CMS is currently supporting several initiatives to support the effective use of HIT 

to improve the quality and efficiency of healthcare. Through Quality Improvement 

Organizations, CMS offers assistance to physicians’ offices in adopting and using 

information technology in the Doctor’s Office Quality Information Technology 

Project (DOQ-IT). This project provides primary care physicians with information on more than 60 private electronic health record systems (EHRs) and tools 

to select and implement the best EHR for their practice.As a part of this effort, 

CMS is working withVHA to reconfigureVistA, theVHA’s Electronic Healthcare 

Record (EHR) technology, which is a low-cost alternative for certain small physician offices or safety net providers. In another effort to accelerate the adoption of 

HIT, CMS is developing the Care Management Performance Demonstration 

program, a pay-for-performance demonstration program in which physicians 

will be reimbursed, in part, based on their use of HIT to improve quality of care. 

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118 

CMS is also accelerating the adoption of e-prescribing by requiring sponsors of 

the new outpatient drug benefit to comply with standards to enable e-prescribing. 

To empower Medicare beneficiaries with information about their own care, CMS 

has initiated the Medicare Beneficiary Portal demonstration project. This project 

is being implemented nationally on a rolling basis throughout 2005 and will allow 

beneficiaries direct Web access to their Medicare claims information, including 

claims type, dates of service, and procedures in a way that will protect their privacy 

and the security of their information. 

Finally, CMS has provided funding for some State activity related to the use of 

information technology. NewYork State is planning to use approximately $200 

million in savings from a Section 1115 Medicaid Waiver to promote the adoption 

of e-prescribing, EHRs, and regional health information programs. 

For more information, please contact:

Ms. Kelly Cronin, Senior Advisor to the Administrator 

Centers for Medicare and Medicaid Services 

7500 Security Boulevard 

Baltimore, MD 21244-1850 

Phone: 202-260-6726 

E-mail: kelly.cronin@cms.hhs.gov 

Web site: http://www.cms.hhs.gov 

The Cancer Biomedical Informatics GridTM (caBIGTM) 

Aiming to speed the delivery of innovative approaches for the prevention and 

treatment of cancer, the cancer Biomedical Informatics GridTM (caBIGTM) was 

launched in February 2004 with an initial budget of $20 million from the 

National Cancer Institute (NCI). Currently in the second year of a three-year 

pilot project, caBIGTM operates with 50 NCI-designated cancer centers as well as 

with other organizations. caBIGTM enables clinical researchers to exchange a wide 

range of data, including lab tests, tissue samples, and research information using a 

semantically interoperable infrastructure. 

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caBIGTM is developing open and shared biomedical informatics tools, standards, 

infrastructure, and data, focusing on the following: 

• Clinical trial management systems; 

• Integrative cancer research; 

• Tissue banks and pathology tools; 

• Architecture; and 

• Vocabularies and common data elements. 

caBIGTM is expanding participation of both NCI- and non-NCI-designated 

cancer centers in the interoperable system, with the ultimate goal of supporting 

patient-centric molecular medicine. Discussions are also taking place regarding 

potential partnerships between caBIGTM and other NIH components, Federal 

agencies, and international initiatives. 

For more information, please contact:

Dr. Kenneth Buetow, Director, NCI Center for Bioinformatics 

6116 Executive Blvd., Suite 403 

Rockville, MD 20852 

Phone: 301-435-1520 

E-mail: buetowK@mail.nih.gov 

Web site: https://cabig.nci.nih.gov/ 

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Department of Defense (DoD) 

The Department of Defense (DoD) has been working on electronically coordinating healthcare information among the United States Army, Navy, and Air 

Force since the approval to deploy the Composite Health Care System worldwide 

in 1993. Since these initial efforts toward an interoperable health system in the 

military, DoD has invested more than $2 billion dollars toward health IT adoption. 

DoD’s efforts toward healthcare interoperability span a wide range of methods 

throughout the echelons of medical care, ranging from treatment on the battlefield 

to the rehabilitation facilities in the various branch hospitals. 

Today, DoD is investing in initiatives such as the Composite Health Care 

System II (CHCS II), the Pharmacy Data Transaction Service (PDTS,) telehealth, 

and other efforts to facilitate communication in the Military Health Services. 

These initiatives are often part of larger interoperable efforts such as the Executive Information/Decision Support, which provides real-time, accurate decision 

information that supports the Defense’s TRICARE program; the Theater Medical 

Information Program (TMIP), which provides interoperable health information 

to the services during combat or contingency operations across all echelons of 

care; and the Clinical Information Technology Program Office (CITPO), which 

manages clinical information technology support for the Military Health Services. 

Along with these initiatives to connect the three service branches within DoD, 

DoD is collaborating withVA to coordinate connected health information in 

the future. 

For more information, please contact:

Ms. Marianne Coates, Director of Communications for OASD Health Affairs 

5111 Leesburg Pike, Suite 601 

Falls Church, VA 22041 

Phone: 703-681-1698 

E-mail: marianne.coates@ha.osd.mil 

Web site: www.defenselink.mil/ 

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HEALTHeFORCESTM 

Established under congressional direction in 2000 at the Walter Reed Army 

Medical Center (WRAMC), HEALTHeFORCESTM was created with patient 

involvement and communication at the heart of the delivery system. Effective 

communication combined with comprehensive digital records, advanced analytical 

tools, and Web-based access allows the medical staff to make informed decisions 

to reduce incidence of chronic illness, prevent clinical errors, and contain costs— 

all while increasing the quality of care to all patients. With the extension of this 

application into civilian rural underserved areas, these methods will give patients 

and doctors state-of-the-art information and the ability to predict and identify 

health threats for both the military and civilian communities. 

The strength of HEALTHeFORCESTM is its modular design and universal Webbased access. HEALTHeFORCESTM uses modules such as HEALTHeSURVEYS, 

where patients provide valuable feedback; HEALTHeCARDS, which document 

clinical practice guideline data and reference Web sites for provider and/or patient 

education; and HEALTHeNOTES, a clinical note writer. The system has evolved 

from a low-cost military application into one that can be employed throughout 

the United States. HEALTHeFORCESTM currently operates from a $5 million 

annual budget, which includes an active programming effort with an eight-week 

release schedule. 

HEALTHeSTATESTM, a civilianized technology transfer of the 

HEALTHeFORCESTM application, focuses on rural, medically underserved 

areas. It launched its first program in WestVirginia in 2004. The program 

permits real-time collection of patient health status information and allows the 

provider to assess identified issues immediately and to document the encounter 

thoroughly and appropriately. 

The United States Air Force is prepared to offer HEALTHeSTATETM as opensource software to public and private institutions through a Cooperative Research 

and Development Agreement (CRADA). This public/private partnership will 

collaborate on intellectual property, labor, licensing, patents, data sharing, and 

distribution to limit the risks of adoption that private sector partners face. 

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122 

HEALTHeFORCESTM was the first and only civilian or military organization 

to receive six Disease Specific Care Certifications from the Joint Commission 

on Accreditation of Healthcare Organizations (JCAHO) and has been nationally 

recognized with the following awards: 

• Disease Management Association of America’s “Best Disease Management 

Program in the Military”; 

• Grace Hopper “Gracie”Technology Leadership Award for “Leadership in the 

Innovative Application of Information Technology Contributing to the 

Advancement of Scientific Knowledge and Applications”; 

• Emerging Technology and Healthcare Innovations Congress’ 

“Best In Show” and Most Innovative Technology in the Hospital 

Community” TETHIE Awards; 

• American Council for Technology (ACT)’s “Innovative Approach to Service 

to the Citizen”Award. 

For more information, please contact:

Colonel Peter Demitry, Assistant Surgeon General, Modernization Directorate, AF/SGR 

5201 Leesburg Pike, Suite 1401 

Falls Church, VA 22041 

Phone: 703-681-7055 

E-mail: peter.demitry@pentagon.af.mil or Jill.Phillips@pentagon.af.mil 

Web site: www.healtheforces.org 

Indian Health Services (IHS) 

The Indian Health Services (IHS) is an agency within DHHS that operates a 

comprehensive health service delivery system for approximately 1.8 million of 

the nation’s estimated 3.3 million American Indians and Alaska Natives living 

mainly on reservations and in rural communities. IHS’s annual budget for its 

many initiatives is $3.5 billion. 

IHS has an extensive history of using IT to improve patient care and data 

reporting, including the following: 

• Resource and Patient Management System (RPMS)—designed as a suite of 

more than 60 software applications, RPMS is an easy and integrated way to 

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• Clinical Reporting System (CRS)—a population-based software application 

that facilitates reporting on more than 40 clinical quality measures. CRS 

produces local reports that are then exported to the regional and national 

levels to evaluate quality of care. 

• Indian Health Performance Evaluation System (IHPES, formerly ORYX) 

—to receive private certification for quality patient care, IHS implemented 

this tool to help track statistical outcome indicators of care. 

• National Patient Information Reporting System (NPIRS)—building upon 

RPMS data, NPIRS receives, processes, and reports all patient demographics 

and patient care related activity for IHS on a national basis. NPIRS allows 

better management of individual patients, local facilities, and regional and 

national programs. 

Currently, IHS is upgrading its systems to a National Data Warehouse (NDW), 

a new, state-of-the-art, enterprisewide data warehouse environment. Once 

established, the NDW database will continue as the source for aggregate patient 

and population information that facilitates compliance with administrative, 

accreditation, and patient care needs. 

For more information, please contact:

Dr. Theresa Cullen, Senior Medical Informatics Consultant 

300 West Congress 

Tucson, AZ 85701 

Phone: 520-670-4803 

E-mail: theresa.cullen@ihs.gov 

Web site: http://www.ihs.gov 

Existing Efforts
124 

Health Resources and Services Administration (HRSA) 

HRSA’s mission is to provide the national leadership, program resources, and 

services needed to improve access to culturally competent, quality healthcare. 

In fiscal year 2005, HRSA’s budget totaled $7.4 billion to support access to 

primary and other health services to uninsured, underinsured, and special 

needs populations. 

HRSA’s health information technology initiatives encompass a variety of 

programs aimed at improving the quality and safety of health services delivered 

by safety net providers in rural areas, medically underserved communities, and 

to special populations such as those with HIV/AIDS. 

• Community Health Centers—Over the past 10 years, HRSA has invested 

nearly $95 million in 50 networks of health centers that provide health 

information technology services to 410 grantees around the country, 

including support for electronic health records. One of these networks, 

the Health Choice Network in Florida provides HIT services to 14 

centers in Florida, six centers in New Mexico, and seven centers in Utah. 

These networks will be among the major mechanisms for disseminating 

health information technology to other centers and safety net providers 

around the country. 

• Health Community Access Programs (HCAP)—HRSA supports HIT 

through HCAP, which is funded with more than $80 million a year. This 

program helps safety net providers in a community reorganize their delivery 

systems to provide better coordinated, more efficient care for uninsured 

residents. Using HIT to share information on uninsured patients between 

hospitals and local clinic services is one common strategy supported by 

this program. 

• HIV/AIDS Program—The Special Projects of National Significance supports 

demonstrations that evaluate the use of health information technology on the 

quality of primary care for people living with HIV. Six grantees have been 

funded in the four-year initiative, which will continue through 2006. 

• Office for the Advancement of Telehealth—This program awards 15 grants 

a year totaling about $4 million for rural telemedicine and telehealth 

network projects. 

Ending the Document Game Ending the Document Game 
125

• Chronic Disease Management and Rural Health Programs—As part of its 

efforts to improve healthcare quality, HRSA supports investments in HIT 

under its Health Disparities Collaboratives in health centers. Collaboratives 

are organized around a care model that uses disease registries and other 

clinical information systems that track patient care and patient self-management for patients with diabetes, cancer, and other chronic diseases. Similar 

investments are available for rural health programs such as critical access 

hospitals and rural health clinics. 

For more information, please contact:

Dr. Dennis Williams, Deputy Administrator for HRSA 

5600 Fishers Lane, Room 14-05 

Rockville, MD 20857 

Phone: 301-443-2194 

E-mail: dwilliams1@hrsa.gov 

Web site: www.hrsa.gov 

National Committee on Vital and Health Statistics (NCVHS) 

NCVHS was established by Congress to serve as an advisory body to DHHS 

on health data, health statistics, and national health information policy. Its work 

includes advising on the development of a National Health Information 

Infrastructure (NHII), the selection of health data standards and the promotion 

of privacy policies to ensure public trust. The NCVHS 2005 budget includes $1.3 

million from DHHS, including staff costs. The overall focus of NCVHS is on 

identifying the information and information technologies needed to improve the 

health of the U.S. population. 

NCVHS has delivered several reports and recommendations to the Secretary of 

DHHS focusing on standards identification and development, e-prescribing, and 

technical infrastructure. 

• E-prescribing, 2004–2005—The Medicare Modernization Act directed 

NCVHS to identify and recommend standards for e-prescribing that could 

be used in implementing the new Medicare Part D benefit. 

• Information for Health:A Strategy for Building the National Health 

Information Infrastructure, 2001—Recommended the creation of 

ONCHIT and proposed a vision and framework for interoperable 

health information technology.

Existing Efforts
126 

• Uniform Data Standards for Patient Medical Records Information, 

2000–2003—Set forth a strategy, framework, and criteria for selection 

of clinical data standards and recommended to DHHS specific clinical data 

standards that became the foundation of the Consolidated Healthcare 

Informatics Standards. 

NCVHS continues to examine issues and make recommendations, focusing on 

the following: 

• HIT standards and harmonization; 

• Privacy and security issues and solutions; 

• Developing National Health Information Networks (NHINs); 

• Other HIT strategy issues such as personal health records; and 

• Health and healthcare disparities. 

For more information, please contact:

Marjorie S. Greenberg, Executive Secretary 

National Center for Health Statistics, CDC 

3311 Toledo Road, Room 2413 

Hyattsville, MD 20782 

Phone: 301-458-4245 

E-mail: msg1@cdc.gov 

Web site: www.ncvhs.hhs.gov 

Ending the Document Game Ending the Document Game 
127

The Veterans Health Administration (VHA) 

Since 1985,VA has been working to automate health information. In late 1996, 

VHA launched the Computerized Patient Record System (CPRS) to provide 

a single interface to allow healthcare providers to review and update a patient’s 

medical record and use computerized order entry for a variety of services and 

items, including medications, special procedures, x-rays, patient care nursing 

orders, diets, and laboratory tests. Of theVHA’s 2005 fiscal year budget, 4.86%, 

or approximately $78 per enrollee, is dedicated to information technology. 

Today, CPRS supports one of the largest integrated health systems in the 

United States. CPRS serves more than five million veterans and is used in all 

VA Medical Centers (157 hospitals), 134 nursing homes, and 887 outpatient 

clinics. The Bar Code Medication Administration (BCMA) is a component of 

CPRS that electronically validates and documents medications for inpatients in all 

VA Medical Centers, handling more than 590,000 inpatient medications each day. 

My HealtheVet is a Web-based personal health record that creates a new, on-line 

environment where veterans, family, and clinicians may come together to optimize 

veterans’ healthcare. By the end of calendar year 2005, appointment scheduling 

and medication refill ordering will be added to the current functionality. The 

next generation, HealtheVetVistA, will move to a person-centered, fully sharable 

system that will improve flexibility to respond to future health needs while 

lowering the cost of maintenance. 

HealthePeople is a collaborative strategy to increase interoperability while providing 

a new platform for information sharing among other healthcare providers. Since 

1995,VA’s budget has increased 51% while the number of patients has increased 

104%. The number of employees has decreased 5%. 

For more information, please contact:

Ms. Gail Graham, Director, Health Data and Informatics 

Veterans Health Administration (19F2) 

810 Vermont Avenue, N.W. 

Washington, DC 20420 

Phone: 202-273-9220 

E-mail: gail.graham@va.gov 

Web site: www1.va.gov/vha_oi/ 

Existing Efforts
128 

Disclaimer: The contents of the digital map and HIT database are solely the 

responsibility of the authors and do not necessarily represent the official view 

of the Center for Health Information and Decision Systems or the University of 

Maryland. The material contained in this document is for informational purposes 

only. CHIDS makes no guarantees as to the accuracy and/or completeness of this 

information. Copyright in any third-party materials found in this document must 

be respected. Some webpage links are provided to other Internet sites for the 

convenience of users. CHIDS is not responsible for the availability or content of 

these external sites, nor does CHIDS endorse, warrant, or guarantee the products, 

services, or information described or offered at these other Internet sites. 

Ending the Document Game 

Health IT Activity in USA as of July 2005
129

The database and digital map were compiled by the Center for Health Information 

and Decision Systems (CHIDS), an academia-led, health information technology 

research and development center located in the Robert H. Smith School of Business 

at the University of Maryland. The mission of CHIDS is to improve the delivery of 

health care by offering researched solutions in health information technology that 

have an impact on safety, quality, access, efficiency, and return on investment. 

For more information regarding CHIDS’ capabilities or to inquire about a dynamic, 

interactive version of the CHIDS HIT Digital Map and HIT database, please contact 

a CHIDS representative at 301.405.0702 or chids@rhsmith.umd.edu. 

Center for Health Information and Decision Systems 

Robert H. Smith School of Business 

University of Maryland 

College Park, MD 20742 

CHIDS HIT Digital Map 

Project Lead: Corey M. Angst, Associate Director, CHIDS 

Other Personnel: Ken Yale, Senior Fellow, CHIDS 

Ritu Agarwal, Director, CHIDS 

© 2005, Center for Health Information and Decision Systems (CHIDS), 

University of Maryland, All Rights Reserved. 

Nationwide Bridges-to-Excellence (POL) 

Bridges to Excellence Physician Offi ce Link (POL) reward program - eligible 

physicians must demonstrate that they have implemented systematic offi ce 

processes passing NCQA’s offi ce practice performance assessment program. Offi ce 

practices are assessed in three critical system areas: clinical information systems, 

patient education and support, and care management. 

Enables physician offi ce sites to qualify for bonuses based on their implementation 

of specifi c processes to reduce errors and increase quality. They can earn up to $50 

per year for each patient covered by a participating employer or plan. In addition, 

a report card for each physician offi ce describes its performance on the program 

measures and is made available to the public. 

Medstat Group 

1-800-224-7161 

bridgestoexcellence@thomson.com 

BTE_01 

Nationwide Bridges-to-Excellence (DCL) 

To obtain the rewards available through the Bridges to Excellence Diabetes Care 

Link (DCL) reward program, eligible physicians must demonstrate that they provide 

high levels of diabetes care by passing NCQA’s diabetes performance assessment 

program. Two performance assessment options are available through NCQA: 

-For 1-year certifi cation for BTE rewards-eligible physicians, physicians submit data 

on HbA1c, blood pressure, and lipid testing for diabetes patients. 

-For 3-year recognition from NCQA’s Diabetes Physician Recognition Program 

(DPRP), physicians submit data on the same three outcome measures as needed for 

1-year certifi cation, as well as data on eye, foot, and nephropathy exams for their 

diabetes patients. 

NCQA 

2000 L Street, NW, Suite 500 

Washington, DC 20036 

202-955-3500, 

Customersupport@ncqa.org 

BTE_03 

Nationwide Bridges-to-Excellence (CCL) 

To obtain the rewards available through the Bridges to Excellence Cardiac Care Link 

(CCL) reward program, eligible physicians must demonstrate that they provide high 

levels of cardiac care by passing NCQA’s cardiac performance assessment program. 

Physicians must submit data on blood pressure, lipid and cholesterol testing, 

aspirin/antithrombotic use, and smoking cessation status for their cardiac patients. 

NCQA 

2000 L Street, NW, Suite 500 

Washington, DC 20036 

www.ncqa.org/hsrp, 888-275-7585 

BTE_04 

Existing Efforts 
Medem (free Personal 

wide 

Health Record) and 

Allscripts Healthcare 

Solutions 

130

Medem (free Personal 

Nation- Health Record) and Health Record) and 

wide Allscripts Healthcare 

Solutions

Medem, a for-profit company affiliated with the American Medical Association, 

announced it would offer patients free, personal health records. The new 

service, called iHealthRecord, allows patients to enter information about the 

medications they take, their allergies, emergency contact information and other 

data and share that information with physicians or other authorized users. About 

100,000 physicians pay $25 a month to subscribe to Medem’s other online patient 

communications services. Medem has partnered with EMR vendor Allscripts 

Healthcare Solutions its records to exchange data with the iHealthRecord. 

Ed Fotsch, M.D., CEO MEDEM 

649 Mission Street, 2nd Floor 

San Francisco, CA 94105 PHIT_30 

info@medem.com 

415-644-3800 

Nationwide Kaiser Permanente and 

Epic Systems 

A three-year research project that measures the effects of using an electronic 

medical record across 110 physician teams at Kaiser Permanente could have 

wide-ranging implications for physician practices across the country. Entitled 

“The Impact of Health Information Technology on Clinical Care,” the project will 

measure the effects of staggered installation of technology developed by Epic 

Systems that includes an electronic medical record, provider order entry and clinical 

decision support. The nearly $1.5 million research initiative is designed to test 

the assumption that healthcare information technology can improve the quality of 

care and patient safety while at the same time reducing the number of visits to the 

doctor’s office. A grant from the Agency for Healthcare Research and Quality will 

pay for the study. 

John Hsu, Principal Investigator 

Kaiser Foundation Research 

Oakland, CA 

PHIT_31 

Nationwide 

Trigon, Blue Cross Blue 

Shield of Illinois, Blue Cross 

Blue Shield of Michigan, 

and Independence Blue 

Cross (PA) 

Trigon, an Anthem affiliate health plan, operates a program similar to Empire’s 

in that the health plan rewards hospitals for adopting Leapfrog standards for 

safe practices. Rewards are tied to patient safety improvements in the individual 

hospitals. Blue Cross Blue Shield of Illinois, Blue Cross Blue Shield of Michigan, 

and Independence Blue Cross (PA) are examples of other health plans using 

Leapfrog standards to encourage patient safety improvements. 

Anthem Blue Cross and Blue Shield 

2 Gannett Drive 

South Portland, ME 04106 

PHIT_32 

Nationwide 

MedicAlert Foundation and 

CapMed eHealthKey PHR 

Initiative 

The MedicAlert® E-HealthKEY is USB-based tool that launches critical health 

information when plugged into a computer. It also allows people to their complete 

personal health record at all times. 

Ramesh Srinivasan, VP Marketing 

MedicAlert Foundation 

209-669-2407 or Wendy Angst 

CapMed, wangst@capmed.com 

267-757-3315 

PHIT_34 

Region Bridges-to-Excellence 

(General) 

The four coalitions launching BTE-related projects are located in Illinois (two in 

Illinois), Colorado and Arkansas. The coalitions, through a licensing arrangement 

with BTE, have begun talking with employers and estimate launching customized 

programs in their respective markets later this year. Business coalitions are well 

suited to coordinating such incentive programs - by coordinating activities among 

employers, they can pool resources and streamline related operations, thus making 

the efforts more attractive to employers and physicians. All four coalitions are 

members of the National Business Coalition on Health (NBCH), a 70-coalition 

member strong organization that strongly supports pay-for-performance. 

Francois de Brantes 

Bridges to Excellence 

1-800-224-7161 

bridgestoexcellence@thomson.com 

BTE_02 

Various Healthcare Collaborative 

Network (HCN) 

The goals of the Healthcare Collaborative Network (HCN) are as follows 

• Demonstrate both the feasibility and the value of a standards-based, 

interconnected, electronic model of data interchange to a wide variety of 

stakeholders; • Demonstrate how electronic communications using common 

standards can help patients receive necessary and timely medical treatment and 

guard against medical errors, incorrect prescriptions and adverse drug. 

Bruno Nardone, CHE, Managing 

Consultant, Healthcare Strategy 

and Change Practice, IBM Business 

Consulting Services, Waltham, MA 

HIE_138 

AK Qualis Health 

Practices that participate in DOQ-IT will receive free assistance to select, 

implement, and optimize IT systems such as EHRs, e-prescribing, and registries. 

CMS has contracted with Qualis Health to provide DOQ-IT services to participating 

physicians in Washington, Idaho, and Alaska. 

Terry Keith, BS, RHIA / 

Clinical Consultant 

907-562-2133 

800-878-7170 

tkeith@qualishealth.org 

DOQ_02 

AK Multi Facility Integration 

(MFI) 

This HIE was started in 1974 under the auspices of the Indian Health Services (IHS), 

with data stored on microfiche. Since the mid 80s data has been stored on an IHS 

system called the “Resource and Patient Management System” (RPMS). 

Richard Hall 

4141 Ambassador Dr. 

Anchorage, AK 99508 

907-729-2622 

rhall@anthc.org 

HIE_003 

wide

Nation- Kaiser Permanente and 

Epic Systems

Trigon, Blue Cross Blue 

Nationwide

Nationwide

Bridges-to-Excellence Region

Healthcare Collaborative Various Network (HCN)

AK

Ending the Document Game 
131

AK Alaska Health Passport 

This HIE was set up as a medication management program to assist avoid adverse 

drug interactions and allergic reactions. The program is a partnership between the 

Alaska State Hospital Association and the Alaska State Nursing Home Association. 

The program uses “smart cards” carried by patients that records medication 

information and basic insurance coverage info. The system is also described as a 

way to accurately identify individual patients. 

Heidi Gosho

426 Main St.

Juneau, Alaska 99801

907-586-1790

hgosho@ashnha.com

HIE_004 

AK 

Central Kenai Peninsula 

Health Collaborative 

Technology 

Assesses current technology resources and plans implementation of area-wide 

electronic communications and connectivity to electronic health records and a 

patient-support Web-based data system. 

Edward Burke, Central Peninsula 

General Hospital, Inc., Soldotna, AK AHRQ_001 

AL Alabama Quality Assurance 

Foundation (No specific DOQ-IT information) 205-970-1600 800-760-4550 DOQ_01 

AL 

Dynamic Online Event 

Reporting System 

(DOERS PRO) 

DOERS is an adverse event reporting system that identifies “medication error and 

near miss” and reports it. The system is touted to be a medication error reporting, 

medication management, and medication safety education tool. The system is used 

by members of this HIE to assist with risk management. 

Barbara Traylor 

2800 University Drive, Ste. 304 

Birmingham, AL 35233 

250-939-7443 

BTraylor@stv.org 

HIE_001 

AL Montgomery Area 

Information Network 

The Montgomery Area Community Wellness Coalition was started in 2002, and 

advertises itself as an HIE. Their “Shared Patient Information Network” is intended 

to assist with health quality, efficiency, and effectiveness improvements. In 2003 

they started a database to assist with the health needs of the homeless, called 

“Homeless Management Information System”. Currently the two initiatives are 

called the Montgomery Area Information Network, providing a health and social 

services data repository for users. 

Carroll S. Nason, Dr PA 

3090 Mobile Highway 

Montgomery, AL 36108 

334-293-6504 

cnason@adph.state.al.us 

HIE_002 

AR Bridges-to-Excellence (POL) 

CMS is looking towards the BTE Physician Office Link program as a possible 

element in its forthcoming Medicare Care Management Performance 

Demonstration project, an initiative which will promote the adoption and use of 

health information technology to improve the efficiency and quality of patient care 

for chronically ill Medicare patients. Doctors who meet or exceed performance 

standards established by CMS in clinical delivery systems and patient outcomes 

will receive performance payments for managing the care of eligible Medicare 

beneficiaries. 

Medstat Group 

1-800-224-7161 

bridgestoexcellence@thomson.com 

BTE_01a 

AR 

Bridges-to-Excellence 

(General) - Employers’ 

Health Coalition 

The four coalitions launching BTE-related projects are located in Illinois (two in 

Illinois), Colorado and Arkansas. The coalitions, through a licensing arrangement 

with BTE, have begun talking with employers and estimate launching customized 

programs in their respective markets later this year. Business coalitions are well 

suited to coordinating such incentive programs - by coordinating activities among 

employers, they can pool resources and streamline related operations, thus making 

the efforts more attractive to employers and physicians. All four coalitions are 

members of the National Business Coalition on Health (NBCH), a 70-coalition 

member strong organization that strongly supports pay-for-performance. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org

 202-775-9300 

BTE_02d 

AR Arkansas Foundation for 

Medical Care 

Vision: Quicker access. Fewer errors. Improved efficiency. Electronic health records 

could transform your practice. But success takes time, planning and strategy. AFMC 

can help. As part of our commitment to improving health care in Arkansas, AFMC is 

taking part in a special study to help primary care offices understand and use this 

rapidly growing technology. We can help you analyze available options. 

Nancy Archer, 501-375-5700, ext. 661 

Hotline: 877-375-5700 

narcher@arqio.sdps.org 

physicianoffice@afmc.org 

DOQ_04 

AR 

Washington Regional 

HealthMedx Health 

Information Exchange 

The Washington Regional Health Information Exchange (called HealthMedx) is 

designed as a patient registry with a variety of information, including medical 

records scanned into the system. The HIE is looking for grant funding to expand. 

Washington Regional Medical Center created the Arkansas Institute for Research 

and Education Education in August 2002. 

Becky Magee 

1125 N. College Ave. 

Fayetteville, AR 72701 

bmagee@wregional.com 

HIE_005 

HIE_004

Existing Efforts 
132 

AR 

Arkansas Delta Inpatient/ 

Outpatient Quality 

Improvement 

Implements a computer decision-support system in a 23-county service area in 

both inpatient and outpatient settings, including several rural clinics; includes a 

training component for physicians and other health care providers as well as a 

hospital pharmacy component for adverse drug event management and prevention 

strategies. 

Cinda Bates 

St. Bernards Medical Center 

Jonesboro, AR 

AHRQ_002 

AZ Bridges-to-Excellence 

(General) 

CIGNA HealthCare is licensing the Bridges to Excellence program and is working 

with employers to pursue a pay-for-performance effort. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org

 202-775-9300 

BTE_02j 

AZ Health Services Advisory 

Group 

HSAG can provide the following free consulting services to a practice considering 

or in the process of implementing an EHR system: Assessment of your practice IT 

needs, practice workflows and efficiencies, staff IT competency levels, Assistance 

in planning and preparing your practice for an IT implementation, An evidencebased approach to helping you select the right IT solution, Help in using your 

IT system for better care management and improvement of your care delivery 

processes 

Sharon Miller/Director, Health 

Information Technologies

 602-745-6200 

smiller@azqio.sdps.org 

DOQ_03a 

AZ Health Care Excel 

Through this initiative, Health Care Excel (HCE), the Medicare Quality Improvement 

Organization for Indiana, will assist primary care physicians in adopting Electronic 

Health Record (EHR) systems with the ultimate goal of improving office efficiency 

and patient outcomes. This initiative is sponsored by the Centers for Medicare & 

Medicaid Services (CMS). 

Darlene Skelton 

812-234-1499 

602-441-3068 

DOQ_03b 

AZ AHCCCS Health Information 

Exchange 

This is a proposed HIE that would function as a data repository/warehouse which 

aggregates data from multiple sources, including but not limited to AHCCCS, Health 

Plans, RBHAs and PBMs. Data may include provider and member demographics, 

Health Plan PCP and RBHA behavioral health physician assignments by member and 

pharmacy data by member. 

Bonnie Marsh 

701 E. Jefferson 

Phoenix, AZ 85034 

602-417-4510 

BJMarsh@ahcccs.state.az.us 

HIE_006 

AZ Tele-health Arizona 

Community Health Centers 

This project is to install connectivity of tele-health videoconferencing so as to 

increase collaboration on DM programs among clinical staff. The project will 

integrate the qualified community health centers into a network to work together 

clinically, in management, and in educational and quality control. 

NA HIE_007 

CA Bridges-to-Excellence (POL) 

CMS is also looking towards the BTE Physician Office Link program as a 

possible element in its forthcoming Medicare Care Management Performance 

Demonstration project, an initiative which will promote the adoption and use of 

health information technology to improve the efficiency and quality of patient care 

for chronically ill Medicare patients. Doctors who meet or exceed performance 

standards established by CMS in clinical delivery systems and patient outcomes 

will receive performance payments for managing the care of eligible Medicare 

beneficiaries. 

Medstat Group 

1-800-224-7161 

bridgestoexcellence@thomson.com 

BTE_01b 

CA Lumetra 

Lumetra, assisted by key partners, is providing support to small- to medium-sized 

practices in implementing EHRs free of charge. Lumetra is helping physician 

practices: Assess practice readiness, Define EHR goals, Select an EHR vendor*, 

Prepare staff and office for EHRs, Conduct post implementation evaluations, Review 

EHR implementation and impact analysis 

John Weir 415-677-2083 

General: 415-677-2000 

doqit-ca@caqio.sdps.org 

DOQ_05 

CA Virtual Clinical Network 

Expansion 

The Virtual Clinical Network is designed to help track uninsured, Medicaid 

(MediCal), and county medical services beneficiaries. The system allows 

identification of patients when they present to an emergency room or other facility 

that does not have their medical records, and reports on their medical conditions 

and medications. It assists with proper treatment and to ensure persons are over 

medicating on controlled substances or are not in compliance with their medication 

regimen. 

Patrick Hughes 

360 Campus Lane, #100 

Fairfield, CA 94534 

707-863-4440 

PHughes@partnershiphp.org 

HIE_008 

AR 

Arkansas Delta Inpatient/

Outpatient Quality 

Improvement Improvement 

AZ Bridges-to-Excellence 

(General)

Health Services Advisory 

Group

AZ

AZ

AZ

Bridges-to-Excellence (POL)

CA Lumetra

CA

Ending the Document Game 
133

CA Healthy Fontana Online Healthy Fontana Online is on online HIE community for residents of the city of 

Fontana, CA. 

Mark Mayuga 

8353 Sierra Avenue 

Fontana, CA 92335 

909-350-7620 

mmayuga@fontana.org 

HIE_009 

CA Sierra Nevada Health Care 

Data Exchange 

This HIE is designed to be a medical and financial record accessible by physicians. 

A centralized database repository may be accessed and modified by physicians over 

the Internet. It is not clear whether this HIE is actually operational, or just in the 

design stage. 

Stuart Fleming MD 

640 East Main Street, Suite 2 

Grass Valley, CA 95945 

530-271-3201 

sfleming@gv.net 

HIE_010 

CA Virtual Information Highway 

(VIH) model 

This is a collaboration of stakeholders interested in developing a “federated” model 

of interconnected organizations that can exchange information with each other 

when an individual presents for treatment without their medical information. They 

also wish to use the system as a way to track, analyze, and study community health 

and disease prevalence. They will use a “VIH” model. 

Frederick W. James, MD 

Department of Pediatrics 

Charles R. Drew University 

Los Angeles, CA 

310-668-4641 

frjames@cdrewu.edu 

HIE_011 

CA Health-e-LA Health-e-LATM is going to develop the infrastructure to allow exchange of clinical 

information to participants in Los Angeles city and surrounding areas. 

Mark S. Windisch, Esq. 

L.A. Care Health Plan 

555 West Fifth Street, 29th floor 

Los Angeles, CA 90013 

213-694-1250, ext. 4144 

mwindisch@lacare.org 

HIE_012 

CA Long Beach Networking for 

Health & Surveillance 

This is described as a collaborative that intends to build the infrastructure to 

allow interconnectivity of health stakeholder databases (e.g. hospitals, physicians, 

laboratories, pharmacies, etc.) to exchange data to help improve healthcare of the 

local population. 

Laura Landry 

2525 Grand Avenue 

Long Beach, CA 90815 

562-570-4148 

laura_landry@longbeach.gov 

HIE_013 

CA Provider-Payor Network 

clinical data exchange 

Working on the infrastructure to allow exchange of clinical information between 20 

medical groups, 20 hospitals, and a “health plan reference library” to assist with 

treatment of patients with diabetes, asthma, and cardiovascular diseases. 

Donald Crane, President 

515 S. Figueroa Street Suite 1300 

Los Angeles, CA 90071 

213-538-0772 

DCRANE@CAPG.ORG 

HIE_014 

CA HealthConnect 

This project is designed to create the infrastructure to exchange clinical and 

administrative data over the Internet among stakeholders, including providers, 

payors, pharmacies, laboratories, government agencies, and patients. The platform 

is called “HealthConnect” and is designed to provide a common platform, reduce 

the cost of IT adoption, and allow for secure information exchange. 

DeLeys Brandman, MD 

510 Logue Ave 

Mountain View, CA 94043 

650-962-2680 

dbrandman@commerce.net 

HIE_015 

CA Circle of Care 

LMFC has created a coalition of technology companies, providers, a payer, and a 

medical information content provider to develop the Circle of Care project. The 

project is designed to build the infrastructure for electronic data interchange to 

exchange health information. 

Zara Marselian, CEO 

4185 Fairmount Avenue 

San Diego, CA 92105 

619-584-1612 

zaramarselian@lamaestra.org 

HIE_016 

CA 

Clinical Information 

Exchange Improvement 

Through Direct Patient 

Data Entry 

This is an initiative by two medical groups (with 320+ physicians) partnering to 

develop the infrastructure to allow information exchange between physicians and 

patients over the Internet. They hope to expand to 2,500 physicians. 

Joseph Traube, MD 

4275 Campus Point Court-CP220 

San Diego, CA 92121 

858-678-6087 

traube.joseph@scrippshealth.org 

HIE_017 

HIE_009

Existing Efforts 
134 

CA Santa Barbara County Care 

Data Exchange (CDE) 

This is considered a “public utility” model for clinical information exchange, 

with a “federated,” or peer-to-peer exchange of information between participant 

organizations, providers, and patients. 

Philip Greene 

110 Castillian Way 

Santa Barbara, CA 93117 

805-685-9525 

phil@sbrha.org 

HIE_018* 

RHIO_018 

CA Santa Cruz County Health 

Information Exchange 

This is designed to build the infrastructure to allow exchange of a broad range of 

clinical information for stakeholders within the county. 

Rama Khalsa 

1080 Emeline Ave. 

Santa Cruz, CA 95010 

831-454-4474 

rama.khalsa@health.co.santa-cruz.ca.us 

HIE_019 

CA Tulare District Hospital 

Patient Care Collaborative 

This HIE initiative is designed to create the infrastructure to allow sharing of 

clinical information between the sole, rural hospital in this community, the 

community clinic, and physicians. 

John Clark 

869 Cherry Street 

Tulare, CA 93274 

559-685-3409 

jclark@tdhs.org 

HIE_020 

CA Collaborative Health 

Information Project (CHIP) 

This project is designed to develop the infrastructure to allow secure information 

exchange between the health department and health organizations. They are first 

developing an electronic health record standard for the county. The project includes 

adoption of a document management system, central information repository, 

role-based access control (or similar protocol), and uploading of information to the 

central database. 

David B. Nelson 

10 Cottonwood 

Woodland, CA 95695 

530-666-8958 

David.Nelson@Yolocounty.org 

HIE_021 

CA Redwood Mednet 

Redwood MedNet seeks to Enhance the quality of health care for all residents 

of Mendocino and Lake Counties; Facilitate the individual and collective practice 

of medicine; Encourage adoption of Electronic Health Records; Interconnect all 

participants in the local health care community; and Collaborate with regional, 

State and Federal health information technology initiatives. Redwood MedNet’s 

initial focus is interoperable health records at solo and small practices. Later plans 

call for community wide participation with a special focus on population level 

Public Health monitoring and on HIE services for the five hospital emergency rooms 

in our region. 

Will Ross 

707-272-7255 

wross@openhre.org 

HIE_136 

CA CalRHIO 

CalRHIO’s goals are to: Encourage business, healthcare, and policy leaders to 

create private and public policy agendas - and to make funding commitments 

- in support of rapid development and implementation of health information data 

exchange technology in CA, facilitate creation of common governance, process, 

technology, and other elements needed to run one or more RHIOs under the 

auspices of a non-profit statewide umbrella organization, initiate sponsorship of 

projects that demonstrate the feasibility, utility, quality and financial benefits of 

health information data sharing, help organizers of existing data exchange efforts 

in California work toward common goals and to share information, materials, 

technology and learnings, support safety net provider and underserved population 

participation in governance, financing, and data exchange development priorities 

and support legislation, if required, for successful implementation of an integrated 

statewide health data exchange network. 

Ann Donovan, Project Director 

415-537-6938 

adonovan@healthtech.org 

HIE_137 

CA Smart Health Smart Valley is using Health Alliant to analyze the healthcare system in Silicon 

Valley and build a financial model. 

Seth Fearey, 408-938-1511 

s_fearey@jointventure.org HIE_141 

CA 

California Information 

Exchange-Linking Partners 

for Quality Healthcare 

(CALINX) 

CALINX convened work groups to establish detailed data standards and rules for 

data exchange in certain clinical and administrative areas. CALINX data standards 

were based on ANSI and other well-established national standards. CALINX also 

managed pilot efforts to demonstrate the cost-effectiveness of exchanging data 

using those standards in a secure, private way. 

David Hopkins, Pacific Business Group 

on Health, (415) 615-6322 

dhopkins@pbgh.org 

HIE_144 

CA Santa Barbara County Care 

Data Exchange (CDE)

CA Santa Cruz County Health 

Information Exchange

CA Tulare District Hospital 

Patient Care Collaborative

Collaborative Health 

CalRHIO

CA

Ending the Document Game 
135

CA Sutter Health and 

Epic Systems 

Sutter Health has made a commitment to deploy an electronic health record (EHR) 

inpatient-outpatient system network-wide over the next few years. This newest 

commitment expands on $154 million investment in EHR technology (EPIC). Sutter’s 

online system will electronically connect more than 5,000 physicians, 27 hospitals 

and millions of patients across its not-for-profi t Northern California network. 

Also has a patient safety initiative over the next 10 years, including bar-coding 

technology for safe bedside administration of medications, digital imaging and 

computerized physician order entry. 

John Hummel, Sutter Health Sr VP, CIO 

or Karen Garner 

Communications Manager 

916-286-8297 

garnerk@sutterhealth.org 

PHIT_01 

CA Wellpoint eRx or 

Paper Reduction 

WellPoint is spearheading an electronic initiative at a cost of $40 million that 

will reach 19,000 physicians. In California, Georgia, Missouri, and Wisconsin, 

physicians will be given the opportunity to choose from either of two electronic 

packages: a Prescription Improvement Package or a Paperwork Reduction Package. 

Ron J. Ponder, PhD, EVP 

Information Services, WellPoint or 

Nadia Leather – CGEY 

nadia.leather@capgemini.com 

212-314-8233 

PHIT_02a 

CA Cedars-Sinai Medical 

Center 

Cedars-Sinai Medical Center in Los Angeles, tried to move to an electronic medical 

record system, with disastrous results. The hospital’s computerized physician order 

entry (CPOE) system was suspended when physicians complained that the new 

system slowed down the process of fi lling and checking the accuracy of prescription 

orders and even lost some orders in the system. Cedars-Sinai plans to eventually 

reinstall the CPOE system when problems are resolved. 

Cedars-Sinai Medical Center 

8700 Beverly Blvd. 

Los Angeles, CA 90048 

Main Switchboard 

310-423-3277 

PHIT_03 

CA 

Integrated Healthcare 

Association, RWJF 

grant, and the California 

Healthcare Foundation 

Integrated Healthcare Association (IHA), supported through funds from its 

members, a Robert Wood Johnson Foundation grant (for evaluation), and the 

California Healthcare Foundation (for implementation), convened California’s six 

leading health plans (Aetna, Blue Cross of California, Blue Shield of California, 

CIGNA HealthCare of California, Health Net, and Pacifi Care with a seventh 

– Western Advantage - to join in 2004) to launch a program that ‘pays for 

performance’. The IT portion of the bonus is based on the groups’ ability to match 

multiple clinical data sets at the patient level and to deliver electronic data at the 

point of care (e.g., electronic lab results in the physician offi ce, registries, EHRs). 

Sheera Rosenfeld, The Health 

Strategies Consultancy LLC, 1350 

Conn. Ave, N.W., Suite 900 

Washington, DC 20036 

202-207-1308 

SRosenfeld@healthstrategies.net 

PHIT_04 

CA El Dorado County Safety 

Net Technology Project 

Develops a comprehensive plan for health IT implementation and integration 

by assessing specifi c clinical and organizational needs, feasibility of health IT 

implementation, defi ning project parameters, developing the implementation plan, 

and specifying procedures for ongoing evaluation and feedback. 

Neda West, Marshall Medical 

Placerville, CA AHRQ_003 

CA Crossing the Quality Chasm 

in Eastern Rural County 

Develops a regional collaborative and business plan for implementing health IT 

in a rural region; also conducts a telemedicine demonstration project to assess 

the barriers and issues of broad health IT intervention including telemedicine/ 

teleradiology, scan/store medical record, chronic disease registry and personal 

health record, and linking the region’s partners. 

Kiki Nocella, Tehachapi Hospital 

Tehachapi, CA AHRQ_004 

CA 

Tulare District Hospital 

Rural Health EMR 

Consortium 

Paul Galloway, Healthcare 

Management Systems, Tulare, CA AHRQ_006 

CA Santa Cruz County, CA 

Diabetes Mellitus Registry 

Expands an established Web-based, interactive Diabetes Mellitus Registry that 

provides patient histories and needed tests at the point of care among public, 

private, and not-for-profi t health care providers; also tracks the diabetes population 

to identify trends in key indicators of care. 

F. Wells Shoemaker, Pajaro Valley 

Community Health, Watsonville, CA AHRQ_007 

CA IT Systems for Rural Indian 

Clinic Health Care 

Integrates health services research, clinic redesign, and electronic practice 

management through the implementation of electronic health records and 

clinical decision support systems (CDSSs) by partnering with three rural Tribal 

Health Programs to implement electronic health records with clinical decision 

support systems. 

Susan Dahl, California Rural Indian 

Health Board, Sacramento, CA AHRQ_005 

Builds on an existing infrastructure to construct a fully integrated EMR to give 

clinicians real-time access to patient data through pharmacy management, 

laboratory management, patient scheduling, barcoding, clinical physician order 

entry, electronic signature, insurance eligibility, and Pyxis medication-dispensing 

units at nursing stations. 

Existing Efforts 
Impact of Health 

Information T

136

CA echnology on 

Clinical Care 

Evaluates the effects of staggered installation of an Epic health IT system that 

includes an electronic medical record (EMR) with provider order entry and clinical 

decision support in primary care settings on quality, safety, and resource use 

within a large integrated delivery system on cohort of 780,000 members with 

chronic illnesses. 

John Hsu, Kaiser Foundation Research 

Oakland, CA AHRQ_008 

CO 

Bridges-to-Excellence 

(General) - Colorado 

Business Group on Health 

The four coalitions launching BTE-related projects are located in Illinois (two in 

Illinois), Colorado and Arkansas. The coalitions, through a licensing arrangement 

with BTE, have begun talking with employers and estimate launching customized 

programs in their respective markets later this year. Business coalitions are well 

suited to coordinating such incentive programs - by coordinating activities among 

employers, they can pool resources and streamline related operations, thus making 

the efforts more attractive to employers and physicians. All four coalitions are 

members of the National Business Coalition on Health (NBCH), a 70-coalition 

member strong organization that strongly supports pay-for-performance. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org

 202-775-9300 

BTE_02c 

CO Colorado Foundation for 

Medical Care CFMC conducts DOQ-IT activities in Colorado under the direction of CMS. 

Cynthia King, RN, BSN, MSCIT 

informatics quality improvement 

advisor; 303-306-4483 or 

1-800-950-8250 x3156 

cking@coqio.sdps.org 

DOQ_06 

CO Roaring Fork Valley 

Community Health Plan 

This health plan intends to develop the infrastructure to exchange information with 

providers, employers, and beneficiaries. 

William Hanisch 

315 Oak Run Road 

Carbondale, CO 81623 

970-963-8044 

wdhresource@earthlink.net 

HIE_022 

CO 

Colorado Access Project to 

Enhance Proider-MemberPlan Communications 

This HIE is designed to exchange administrative information (eligibility, 

authorization, referral, claims, etc) with providers over the Internet. Other functions 

include secure email between providers, pharmacy data, educational material, 

health plan information, and other information useful to providers. This group is 

considering the inclusion of electronic medical record information from providers. 

Marshall Thomas, MD 

10065 E Harvard Ave. Suite 600 

Denver, CO 80231 

720-744-5404 

marshall.thomas@coaccess.com 

HIE_023 

CO Colorado Health Information 

Exchange (COHIE) 

This is a collaborative of stakeholders with a governing body to oversee 

membership, security, access, maintenance, and other matters. It is designing the 

infrastructure for secure transmission of information based on standards being 

developed nationally (e.g., through the ONCHIT Standards Harmonization initiative 

and the NHIN program). The intention is to allow interconnectivity between various 

systems (not develop a central information repository) that will allow information 

exchange accessed by providers to facilitate point-of-care services to patients. 

Matt Madison 

303-724-0334 

matthew.madison@UCHSC.edu 

HIE_024* 

RHIO_024 

CO Connecting Colorado 

This HIE is designed to develop the infrastructure for a “clearinghouse” function, 

or “federated” system that allows authenticated users to query various databases 

located at participating organizations. One component of the data exchange is the 

Continuity of Care Record (CCR) and development of a template for patients having 

no electronic health information. 

Robert Dellavalle 

4200 E. Ninth Ave., B-153 

Denver, CO 80262 

303-315-2957 

robert.dellavalle@uchsc.edu 

HIE_025 

CO Mesa County Health 

Information Network 

This HIE will develop a clinical information record for Mesa County residents that 

can be shared with providers involved with their care. 

Curt Hatch 

2764 Compass Drive, Suite 107 

Grand Junction, CO 81506 

970-248-8031 

CURTHATCH@aol.com 

HIE_026 

CO Kaiser Permanente and 

Epic Systems The Colorado region plans to go live with the new records system this fall. 

Louise Liang, MD, SVP for Quality 

and Clinical Systems Support 

Kaiser Foundation Health Plan 

One Kaiser Plaza, Oakland, CA 94612 

510 271-6317 

PHIT_05c 

CA 

Impact of Health 

Information Technology on 

Clinical Care

CO

Bridges-to-Excellence 

(General) - Colorado 

Business Group on Health

CO Colorado Foundation for 

Medical Care

CO

CO

Colorado Health Information Information 

CO Connecting Colorado

CO

CO

Ending the Document Game 
137

CO 

Colorado Connecting 

Communities—Health 

Information Collaborative 

(C3-HIC) 

Contract that implements Statewide information and communications technologies 

to enable clinicians to access patient information from other clinical data 

repositories at the point of care. 

Project Director: Arthur J. Davidson 

University of Colorado Health Sc Ctr 

Aurora, CO 

Arthur.Davidson@UCHSC.edu 

AHRQ_009 

CT Qualidigm

 (No specific DOQ-IT information) Qualidigm is Connecticut’s Quality Improvement 

Organization (QIO). Under contract with the Centers for Medicare & Medicaid 

Services (CMS), Qualidigm works with health care providers, such as home health 

agencies, nursing homes, hospitals and physicians to improve the quality of care 

they provide. Qualidigm also focuses on educating Medicare beneficiaries about the 

type of care they deserve and how to stay healthy. 

http://www.qualidigm.org/ 

who_contact.asp 860-632-2008 

info@qualidigm.org 

DOQ_07 

CT C-VAMS 

This is a data repository at the Griffin Hospital intended to collect health 

record information from participating providers. The data repository also has 

administrative, clinical, and financial applications used by the hospital. Remote 

access will be provided for authorized users to help network providers in the 

community and facilitate health care delivery, referrals, enrollment, etc. 

Susan Rosen 

67 Maple Avenue 

Derby, CT 6418 

203-732-1330 

srosen@vwhcc.org 

HIE_027 

CT Wellness Information 

Network 

The WIN program was created for uninsured persons. It has an electronic medical 

record available through the Internet linking emergency rooms in local health 

facilities (Fair Haven Clinic, Hill Health Center, Yale-New Haven Hospital, Hospital 

of St. Raphael). It was designed to allow exchnage of clinical information for 

persons seeking primary care through emergency departments. 

James Rawlings, Executive Director 

Community Health 

20 York Street 

New Haven, CT 06504 

203-688-5645 

jim.rawlings@ynhh.org 

HIE_028 

CT Electronic Records to 

Improve Care for Children 

Implements and evaluates a community-wide EHR for health care providers in 

pediatric primary care, school health, specialty care, and emergency medicine who 

provide care for inner city children with asthma. 

Richard Shiffman, Yale University, 

New Haven, CT, 203-737-5213

 richard.shiffman@yale.edu 

AHRQ_010 

CT 

Web-based Renal 

Transplant Patient 

Medication System 

Develops and evaluates Web-enabled education tools in hospitals and homes 

for renal transplant patients to reduce medication errors and improve safety and 

compliance using wireless portable computers. 

Amy Freidman, Yale University 

New Haven, CT 

203-785-2565 

amy.friedman@yale.edu 

AHRQ_011 

DC American Healthways American Healthways will provide services directly to beneficiaries in Maryland and 

the District of Columbia and in collaboration with CIGNA HealthCare in Georgia. 

American Healthways, Inc. 

3841 Green Hills Village Drive 

Nashville, TN 37215 

800-327-3822 

CCIP_2 

DC Connecting Visiting Nurses, 

Patients and Physicians 

This Telehealth project extends the reach and scope of MedStar’s visiting nurses 

and facilitates timely and secure communications among nurses, physicians and 

patients. 

Allison Stover 

100 Irving Street, NW, Suite EB-6106 

Washington, DC 20010 

703-780-4942 

allison.stover@medstar.net 

HIE_132 

DC Evidence-Based Medicine 

(EBM) Online 

This HIE proposes to offer three online EBM workshops that will be interactive 

and learner-centered. These workshops will focus on helping practicing clinicians 

become more efficient knowledge managers. 

Karen Lencoski 

2501 M Street NW, Suite 575 

Washington, DC 20037 

202-887-5150 

lencoskik@sgim.org 

HIE_133 

DC 

CareFirst BlueCross 

BlueShield’s Bridges To 

Excellence (BTE) program 

A continuing effort to enhance quality care for its policyholders led CareFirst 

BlueCross BlueShield (CareFirst) to expand its partnership with Bridges To 

Excellence (BTE), which provides recognition and financial rewards to physicians 

who implement specific steps to deliver safe, high quality care. CareFirst expanded 

the innovative pay-for-performance pilot program to include 94 physicians in 29 

practices that serve nearly 60,000 CareFirst members. CareFirst estimates that 

nearly $1.3 million in rewards will be paid out in 2005. 

William L. Jews, CareFirst 

10455 and 10453 Mill Run Circle 

Owings Mills, MD 21117 

410-581-3000 

BTE_01f 

AHRQ_009

Existing Efforts 
138 

DC Delmarva Foundation for 

Medical Care 

Delmarva Foundation, the Quality Improvement Organization (QIO) for Maryland and 

the District of Columbia will provide technical assistance and support free of charge 

to adult primary care physician practices 

Carmen Tyler Winston 

Director, DOQ-IT Program 

202-496-6559 

Corporate HQ: 410-822-0697 

doqitdelmarva@dfmc.org 

DOQ_51 

DE Quality Insights of 

Delaware 

Quality Insights of Delaware is an affiliate of the West Virginia Medical Institute 

(WVMI), a nonprofit physician sponsored organization dedicated to improving the 

health of the people we serve. 

As part of the project, Quality Insights will help participants to assess their 

information technology readiness and to select an Electronic Health Record (EHR) 

vendor. We will help physicians implement the new technology and offer strategies 

to optimize office efficiency. 

Beth Schindele 

DOQ-IT Project Manager 

302-478-3600 ext.114 

1-866-475-9669 ext.114 

bschindele@wvmi.org 

DOQ_08 

DE Delaware Health 

Information Network 

The DHIN is a participant in the Patient Safety Institute HIE project designed to 

provide governance with consumer input, and the infrastructure to allow data 

transmission with patient consent to authenticated providers. The DHIN intends to 

make clinical information available to providers at the point-of-care. 

A. Herbert Nehrling 

Delaware Health Information Network 

540 S. DuPont Highway, Suite 8 

Dover, DE 19901 

302-744-1220 

Robin.Lawrence@state.de.us 

HIE_029 

FL Bridges-to-Excellence 

(General) 

In July 2004, United Healthcare became the first health care company to license the 

BTE model, working with employers in Omaha, St Louis, Dayton and South Florida 

to offer network doctors certain incentives for earning NCQA recognition. 

Susan Dorsey, Director NBCH 1015 

18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org

 202-775-9300 

BTE_02h 

FL Humana /Pfizer 

Pfizer Health Solutions partners with Humana and healthcare and community 

organizations to implement patient-centered programs that focus on prevention, 

disease management and care coordination.

 Tom Noland 

Humana Corporate Comm. 

502-580-3674 

tnoland@humana.com 

CCIP_5 

FL Florida Medical Quality 

Assurance 

(No specific DOQ-IT information) Florida Medical Quality Assurance, Inc. (FMQAI), 

a subsidiary of Health Services Holdings (HSH), is Florida’s Medicare Quality 

Improvement Organization (QIO) and the End Stage Renal Disease (ESRD) Network 

of Florida. FMQAI is federally funded and under contract with the Centers for 

Medicare & Medicaid Services (CMS) at the U.S. Department of Health and Human 

Services (HHS). 

John Kupkovits /Health Information 

Technology Consultant 

813-354-9111 ext. 3542 

hit-fl@flqio.sdps.org 

DOQ_09 

FL 

Improving Health and 

Communication with the 

Patient Centric Record 

This organization states they have an electronic data repository that allows secure 

access to medical information. To be fully operational, they indicate a need to 

create “additional system modules” and educate the health industry and the public 

about health information exchange. 

John Principato 

460 Timber Ridge Drive 

Longwood, FL 32779 

407-389-4442 

jprincipato@cfl.rr.com 

HIE_030 

FL Healthcare Access 

Demonstration 

This is a coalition of healthcare stakeholders in Orange County who intend to host a 

disease management service targeted to uninsured persons with chronic illnesses. 

The members of the organization intend to develop a technology infrastructure for 

secure communication, and hope to realize savings in the cost of care by reducing 

hospital stays and emergency room use. 

James Kragh / Mark Brewer 

1411 Edgewater Dr. 

Orlando, FL 32804 

407-629-0304 

jkragh@amnetwork.com 

HIE_031 

FL HIT for Medication Safety 

in Critical Access Hospitals 

Develops an implementation plan for pharmacy health information systems in 

critical access hospitals to include an onsite survey of health IT, flowcharting the 

medication use system, and an assessment of resources. 

Abraham Hartzema, Doctor’s Memorial 

Hospital, Bonifay, FL AHRQ_012 

DC Delmarva Foundation for 

Medical Care

Quality Insights of 

Delaware

DE Delaware Health 

Information Network

Assurance

Improving Health and 

Communication with the 

Patient Centric Record

FL Healthcare Access 

Demonstration

Ending the Document Game 
AHRQ_013 

139

GA Cigna HealthCare 

(w/ American Healthways) 

By partnering with American Healthways, CIGNA can extend collaboration efforts 

and develop industry-leading DM capabilities. 

Amy Turkington, CIGNA 

1-860-226-3489 CCIP_3 

GA Georgia Medical Care 

Foundation 

gmcf will provide the following services: Analysis of practice processes, 

Recommendations for improved office efficiencies, Assistance with EHR vendor 

selection, Development/Analysis of Request for Proposal (RFP), Assistance with 

EHR implementation, Post-implementation monitoring 

678-527-3448 

doqit@gmcf.org DOQ_10 

GA Georgia EMR 

This is a coalition of rural community health centers who intend to install electronic 

medical records in 13 of the member organizations. The project includes training, 

disease reporting, quality improvement, and standardizing data elements and 

clinical workflow. 

Bruce M. Whyte, M.D. 

The Grant Building 

44 Broad St, Suite 410 

Atlanta, GA 30303 

404-659-2861 

bmwhyte@bellsouth.net 

HIE_032 

GA OrderComm 

This is a home-grown, order entry system using scanner technology intended to 

be used by the health system to transmit information from clinical areas to other 

areas of the health system to improve workflow and patient safety and lower 

administrative costs. MCG Health System believes it also meets JCAHO 

standards of care. 

Julie Trackman 

1120 15th Street 

Augusta, GA 30909 

706-721-5585 

jtrackman@mail.mcg.edu 

HIE_033 

GA Tri-County Plus Rural Health 

Network (TCPRHN) 

The Tri-County Plus Rural Health Network is implementing health information 

exchange to help coordinate care for a rural, underserved area of the State of 

Georgia. They are focusing on care management, admissions, discharge, improved 

patient safety, provider satisfaction, and lower costs. 

Max E Stachura, MD 

1120-15th Street (EA100) 

Augusta, Georgia 30912 

706-721-6616 

maxs@mcg.edu 

HIE_034 

GA West Georgia Health 

Information Exchange 

This HIE intends to tie together the three hospitals in the Tanner group and 

physician offices in this rural section of the States of Georgia and Alabama. This 

will include medical records as well as administrative information (e.g., insurance 

information and patient demographics) as well as lab orders and results. 

Denise L. Taylor, President & CEO 

303 Ambulance Drive 

Carrollton, GA 30117 

770-836-9871 

dtaylor@tanner.org 

HIE_035 

GA Wellpoint eRx or Paper 

Reduction 

WellPoint is spearheading an electronic initiative at a cost of $40 million that 

will reach 19,000 physicians. In California, Georgia, Missouri, and Wisconsin, 

physicians will be given the opportunity to choose from either of two electronic 

packages: a Prescription Improvement Package or a Paperwork Reduction Package. 

Ron J. Ponder, PhD, EVP, Information 

Services, WellPoint or 

Nadia Leather - CGEY 

nadia.leather@capgemini.com 

212-314-8234 

PHIT_02b 

GA 

Comprehensive IT Solution 

for Quality and Patient 

Safety 

Implements a series of new health information technologies in carefully staged 

processes over 2 years to include an Inpatient Pharmacy System, Electronic 

Medication Administration Record, Bar Coding System, and a CPOE System; 

evaluates the impact of these systems on safety, quality and efficiency. 

Ann Beach 

Children’s Healthcare of Atlanta, GA 

404-785-7463 

AHRQ_014 

HI Mountain-Pacific Quality 

Health Foundation 

(No specific DOQ-IT information) Mountain-Pacific Quality Health Foundation is the 

quality improvement organization (QIO) for Montana, Wyoming, Hawaii, and the 

territories of Guam, the Commonwealth of the Northern Marianas and American 

Samoa. The Foundation operates out of offices in Helena, Montana; Cheyenne, 

Wyoming; and Honolulu, Hawaii. As a QIO, we receive funding from the federal 

government to enact programs that help ensure people with Medicare receive 

appropriate, high-quality care. We also hold contracts with other government 

agencies and private insurance companies. 

808-545-2550 

pacific@mpqhf.org DOQ_11 

AHRQ_013

Promoting Patient Safety 

with Web-based Patient 

Profiles 

FL 

Explores the feasibility of a community-wide strategic implementation plan for 

Web-based standardized patient care to provide point-of-care access to patient 

information across acute and long-term care systems and services. 

Rosemary Laird, Health First, Inc. 

Cocoa Beach, FL 

321-868-7641

Existing Efforts 
Hawaii Health Information 

Exchange 

140

HI 

HHIC is a coalition of healthcare industry organizations that has worked in the past 

to coordinate initiatives such as HIPAA, and is now involved with development 

of health information exchanges. They have developed a couple of data sets for 

inpatient services and and emergency departments. They are looking to expand 

into other areas, such as assisting with the conversion from ICD-9 to ICD-10, and 

focusing on community health centers. 

Susan Forbes, MPH, DrPH 

600 Kapiolani Blvd, Suite 406 

Honolulu, HI 96813 

808-534-0288 

sforbes@hhic.org 

HIE_036 

HI 

Quality Healthcare 

Alliance Health 

Information Exchange 

This is a broad alliance of healthcare stakeholders, including employers, bridges 

to excellence, and government representatives, intended to develop and HIE. 

They are looking to work on a patient identifier, electronic prescribing, lab results, 

evidence based decision support tools, patient portal, electronic health records, 

and education. 

Mr. Gary Allen 

Executive Director, Hawaii Business 

Health Council 

3814 Pukalani Place 

Honolulu, HI 96816 

808-372-9576 

garyallen@hbhc.biz 

HIE_037 

HI Kaiser Permanente and 

Epic Systems 

Three Kaiser Permanente care centers in Hawaii introduced a new outpatient 

electronic medical records system. The Hawaii implementations represent more 

than just three additional providers embracing the latest technology—they are the 

first step in Kaiser’s $1.8 billion initiative to automate records for its 8.4 million 

members nationwide. The project is called HealthConnect. 

Louise Liang, MD, SVP for Quality and 

Clinical Systems Support 

Kaiser Foundation Health Plan 

One Kaiser Plaza, Oakland, CA 94612 

510-271-6317 

PHIT_05a 

HI Holomua Project-Improving 

Patient Hand-Offs in Hawaii 

Develops approaches to share data on patient clinical and diagnostic information 

across systems and creates an implementation plan for systems integration. 

Christine M. Sakuda, Hawaii Primary 

Care Association, Honolulu, HI 

808-536-8442, 

csakuda@hawaiipca.net 

AHRQ_015 

HI Quality Focused 

Connectivity 

Implements an HIE to the three rural islands of the State of Hawaii: Maui, Kauai, 

and the island of Hawaii that focuses on preventive health care providing an 

opportunity for care to be addressed in a comprehensive manner so that the 

responsibility of health improvement shifts from the current physician focus on 

illness to a patient-centered focus on wellness. 

Daniel Heslinga, Quality Healthcare 

Alliance, Honolulu, HI AHRQ_016 

IA Iowa Foundation for 

Medical Care 

The Iowa Foundation for Medical Care (IFMC) is the Quality Improvement 

Organization (QIO) for Iowa. QIOs work with physicians and health care 

professionals to promote high quality medical care for Medicare consumers. 

IFMC is contracted by the Centers for Medicare & Medicaid Services (CMS), 

an agency of the U.S. Department of Health and Human Services. (No specific 

DOQ-IT information) 

515-223-2900 

1-800-383-2856 DOQ_15a 

IA Health Care Excel 

Through this initiative, Health Care Excel (HCE), the Medicare Quality Improvement 

Organization for Indiana, will assist primary care physicians in adopting Electronic 

Health Record (EHR) systems with the ultimate goal of improving office efficiency 

and patient outcomes. This initiative is sponsored by the Centers for Medicare & 

Medicaid Services (CMS). 

Darlene Skelton 

812-234-1499 

515-725-1245 

DOQ_15b 

IA Telehealth 

This is an HIE concept based in the local, county visiting nurses association 

and designed to develop home monitoring of home health patients. A variety 

of “telehealth” services are envisioned to monitor and report vital signs to a 

central repository. 

Gail Coughlin 

1225 E. River Drive 

Davenport, IA 52803 

563-421-5256 

coughling@genesishealth.com 

HIE_047 

IA 

Using Physician-Patient 

Online Messaging to 

Improve Outcomes 

This HIE proposes to use web-based communications between physicians and their 

patients to improve patient compliance. Using a series of automated messages 

from the physicians, the system is designed to educate patients about their 

condition and medications. Participants in this HIE include Columbia University, 

ConnectiCare (a Connecticut-based health plan) and the University of Iowa. 

Michael Kienzle, MD 

200 Hawkins Drive 

Iowa City, IA 52242 

319-335-9788 

michael-kienzle@uiowa.edu 

HIE_048 

Hawaii Health Information 

Exchange

HI

Quality Healthcare 

Alliance Health 

Information Exchange

Kaiser Permanente and 

Epic Systems

HI 

Medical Care

Health Care Excel

IA Telehealth

IA

Ending the Document Game 
141

IA EMR Planning to Improve 

North Iowa Health Care 

Designs a system-wide patient-centered planning process and an EHR 

implementation plan that will securely exchange patient information within and 

across diverse healthcare settings for the Hancock County Memorial Hospital and 

21 affiliated physician health organization clinics. 

Toni Ebeling, Hancock County Health 

Services, Britt, IA AHRQ_028 

IA 

Rural Iowa Redesign of 

Care Delivery with EHR 

Functions 

Implements a comprehensive, integrated, EHR system with CPOE and clinical 

decision-support tools in hospital inpatient units, ambulatory care, primary care 

and specialty clinics, home health, and hospice care; also evaluates medical errors 

and near misses, use of evidence-based practices, responsiveness to adverse drug 

alerts, and patient/provider satisfaction. 

Donald Crandall, Mercy Medical 

Center—North Iowa, Mason City, IA AHRQ_029 

IA 

Health Information 

Technology Value in Rural 

Hospitals 

Documents the patient safety and healthcare quality challenges in critical access 

to rural hospitals, and assesses health IT capacity in these rural hospitals and how 

they would use health IT to improve safety and quality; develops a decision-making 

health IT toolkits for other rural hospitals. 

Marcia Ward, University of Iowa 

Iowa City, IA 

319-384-5131 

marcia-m-ward@uiowa.edu 

AHRQ_030 

IA Microsoft and Health 

Alliance Medical Plans 

Health Alliance Medical Plans - Health Insurance Provider Migrates to Microsoft 

Integration Solution and Reduces TCO , Health Alliance Medical Plans chose to 

evaluate a Microsoft® solution based on Microsoft BizTalk® Server 2004 and 

Microsoft BizTalk Accelerator for HIPAA. Microsoft recommended that the company 

work with Washington Publishing Company (WPC)—a Microsoft Certified Partner 

and publisher of HIPAA Implementation Guides—to complete a two-week proof-ofconcept (POC) study at the Microsoft Technology Center (MTC) in Chicago. 

Health Alliance Medical Plans 

800-851-3379 

www.healthalliance.org 

PHIT_06b 

ID Qualis Health 

Practices that participate in DOQ-IT will receive free assistance to select, 

implement, and optimize IT systems such as EHRs, e-prescribing, and registries. 

CMS has contracted with Qualis Health to provide DOQ-IT services to participating 

physicians in Washington, Idaho, and Alaska. 

Helen Stroebel, RN MPH 

800-488-1118, ext. 5053 

helens@qualishealth.org 

DOQ_12 

ID North Idaho Community 

Connections (NICC) 

This is a consortium of hospitals in northern Idaho that has already implemented 

a number of technologies, including interactive video, wide area network, and 

telemedicine related. They are working to connect with individual physicians. They 

are now working to develop and launch an EMR. 

Sue Fox, MPH 

P.O. Box 1448, Sandpoint, ID 83864 

208-265-3390, 

suefox@sandpoint.net 

HIE_038 

ID 

Rural Connection: 

Strengthening Care 

Through Technology 

Explores health IT as a method of sharing patient information and develops 

an electronic health record for patients who utilize rural, urban, acute, and 

rehabilitation facilities. 

Anne Oglevie, Weiser Memorial 

Hospital, Weiser, ID AHRQ_017 

IL 

Bridges-to-Excellence 

(General) - Tri-State Health 

Care Coalition 

The four coalitions launching BTE-related projects are located in Illinois (two in 

Illinois), Colorado and Arkansas. The coalitions, through a licensing arrangement 

with BTE, have begun talking with employers and estimate launching customized 

programs in their respective markets later this year. Business coalitions are well 

suited to coordinating such incentive programs - by coordinating activities among 

employers, they can pool resources and streamline related operations, thus making 

the efforts more attractive to employers and physicians. All four coalitions are 

members of the National Business Coalition on Health (NBCH), a 70-coalition 

member strong organization that strongly supports pay-for-performance. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org

 202-775-9300 

BTE_02a 

IL 

Bridges-to-Excellence 

(General) - Heartland 

Healthcare Coalition 

The four coalitions launching BTE-related projects are located in Illinois (two in 

Illinois), Colorado and Arkansas. The coalitions, through a licensing arrangement 

with BTE, have begun talking with employers and estimate launching customized 

programs in their respective markets later this year. Business coalitions are well 

suited to coordinating such incentive programs - by coordinating activities among 

employers, they can pool resources and streamline related operations, thus making 

the efforts more attractive to employers and physicians. All four coalitions are 

members of the National Business Coalition on Health (NBCH), a 70-coalition 

member strong organization that strongly supports pay-for-performance. 

Susan Dorsey, Director NBCH 1015 

18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org

 202-775-9300 

BTE_02b 

AHRQ_028

Existing Efforts 
Aetna Health Management 

142

IL (partnered with 

LifeMasters) 

Aetna was awarded a CCIP for Chicago (20,000 Medicare beneficiaries to be 

involved). Effort to identify health risks among Medicare+Choice members and 

to help manage those risks through targeted case management, DM and 

educational programs. 

Susan Millerick, 860-273-0536 

Clinical/Quality Programs PR 

millericks@aetna.com 

CCIP_1 

IL Illinois Foundation for 

Quality Health Care 

Participating practices will receive free consultative services from the Illinois 

Foundation for Quality Health Care (IFQHC) throughout the process of selecting and 

implementing an EHR system. IFQHC provides resources with expertise on: Culture 

change and leadership, EHR planning and implementation. Workflow analysis and 

preparing practices for EHR readiness. Increased patient safety. 

Grace Martos 

Jeanette Kebisek, 630-928-5808 

630-928-5867 

gmartos@ilqio.sdps.org 

jkebisek@ilqio.sdps.org 

DOQ_13 

IL Advancing an HIE for 

Cardiovascular Care 

This is a proposed HIE targeted to persons with cardiovascular disease, including 

CAD, CHF, and/or HTN. The proposal focuses on technical infrastructure and tools, 

performance metrics, and reports. 

Karen Kmetik, PhD 

515 N. State Street 

Chicago, IL 60610 

312-464-4221 

karen_kmetik@ama-assn.org 

HIE_039 

IL ePrescribing HIE 

This is a consortium of organizations with a concept for an HIE that allows 

exchange, analysis, and use of pharmaceutical information at 2 pilot facilities 

affiliated with the Cleveland Clinic. The consortium includes RxHub, VisionShare. 

The project also proposes researching the impact of electronic prescribing at 

Scripps Mercy Clinic and the underserved in San Diego County who use 

Mercy hospital. 

Thomas M. Leary 

230 E Ohio Street, Suite 500 

Chicago, IL 60611 

571-331-2486 

tleary@himss.org 

HIE_040 

IL Electronic Cancer Reporting 

This HIE focuses on cancer diagnosis and reporting using the College of American 

Pathologists cancer checklist. The concept is to communicate the cancer diagnosis 

protocols to pathologists and facilitate electronic reporting. 

Diane J. Aschman 

325 Waukegan Road 

Northfield, Illinois 60093 

847-832-7250 

daschma@cap.org 

HIE_041 

IL Microsoft and Health 

Alliance Medical Plans 

Health Alliance Medical Plans - Health Insurance Provider Migrates to Microsoft 

Integration Solution and Reduces TCO , Health Alliance Medical Plans chose to 

evaluate a Microsoft® solution based on Microsoft BizTalk® Server 2004 and 

Microsoft BizTalk Accelerator for HIPAA. After talking with Health Alliance about 

its needs, Microsoft recommended that the company work with Washington 

Publishing Company (WPC)—a Microsoft Certified Partner and publisher of HIPAA 

Implementation Guides—to complete a two-week proof-of-concept (POC) study at 

the Microsoft Technology Center (MTC) in Chicago. 

Health Alliance Medical Plans 

800-851-3379 

www.healthalliance.org 

PHIT_06a 

IL 

Rural Community 

Partnerships—EMR 

Implementation Project 

Implements an ambulatory EMR in multiple rural primary and specialist care 

provider settings and measures the impact of health information technology 

on clinical practice, organizational structure, and financial benefits; integrates 

ambulatory electronic medical record case scenarios into the curricula of the Health 

Science and Human Services Department to ensure that future healthcare providers 

have adequate training and exposure to ambulatory EMR technology. 

R’Nee Mullen, Magic Valley Memorial 

Hospital, Twin Falls, ID AHRQ_018 

IL 

Linking Rural Providers 

to Improve Patient Care 

and Health 

Develops a central electronic health record system that will allow sharing of health 

information between a hospital, medical group, county health department, and 

behavioral health organization for rural economically disadvantaged, ethnic/racial 

minority residents, the elderly, and persons with special/complex health care 

needs. 

Timothy Broos, Katherine Shaw Bethea 

Hospital, Dixon, IL 

815-285-5509 

AHRQ_019 

IL 

Sharing Patient Record 

Access in Rural Health 

Settings 

Develops an implementation plan for an ambulatory EMR in a medically 

underserved region that will electronically connect physician offices, the regional 

hospital, ancillary services, and other community health services; identifies 

indicators to track measurable improvements in patient safety, quality of care, 

clinician and patient satisfaction, and operational efficiency. 

Michael DeLuca, Sarah Bush Lincoln 

Health Center, Mattoon, IL AHRQ_020 

Aetna Health Management

(partnered with 

LifeMasters)

Illinois Foundation for 

Quality Health Care

Advancing an HIE for IL Advancing an HIE for 

Cardiovascular Care

IL ePrescribing HIE

IL

IL

Rural Community 

Partnerships—EMR 

Implementation Project

IL 

Linking Rural Providers 

to Improve Patient Care 

Ending the Document Game 
143

IL Enhancing Quality in Patient 

Care (EQUIP) Project 

Implements an electronic health records system in a network of community health 

centers and develops a data warehouse to monitor, aggregate, and provide data for 

quality improvement. 

Alex Lippitt, Erie Family Health Center 

Chicago, IL AHRQ_021 

IL Toward an Optimal Patient 

Safety Information System 

Promotes and evaluates the interchange of patient safety information and the 

reporting of adverse events and close calls among public and private voluntary 

incident reporting systems being used at U.S. hospitals. 

Andrew Chang, Joint Commission 

on Accreditation of Healthcare 

Organizations (JCAHO), 

Oakbrook Terrace, IL 

AHRQ_022 

IL 

Value of Technology 

to Transfer Discharge 

Information 

Assesses the value of software applications to facilitate information transfer 

during the high-risk transition from hospital to home at discharge and compares 

health information technology to usual care for benefits outcomes, adverse events, 

effectiveness, costs, and satisfaction among patients and physicians. 

James Graumlich, Board of Trustees 

of the University of Illinois, Chicago, IL 

309-655-2730 

AHRQ_023 

IN Health Care Excel 

Through this initiative, Health Care Excel (HCE), the Medicare Quality Improvement 

Organization for Indiana, will assist primary care physicians in adopting Electronic 

Health Record (EHR) systems with the ultimate goal of improving office efficiency 

and patient outcomes. This initiative is sponsored by the Centers for Medicare & 

Medicaid Services (CMS). 

Darlene Skelton, 812-234-1499 

1-800-300-8190 

317-347-4500 

DOQ_14 

IN South-Central Indiana 

E-prescribing Network 

This is a collaboration of providers and vendors to implement an e-prescribing 

system. Their not-for-profit organization is called ScriptNet, which is designed 

to develop a central data repository, educate on data standards, provide related 

services, interoperate with other applications, and share costs. 

Michael Sullivan, MD 

501 N. Morton Street Suite 209 

Bloomington, IN 47404 

812-331-2208 

sullivan@xylor.com 

HIE_042 

IN Allen County Connections 

for Care Network 

This consortium of federally qualified health centers, other safety net providers, 

hospitals and vendors proposes to develop a centralized electronic medical record 

(called “WebChart”), link it to an established, limited wide area network (called 

MED-WEB), and expand the service to safety net providers (starting with a three 

clinic pilot). The MED-WEB network already links hospitals and physicians in 

the county. Safety net clinics and local hospital emergency rooms are seeking 

funding so they may link into this network with the proposed electronic medical 

record. Curently they are operating with resources donated by the participating 

organizations. The goals of the group are to reduce duplication of services, improve 

quality and management of care, increase efficiencies and lower costs. 

Mary Haupert, President 

P.O. Box 11949, 1717 S. Calhoun St. 

Fort Wayne, IN 46862 

260-458-2644 

mshaupert@nhci.net 

HIE_043 

IN 

Indiana Health Information 

Exchange/Indianapolis 

Network for Patient Care 

(INPC) 

This HIE has an existing, “population-based” electronic medical record used 

by providers, public health agencies, health services researchers, and other 

stakeholders. The EMR uses standardized data, a central data repository, and data 

mining capabilities. 

Dr. J. Marc Overhage 

1050 Wishard Blvd 

Indianapolis, IN 46202 

317-630-8685 

moverhage@regenstrief.org 

HIE_044* 

RHIO_044 

IN Connecting Cass County 

for Better Health 

This is a county government based coalition of government agency, provider, and 

academic stakeholders interested in health matters of this rural community. The 

coalition proposes to create the infrastructure for the electronic exchange of health 

information, building on the local hospital’s recent acquisition of DSL technology. 

They are looking to put in place hardware, software, and an electronic network. 

Brian T. Shockney 

1101 Michigan Avenue 

Logansport, IN 46947 

574-753-1385 

bshockney@mhlogan.org 

HIE_045 

IN South Bend Community 

HealthLinks 

The South Bend Community HealthLinks HIE is a utility model data exchange 

using a centralized repository for clinical information. The system is designed to 

interface with physician practice, personal health record, and clinical decision 

support software. A related entity, the Michiana Health Information Network, is 

a collaboration of local medical specialty physician practices, formed within the 

South Bend Medical Foundation (SBMF) to develop the infrastructure for a data 

repository for clinical information exchange. 

Michiana Health Info. Network 

215 West Madison Street 

South Bend, IN 46601 

574-968-1001 

Robert King 

531 North Lafayette Blvd. 

South Bend, IN 46601 

574-234-4176 

Bking@sbmflab.org 

HIE_046 

AHRQ_021

Existing Efforts 
An Evolving Statewide 

144

IN Indiana Information 

Infrastructure 

Contract that develops and implements HIE using an established technical 

infrastructure and interconnects local health information infrastructures; also 

implements a Statewide public health surveillance network that links all hospitals 

to share emergency department data 

Project Director: Marc Overhage 

Indiana University School of Medicine 

Indianapolis, IN 

317-630-7070 

joverhag@iupui.edu 

AHRQ_024 

IN 

Improving Health Care 

through HIT in Morgan 

County, IN 

Creates a secure infrastructure for communication among providers to allow 

electronic sharing of patient clinical info with hospitals and other physicians/ 

health providers in the county, region, and State; also assesses the effectiveness 

of the system in improving workflow, timeliness & completeness of information, 

patient safety, continuity of care, health outcomes. 

Paul Clippinger, Morgan Hospital and 

Medical Center, Martinsville, IN AHRQ_025 

IN 

Value of Health Information 

Exchange (HIE) in 

Ambulatory Care 

Assesses the value of HIE in ambulatory care by modifying an existing economic 

model of HIE and tests the model in a randomized controlled trial. 

Marc Overhage, Indiana University 

Indianapolis, IN 

317-630-7070 

joverhag@iupui.edu 

AHRQ_026 

IN 

Value of New Drug 

Labeling Knowledge for 

e-Prescribing 

Creates a prescribing tool with decision support (checking dosage, 

contraindications, and drug interactions) that can be easily integrated into a 

provider’s practices; implements and pilot tests the tool to evaluate its benefits 

and costs. 

Gunther Schadow, Indiana University, 

Indianapolis, IN 

317-278-4636 

gschadow@iupui.edu 

AHRQ_027 

KS Kansas Foundation for 

Medical Care 

The Kansas Foundation for Medical Care, Inc., in support of the proposed work for 

the CMS 8th Scope of Work contract, will be providing free assistance to Physician 

Offices that desire to move to an Electronic Health Record environment. 

800-432-0407 

785-273-2552 

relations@kfmc.org 

DOQ_16 

KS Jayhawk P.O.C. 

This is a hospital based (Pratt Regional Medical Center) HIE tying together all 

of the hospital departments in a central data repository. The system is used to 

communicate patient information. The hospital is proposing to expand the system 

to allow practitioners to access patient information from anywhere in the region. 

Information proposed to be made available includes: medical history, lab results, 

diagnostic imaging, medication and immunization records, insurance information, 

and other personal information. 

DeWayne Bryan 

200 Commodore 

Pratt, KS 67124 

620-450-1485 

dbryan@prmc.org 

HIE_049 

KY Bridges-to-Excellence (DCL) 

Enables physicians to achieve one-year or three-year recognition for high 

performance in diabetes care. Qualifying physicians receive up to $80 for each 

diabetic patient covered by a participating employer and plan. In addition, the 

program offers a suite of products and tools to help diabetic patients get engaged 

in their care, achieve better outcomes, and identify local physicians that meet the 

high performance measures. 

NCQA 

2000 L Street, NW, Suite 500 

Washington, DC 20036 

202-955-3500

 Customersupport@ncqa.org 

BTE_03b 

KY Health Care Excel 

Through this initiative, Health Care Excel (HCE), the Medicare Quality Improvement 

Organization for Indiana, will assist primary care physicians in adopting Electronic 

Health Record (EHR) systems with the ultimate goal of improving office efficiency 

and patient outcomes. This initiative is sponsored by the Centers for Medicare & 

Medicaid Services (CMS). 

Darlene Skelton, 812-234-1499 

502-339-7442 DOQ_17 

KY Connecting Healthcare in 

Central Appalachia 

As an integrated, not-for-profit rural healthcare system serving Eastern Kentucky 

and Southern West Virginia, Appalachian Regional Healthcare, Inc. (ARH) is an 

integrated health collaboration consisting of hospitals, clinics, and home health 

agencies serving rural eastern Kentucky and southern West Virginia. They are 

proposing to develop a web-based, centralized patient information repository and 

portal for providers, and are looking to obtain hardware and staff to implement. 

Information proposed to be collected and stored in the repository includes 

encounter, demographic, and financial data. 

Amanda Fryman, 

Appalachian Regional Healthcare, Inc. 

1220 Harrodsburg Road 

P.O. Box 8086 

Lexington, Kentucky 40533 

859-226-2433 

afryman@arh.org 

HIE_050 

KY Meeting Information Needs 

of Referrals Electronically 

Identifies essential technological needs for accessing and sharing data 

and information between patients and health care providers; develops an 

implementation plan to expand the transmission of referral information 

electronically in a closed health system to an open system. 

Carol Ireson, University of Kentucky 

Research Foundation, Lexington, KY 

859-257-5678 

clires0@email.uky.edu 

AHRQ_031 

An Evolving Statewide 

Indiana Information 

Infrastructure

Improving Health Care 

through HIT in Morgan 

County, IN

Value of Health Information 

Exchange (HIE) in Exchange (HIE) in 

Ambulatory Care

IN 

Value of New Drug 

Labeling Knowledge for 

e-Prescribing

Bridges-to-Excellence (DCL)

Health Care Excel

Ending the Document Game 
145

KY Connecting Healthcare in 

Central Appalachia 

Implements and trains staff on the use of an EMR system in a rural integrated 

health care delivery system in an integrated rural healthcare delivery system 

serving approximately 20 counties throughout Eastern Kentucky and Southern 

West Virginia. 

Polly Bentley, Appalachian Regional 

Health, Hazard, KY AHRQ_032 

KY 

ED Information Systems— 

Kentucky & Indiana 

Hospitals 

Implements and trains users of a Web-based electronic record system in the 

emergency departments of two small community hospitals, one medium-sized 

community hospital, one rural hospital, and three private primary care physician 

practices; evaluates the reduction in medical errors, waiting time, and costs as well 

as patient and physician satisfaction. 

David Pecoraro, Jewish Hospital 

Health Care, Louisville, KY AHRQ_033 

LA Louisiana Health Care 

Review 

Louisiana Health Care Review, Inc. (LHCR) is working with the Centers for Medicare 

& Medicaid Services (CMS) to help primary care physician offices adopt electronic 

health records (EHRs) to improve office efficiencies and quality of care. Project 

Objectives: Facilitate the adoption of Electronic Health Records EHRs in small to 

medium-sized primary care practices, Ensure that practices are using EHRs and IT 

to the fullest capability to improve office efficiency, Use clinical data reports for 

improved practice performance and patient outcomes 

Chris Williams, Team Leader 

Jack Olden, 225-248-7078 

225-926-6353 

cwilliams@lhcr.org 

jolden@lhcr.org 

DOQ_18 

LA 

Catahoula Consortium 

on Health Information 

Exchange 

This is a collaboration between a rural hospital, university, state public health 

department to develop an HIE for clinical information sharing to improve care 

provided to uninsured persons in a rural area. The goal is to connect a majority 

(75%) of local providers, share information, and instigate continuous improvement 

by measuring outcomes and providing results to the participants for quality 

improvement purposes. The participants would like to replicate throughout the 

State the model they are building for a rural health clinic and HIE. 

Holly Purvis, MHA 

P.O. Box 2078 

Jena, Louisiana 71342 

318-992-9200 

hpurvis@lasallegeneralhospital.com 

HIE_051 

LA Catahoula Parish 

Consortium 

This proposed HIE is a collaboration between a rural hospital, university, and state 

public health department to serve Medicaid beneficiaries in a rural area, and other 

patients of participating providers. The project is designed to exchange clinical 

information, track referrals, and allow for eligibility checks and prior authorizations. 

Holly Purvis, MHA 

P.O. Box 2780 

Jena, Louisiana 71342 

318-992-9200 

hpurvis@lasallegeneralhospital.com 

HIE_052 

LA Project Overcoming 

Isolation 

This HIE is targeted to cystic fibrosis patients and uses a “smart card” and webbased site to access a centralized data repository with clinical and treatment 

information. It also is designed to provide an online support community for patients, 

and includes privacy controls. 

Hank Fanberg 

2424 Edenborn Avenue, Suite 290 

Metairie, LA 70001 

504-838-1550 

hank.fanberg@christushealth.org 

HIE_053 

LA 

Cardiovascular Care 

Disparities: Safety-Net 

HIT Strategy 

Designs the implementation of a longitudinal cardiovascular disease information 

system platform to address disparities viewed as a lifelong disease process, and 

examines the impact of health IT on quality improvement, medical and financial 

effectiveness, and increased value. 

Bruce Ferguson, LSU Health Sciences 

Center, New Orleans, LA AHRQ_034 

LA 

Distance Management 

of High-Risk Obstetrical 

Patients 

Develops a technology plan to improve access to maternal-fetal medicine services 

throughout the State and guides the implementation of telemedicine capabilities to 

provide real-time remote diagnostic ultrasound and consultative services to women 

with high-risk pregnancies. 

Helene Kurtz, Woman’s Hospital 

Baton Rouge, LA AHRQ_035 

LA HIT Service Integration 

Creates a detailed assessment of the feasibility of health IT implementation 

including the development of an implementation plan, specification of clinical and 

organizational needs, identification of goals, and identifying barriers and ways to 

address those barriers. 

Michelle Lemming, Franklin Foundation 

Hospital, Franklin, LA AHRQ_036 

AHRQ_032

Existing Efforts 
146 

LA 

Louisiana Rural Health 

Information Technology 

Partnership 

Implements a Complete Medical Record (a computerized emergency department 

communication, documentation, passive tracking, and medical records system) in an 

emergency department and evaluates the use of this technology toward improving 

patient safety and quality of care. 

Paul Salles, Assumption Community 

Hospital, Napoleonville, LA AHRQ_037 

MA Bridges-to-Excellence (POL) 

CMS is also looking towards the BTE Physician Office Link program as a 

possible element in its forthcoming Medicare Care Management Performance 

Demonstration project, an initiative which will promote the adoption and use of 

health information technology to improve the efficiency and quality of patient care 

for chronically ill Medicare patients. Doctors who meet or exceed performance 

standards established by CMS in clinical delivery systems and patient outcomes 

will receive performance payments for managing the care of eligible Medicare 

beneficiaries. 

Medstat Group 

1-800-224-7161 

bridgestoexcellence@thomson.com 

BTE_01d 

MA Bridges-to-Excellence (POL) 

A pay-for-performance initiatives offered by the Bridges coalition in Boston and 

Schenectady/Albany in which 35 medical groups split $800,000 in incentives. 

These were rewards earned by meeting criteria established by the National 

Committee for Quality Assurance (NCQA) related to the adoption of technologybased care management systems. 

Medstat Group 

1-800-224-7161 

bridgestoexcellence@thomson.com 

BTE_01e 

MA MassPRO 

Electronic health records could transform your practice. But success takes time, 

planning and strategy. MassPRO can help.MassPRO is recruiting 150 adult primary 

care (FP, GP, IM) practice sites. Priority will be given to those sites with 8 or fewer 

physicians. During this 15-month project starting in fall 2004, MassPRO will use 

seminars, conference calls, group e-mail, and one-on-one consultation to help 

practices prepare for and successfully implement EMRs. MassPRO, as part of a 

national pilot project, is able to offer these services at no cost. 

Chuck Parker /Director 

Complete List: http://www.masspro. 

org/doqit/index 

htm#contacts, 781-419-2790 

781-890-0011 

Hotline: 800-252-5533 

cparker@maqio.sdps.org 

DOQ_21 

MA 

The Boston Community 

Health Information for 

Improvement (CHII) Project 

This is an alliance of community health and academic medical centers serving 

poor and homeless persons. It proposes to interoperate between 11 outpatient 

databases to share clinical information, specifically to assist with disease 

management and prevention. Components in the project include: outcomes data, 

reporting, quality improvement, and integrating with administrative information. 

Larry Culpepper, MD, MPH, Chairman 

Dowling 5 

Boston, MA 

617-414-6225 

larry.culpepper@bmc.org 

HIE_059 

MA 

Statewide EHR Adoption 

and Health Data Exchange 

in Massachusetts 

This is a collaboration of physician groups, employers, and academic medical 

institutions that promotes use of electronic medical records in the State of 

Massachusetts. The group is designed to support and educate physicians, and 

assist with setting standards and sharing data. 

David Bates, MD, MSc 

Brigham and Women’s Hospital, 

75 Francis St., Boston, MA 21115 

617-732-5650 

dbates@partners.org 

HIE_060 

MA 

Connecting Consumer 

Communities to 

Healthcare Providers 

This is a proposal to develop “use cases” for health information exchange and 

research the exchange of information between and among patients, providers, 

provider groups, and hospitals to foster a better understanding of information 

exchange, especially from the consumer perspective. 

Daniel B. Hoch 

VBK 830 Mass General Hospital 

Boston, MA 21114 

617-726-3311 

dhoch@partners.org 

HIE_061 

MA MA-SHARE MedsInfo 

e-Prescribing Initiative 

This HIE proposes to demonstrate the value of e-prescribing, focusing on 

emergency department and point-of-care my measuring error reduction, workflow 

improvements, outcomes, and the impact on costs. This is seen as the first step 

towards development of a comprehensive clinical information exchange. 

Elliot M. Stone, CEO 

460 Totten Pond Road, Suite 385 

Waltham, MA 02451 

781-890-6042 

EStone@mahealthdata.org 

HIE_062* 

RHIO_062 

MA SAFE Health - Central 

Massachusetts 

This is a collaboration of three health plans, a health system, and a vendor 

(Hewelitt-Packard) to develop a prototype to exchange clinical information in 

emergency rooms and outpatient care settings. They have developed a clinical 

information architecture in a “federated,” or decentralized configuration allowing 

interoperability between different systems. The design includes a master patient 

index, secure information transmission, and interoperability between systems 

having different information technologies. 

Mark Fisher, Chief Operating Officer 

Fallon Community Health Plan 

10 Chestnut Street 

Worcester, MA 01608 

508-368-9303 

mark.fisher@fchp.org 

HIE_063 

Louisiana Rural Health 

LA Information Technology 

Partnership

MA Bridges-to-Excellence (POL)

MA Bridges-to-Excellence (POL)

MA

MA

MA

Statewide EHR Adoption 

and Health Data Exchange 

MA

Connecting Consumer 

Communities to 

Healthcare Providers

MA MA-SHARE MedsInfo 

MA

Ending the Document Game 
147

MA Medication Administration 

Program 

This is a health system medication management platform. It is designed to track, 

document, manage, screen for potential drug interactions, and reduce adverse 

events through an information system and barcoding technology. 

Sharron Finlay 

11 Shattuck Street 

Worcester, MA 01605 

508-334-1485 

finlays@UMMHC.org 

HIE_064 

MA 

Tufts Health Plan and 

Blue Cross Blue Shield 

Massachusetts (BCBSMA) 

and Zix Corp 

Seeking to boost generic drug utilization and increase quality of service, Tufts 

Health Plan (Waltham, Mass.) and Blue Cross Blue Shield Massachusetts 

(BCBSMA, Boston) are joining in a $3 million initiative to offer physicians a 

comprehensive e-prescribing program. The companies will provide approximately 

3,400 physicians hand-held devices equipped with Zix Corp.’s PocketScript eprescribing software. 

Robert Mandel, BCBSMA VP, 

Provider enrollment and services or 

Philip Boulter, M.D., Tufts Health Plan 

PHIT_08 

MA Blue Cross Blue Shield of 

Massachusetts (BCBSMA) 

Backed by $50 million from Blue Cross Blue Shield of Massachusetts (BCBSMA), 

a group of healthcare insurers, doctors, hospitals and others in the state plan early 

next year to wire one community with interoperable electronic medical records. 

The collaboration includes more than 30 organizations, including health-related 

state agencies and large employers that pay for health insurance. John Halamka of 

Healthcare System (Boston), which operates five Boston-area hospitals and is part 

of the cooperative, estimates a statewide e-records project could cost $1 billion, 

but still believes statewide adoption could happen in as few as five years. Projects 

are being led by the Massachusetts eHealth Collaborative, a nonprofit coalition 

launched last year by 34 health-care providers, health plans, and insurers in the 

state, which picked the three communities in March 05 from more than 35 that had 

applied to participate in the two- to three-year study. 

John Halamka, CIO at 

CareGroup Healthcare System 

jhalamka@caregroup.harvard.edu or 

Carl Ascenzo, CIO of BCBSMA 

PHIT_09 

MA 

Statewide Implementation 

of Electronic Health 

Records 

Performs a rigorous evaluation of the impact of a Statewide implementation 

program on EHR adoption by rural and non-rural ambulatory care practices and 

its impact on medication errors and the quality of ambulatory care as a 

collaborative effort among providers, insurers, and businesses in cooperation 

with the State government. 

David Bates, Brigham and Women’s 

Hospital, Boston, MA 

617-732-6040 

AHRQ_043 

MA 

SAFEHealth—Secure 

Architecture for Exchanging 

Health Information 

Creates a local heath information exchange infrastructure that integrates workflow 

and improves communication for patients, healthcare providers, payers, and public 

health agencies. 

Lawrence Garber, Fallon Clinic, Inc. 

Worcester, MA AHRQ_044 

MA 

EMS Based TIPI-IS 

Cardiac Care QI-Error 

Reduction System 

Implements the time-insensitive predictive instruments built into the computerized 

electrocardiograph in emergency medical service settings and emergency 

departments; also evaluates its impact on reducing errors and avoidable delays in 

emergency care. 

Harry Selker, New England Medical 

Center, Boston, MA 

617-636-5009 

HSelker@tufts-nemc.org 

AHRQ_045 

MA 

Improving Pediatric Safety 

and Quality with Health 

Care IT 

Systematically assess improvements in patient safety and experience of care 

associated with implementation of four decision support function embedded in 

an electronic health record: 1) the influence of weight based dosing on pediatric 

adverse drug events; 2) the influence of a test result tracking system on appropriate 

followup of ordered tests; 3) the influence of automated reminders on symptom 

monitoring and medications for children with asthma and attention deficit disorder. 

Timothy Ferris, Massachusetts General 

Hospital, Boston, MA AHRQ_046 

MA 

Improving Safety and 

Quality with Outpatient 

Order Entry 

Examines the impact of integrating ambulatory CPOE with advanced CDSS on 

safety and quality in the ambulatory setting, its organizational efficiency, workflow, 

and satisfaction, and conducts a cost-benefit analysis. 

Tejal Gandhi, Brigham and Women’s 

Hospital, Boston, MA AHRQ_047 

MA Value of Imaging-Related 

Information Technology 

Assesses the impact of Medical Imaging Informatics on health care costs and 

quality and develops a business case related to the acquisition and implementation 

of automated radiology systems; develops a financial model to demonstrate the 

impact of these systems on provider systems and healthcare quality. 

Scott Gazelle, Massachusetts General 

Hospital, Boston, MA AHRQ_048 

HIE_064

Existing Efforts 
T

148

MA 

Health Information 

echnology in the 

Nursing Home 

Assesses the effects of clinical decision support systems in nursing homes on 

medication ordering and monitoring for residents in long term care setting; 

also tracks costs and assesses productivity, impact, and nursing home culture 

and organization. 

Jerry Gurwitz, University of 

Massachusetts, Worcester, MA AHRQ_049 

MA 

Evaluating Smart Forms 

and Quality Dashboards 

in an EHR 

Assesses the value of health IT to clinicians through creation of CDSS tools 

integrated with clinical documentation workflow and physician performance 

feedback, its impact on clinical decision support and quality assessment, and its 

cost-effectiveness. 

Blackford Middleton, Brigham and 

Women’s Hospital, Boston, MA 

617-732-6040 

AHRQ_050 

MA 

ParentLink: Better and 

Safer Emergency Care 

for Children 

Evaluates the completeness and accuracy of information on symptoms, disease 

conditions, medications, and allergies generated by parents using a patientcentered health technology called ParentLink compared to information documented 

by emergency department physicians and nurses; ParentLink’s impact on patient 

safety and quality. 

Stephen Porter, Children’s Hospital 

Corporation, Boston, MA 

617-355-2136 

AHRQ_051 

MA 

E-Prescribing Impact on 

Patient Safety, Use, 

and Cost 

Assesses the impact of a Statewide rollout of e-prescribing using PocketScript® 

software and its effect on safety, quality, cost, formulary compliance and outcomes. 

Joel Weissman, Massachusetts 

General Hospital, Boston, MA AHRQ_052 

MD Lumetra 

Lumetra, assisted by key partners, is providing support to small- to medium-sized 

practices in implementing EHRs free of charge. Lumetra is helping physician 

practices: Assess practice readiness, Define EHR goals, Select an EHR vendor*, 

Prepare staff and office for EHRs, Conduct post implementation evaluations, 

Review EHR implementation and impact analysis 

410-740-8756 

doqit-ca@caqio.sdps.org DOQ_20a 

MD Delmarva Foundation for 

Medical Care 

Delmarva Foundation, the Quality Improvement Organization (QIO) for Maryland 

and the District of Columbia will provide technical assistance and support free of 

charge to adult primary care physician practices 

Carmen Tyler Winston 

Director, DOQ-IT Program 

202-496-6559 

Corporate HQ: 410-822-0697 

doqitdelmarva@dfmc.org 

DOQ_20b 

MD Community Based 

Intervention System (CBIS) 

Johns Hopkins Bloomberg School of Public Health and the Center for 

Communication Programs is working with Appalachian Regional Healthcare, Inc. 

to provide assistance in connecting and improving the healthcare services 

provided to the residents of Central Appalachia by creating elements of a Clinical 

Information System. 

Amanda Fryman 

Appalachian Regional Healthcare, Inc. 

1220 Harrodsburg Road, P.O. Box 8086 

Lexington, KY 40533 

859-226-2433 

afryman@arh.org 

HIE_055 

MD 

MD/DC Collaborative 

for Health Information 

Technology 

This is an alliance of physician group practices, hospitals, health plans, and 

academic medical centers proposing to design and implement a regional health 

information organization (RHIO). It is a non-profit, incorporated entity intended to 

link all parts of the healthcare delivery system for health information exchange. 

Victor Plavner, MD 

10420 Little Patuxent Parkway 

Suite 400, Columbia, MD 21044 

410-992-1880 

vplavner@collaborativeforhit.org 

HIE_056* 

RHIO_056 

MD 

Smart E-Records across 

Continuum of Health 

(SERCH) 

This HIE proposes to assist with continuity of care for elderly persons by 

developing the infrastructure for interoperability between healthcare delivery 

system participants, and specifically by using a “Smart E-Records” electronic 

medical record. 

Dr. Michael Gloth 

210 Business Center Dr 

Reisterstown, MD 21136 

410-526-1490 

mgloth@victorysprings.com 

HIE_057 

MD HHCC Practice Patterns 

and Outcomes 

This HIE proposes to develop a system that will collect, store, and analyze home 

health care, based on the Home Health Care Classification (HHCC) System. 

Ruth G. Irwin, RN MS 

509 Quaint Acres Dr. 

Silver Spring, MD 20904 

301-622-9595 

ruthgirwin@aol.com 

HIE_058 

Health Information 

MA echnology in the 

Nursing Home

MA 

Evaluating Smart Forms 

and Quality Dashboards and Quality Dashboards 

in an EHR

MA 

ParentLink: Better and 

Safer Emergency Care 

T 

for Children

E-Prescribing Impact on 

MA Patient Safety, Use, 

and Cost

MD

MD Community Based 

Intervention System (CBIS)

MD

MD/DC Collaborative 

for Health Information 

Technology

MD

Smart E-Records across 

Continuum of Health 

MD

Ending the Document Game 
149

MD Community HealthLink 

Care: Regional EMR 

Develops a secure, comprehensive, virtual health record for medically underserved 

patients that will lead to the implementation of a health IT infrastructure necessary 

to support a single, shared EMR application to promote the community-wide 

exchange of patient information for clinical decision support, research, and disease 

management on behalf of low-income, uninsured people. 

Thomas Lewis, Primary Care Coalition 

of Montgomery County 

Silver Spring, MD 

AHRQ_042 

ME Northeast Health Care 

Quality Foundation 

(No specific DOQ-IT information) Mission is to encourage and promote improvement 

in health care for the Medicare beneficiaries in our service region. We provide 

educational materials and tools for identified quality improvement projects, and 

conduct reviews to ensure quality of care for beneficiaries and protect the Medicare 

Trust Fund. 

1-800-772-0151 

603-749-1641 

info@nhcqf.org 

DOQ_19 

ME 

Regional Picture Archiving 

Communication System for 

Northern Maine 

This is a proposal for a hospital-based, regional diagnostic imaging data repository 

based around an existing picture archiving and communications system (PACS). The 

current, single site system is also linked with other information systems within the 

hospital. The proposal is to extend the existing PACS to include all ten participating 

hospitals in the region through a virtual private network. 

Deborah Sanford 

P.O. Box 404 

Bangor, Maine 44020404 

207-973-7058 

dsanford@emh.org 

HIE_054 

ME Anthem Blue Cross Blue 

Shield of Maine 

Anthem Blue Cross Blue Shield of Maine administers a program that resembles the 

Bridges for Excellence model. The health plan’s program uses payment differentials 

and rewards specific physicians for improving health outcomes by implementing 

technology improvements. 

Anthem Blue Cross and Blue Shield 

2 Gannett Drive 

South Portland, ME 04106 

PHIT_07 

ME The Chronic Care 

Technology Planning Project 

Plans for standard exchange of clinical information for patients with chronic 

disease when transitioning from acute to non-acute care settings between primary 

care physicians, outpatient specialists, home health providers, nursing homes, and 

hospitals; creates an Institute for Healthcare Improvement Breakthrough Series 

Learning Collaborative to build on their work implementing the Chronic Care Model 

by enhancing the use of IT. 

John Branscombe, The Aroostook 

Medical Center, Presque Isle, ME AHRQ_038 

ME Midcoast Maine Patient 

Safety with IT Integration 

Develops new systems and a high level of integration and cooperation in four 

significant areas: medication management, patient discharge, high-level integration 

of information, and the development of a new paradigm for evaluating, selecting, 

and implementing new technologies. 

Maureen Buckley, Northeast Health 

Foundation, Rockland, ME AHRQ_039 

ME 

Improving Care in a Rural 

Region with Consolidated 

Imaging 

Implements and evaluates the results of the Consolidated Imaging—Picture 

Archiving and Communication System (a shared, standards-based, interoperable 

health information technology) that makes radiology images available for review 

within minutes of when they are acquired. 

Robert Coleman, Maine Medical 

Center, Portland, ME AHRQ_040 

ME 

Improving HIT 

Implementation in a Rural 

Health System 

Implements an outpatient EMR in a rural health system using distinct phases to 

match the expected learning curve and to reduce the potential loss of practice 

productivity often associated with the implementation of an EMR; also collects data 

about patient safety, quality, access, cost, and productivity. 

Daniel Mingle, Maine General 

Medical Center, Augusta, ME AHRQ_041 

MI Michigan Peer Review 

Organization 

MPRO offers assistance at each stage of the electronic health record adoption 

process including assessment, planning, selection, implementation, and post 

implementation. MPRO can help offices maximize efficiencies while documenting 

quality improvement, using information technology. 

MPRO, Michigan’s Medicare Quality Improvement Organization, is conducting a 

survey on the topic of health information technology (HIT). The intent of the 

survey is to collect information about how physicians in Michigan are using HIT 

in their office. 

Marie Beisel, RN, MSN, CPHQ 

Project Director 

248-465-7338 

mbeisel@mpro.org 

DOQ_22 

MI Inter-Plan Guideline 

Adherence 

This is an alliance of health plans, hospitals, and employers to evaluate 

performance of health plans. They propose to take their evaluation tool and provide 

information to the provider/physician level to improve performance and adherence 

to treatment guidelines. 

Dennis White 

1709 Pontiac Trail 

Ann Arbor, MI 48105 

734-741-0333 

dcwhite@umich.edu 

HIE_065 

AHRQ_042

Existing Efforts 
150 

MI Voices of Detroit Initiative 

This is an alliance of local health systems and safety net providers to provide 

free services to uninsured persons. They are now proposing to fully automate 

the administrative functions needed to provide care to this population, including 

specialist referrals and exchanging patient medical histories. They will use a 

web-based platform for enrollment, disenrollment, referral, prevention, outcomes 

measuring, and other administrative functions. The system is also designed to 

identify co-morbidities early and assist with patient compliance with treatments. 

Lucille Smith 

4201 St. Antoine 

Detroit, MI 48323 

313-832-4246 

slucille@med.wayne.edu 

HIE_066 

MI 

Implementing 

Interorganizational EMR 

to Improve Care for 

Disadvantaged Populations 

The HIE is a collaboration between a local university, hospitals, and the state health 

department to develop a an electronic medical record tied to a network allowing 

secure exchange of clinical information. The university already has an HIE network 

in place in 32 clinics at 11 sites in Lansing Michigan using an existing electronic 

medical record system. They are currently networked with some local physician 

practices for purposes of treating Medicaid patients. 

Michael H. Zaroukian, MD, PhD, FACP 

EMR Medical Director 

B-325 Clinical Center 

East Lansing, MI 48824 

517-353-4811 

michael.zaroukian@ht.msu.edu 

HIE_067 

MI 

Use of Smart Card 

Technology to Promote 

Community-Wide Diabetic 

Quality Improvement 

This HIE is a broad collaboration of diabetes health stakeholders proposing to 

implement “smart card” technology to help diabetes patients and providers. 

The technology is used to access medical records, treatment protocols, and 

evidence-based medical practices. 

Kent Bottles, MD 

1000 Monroe Ave NW 

Grand Rapids, MI 49503 

616-732-6206 

kent_bottles@grmerc.net 

HIE_068 

MI 

CLEAN: Communities 

Leveraging e-Health for 

Asthma Needs 

This is a broad collaboration of asthma health stakeholders using a web-based 

application to exchange personal health information on pediatric asthma patients. 

Participants are in the process of implementing information system platforms to 

integrate with the web-based application for diagnostic, treatment, documentation, 

and scheduling purposes. They are proposing to demonstrate measurable 

improvements in outcomes as a result of using their system. 

Angela R. Tiberio, MD 

100 Michigan Ave. NE - MC 843 

Grand Rapids, MI 49503 

616-391-9811 

angela.tiberio@spectrum-health.org 

HIE_069 

MI Picture Archiving and 

Communications Systems 

The HIE is a collaboration of hospitals, radiology specialists, and physician 

practices to implement an diagnostic imaging data repository. There is an existing 

picture archiving and communication system at one of the hospitals. They propose 

to implement a PACS system throughout the region to allow hospitals and 

physicians to improve access to diagnostic imaging information and lower the 

cost of care. 

Dean R Feldpausch 

1210 W Saginaw St. 

Lansing, MI 48915 

517-364-6445 

dean.Feldpausch@sparrow.org 

HIE_070 

MI 

The Health Care 

Interchange of Michigan 

Care Data Exchange 

This HIE is an alliance of major health plans, hospitals, a vendor and a physician 

group in the region. They use a “federated,” or “peer-to-peer” approach to 

exchange both clinical and administrative information. The focus of their pilot is 

Medicaid beneficiaries enrolled in managed care. The goal is to improve continuity 

of care, enhance patient compliance, and allow communication of patient 

information when transient Medicaid beneficiaries change providers. 

Clyde Hanks, COO 

P.O. Box 80745 

Lansing, MI 48908 

517-886-8380 

chanks@hcim.org 

HIE_071 

MI Upper Peninsula Health 

Data Repository 

This is a collaboration of rural health systems and hospitals that has come together 

to share common services over the Internet. Currently they provide services such 

as eligibility verification, claims processing, clinic scheduling, physician billing, and 

other administrative services. Other collaborative services include telemedicine and 

access to immunization and other state health records. They are also developing an 

electronic medical record to serve as an archive and repository of information. 

Sally Davis 

580 West College Avenue 

Marquette, MI 49855 

906-225-3120 

sdavis@mgh.org 

HIE_072 

MI HIT Planning for a Critical 

Access Hospital Partnership 

Plans, develops, and implements health IT to assist local rural communities in 

improving health care access, building local and regional resources to monitor 

the quality of healthcare, and expanding the use of health IT educational, 

communication, and clinical applications. 

Donald Wheeler, Baraga County 

Memorial Hospital, L’Anse, MI AHRQ_053 

MI 

Bar Coding for Patient 

Safety in Northern 

Michigan 

Implements a bar-coding application to an existing integrated health IT network 

that alerts providers to potential drug interactions and allergic reactions, tracks 

“near misses,” and provides a permanent record of the patient’s medication history 

that is accessible by providers at any site. 

Randi Oehlers, Munson Medical 

Center, Traverse City, MI 

231-935-5199 

oehlerr@trinity-health.org 

AHRQ_054 

Voices of Detroit Initiative

MI

Implementing 

Interorganizational EMR 

to Improve Care for to Improve Care for 

Disadvantaged Populations

Use of Smart Card 

Technology to Promote 

Community-Wide Diabetic 

Quality Improvement

MI

MI

The Health Care The Health Care 

MI

Upper Peninsula Health 

Data Repository

MI 

Ending the Document Game 
151

MI HIT Support for Safe 

Nursing Care 

Examines the use of the HANDS software system, an health IT-supported care 

planning process for nursing care, and its ability to be transferable between nurses, 

units, and health care settings. 

Gail Keenan, Regents of the University 

of Michigan, Ann Arbor, MI 

734-763-3705 

gkeenan@umich.edu 

AHRQ_055 

MN Stratis Health 

(No specific DOQ-IT information) Mission: Stratis Health is a non-profit independent 

quality improvement organization that collaborates with providers and consumers 

to improve health care., Vision: Stratis Health’s vision is that of a health care 

system that supports an informed, activated consumer and competent, satisfied 

health care professionals working in settings that promote optimum care and 

reduce chance of error. 

952.854.3306 

1-877-STRATIS 

info@stratishealth.org 

DOQ_23 

MN 

Patient Management 

System for Emergency 

Health Preparedness 

This HIE is a collaboration of hospitals and clinics in an 18 county region of the 

State. They provide a number of services, including immunization registry, eligibility 

verification, and claims processing. They are looking to expand into automated 

reporting to public health agencies. 

Cheryl M. Stephens 

404 W. Superior St., Suite 250 

Duluth, MN 55802 

218-625-5515 

cstephens@medinfosystems.org 

HIE_073 

MN 

MN Collaborative Health 

Information Exchange 

System 

This HIE is a collaboration between health plans, health systems, and the 

State health department to develop a benefit eligibility verification and claims 

status system. 

Dave Moertel 

200 1st Street SW 

Rochester, MN 55905 

507-284-1762 

moertel.david@mayo.edu 

HIE_074 

MN Central Minnesota Health 

Information Network 

This HIE proposes to install a hybrid paper medical and computer-based 

information system based on open system software to better coordinate clinical 

records and administrative functions to better analyze outcomes and resource use 

from clinical data. 

Jeffrey L. Blair 

500 Aberdeen Drive 

Waite Park, MN 56387 

320-252-8550 

cmhin@cloudnet.com 

HIE_075 

MN 

PKI Model & MedNet 

(This project is potentially 

inactive) 

MCHEC worked with HealthKey to build a PKI model in Minnesota to support 

healthcare data exchange. The organization also initiated MedNet, a private, 

non-proprietary, statewide, public-private health care telecommunications network 

in Minnesota, which is exchanging both administrative data and an exchange 

of certain kinds of public health data. They are also continuing to exchange and 

standardize clinical data between public health and providers. They are also looking 

at building the business case for clinical data exchange. 

Walter G. Suarez, MD 

Executive Director, MHDI 

651-917-6700 

walter.suarez@mhdi.org 

HIE_143 

MN 

Microsoft and University 

of Minnesota Physicians 

(UMPhysicians) 

University of Minnesota Physicians (UMPhysicians) wanted to find a way of 

reducing the cost and complexity of paper-based medical records. Used Allscripts 

Healthcare Solutions to deploy a Microsoft® Windows®-based EMR solution 

that includes the deployment of nearly 500 wirelessly enabled Windows MobileTM-

based Pocket PC devices that are used by UMP staff for dictation, reviewing patient 

medical records, and other daily activities. 

Todd Carlon 

Chief Administrative Officer 

University of Minnesota Physicians 

651-603-5320 

PHIT_10 

MN 

A Community-Shared 

Clinical Abstract to 

Improve Care 

Plans the use of IT to enhance communication at care transitions and develops an 

implementation plan for a community- and patient-shared EMR abstract that will be 

available at the point of care. 

Barry Bershow, Fairview Health 

Services, Minneapolis, MN AHRQ_056 

MN HIT Strategic Plan of SW 

Minnesota Health Providers 

Develops a regional health IT strategic plan between 28 healthcare providers 

including a comprehensive needs assessment of all of the participating 

organizations, prioritization of needs, identification of health IT solutions to 

prioritized needs, and development of appropriate implementation plans. 

Charles Ness, Granite Falls Municipal 

Hospital, Granite Falls, MN AHRQ_057 

AHRQ_055

Existing Efforts 
152 

MN 

HIT-based Regional 

Medication Management 

Pharmacy System 

Implements an interactive video-conferencing system at rural hospitals to provide 

continuing education for pharmacist and pharmacy technicians as well as a model 

for bedside verification of medication administration and medication bar coding; 

also evaluates structure, process, and outcomes related to improvement of patient 

safety and more effective patient medication management. 

Mark Schmidt, Clouquet Community 

Memorial, Clouquet, MN AHRQ_058 

MO Bridges-to-Excellence 

(General) 

In July 2004, United Healthcare became the first health care company to license the 

BTE model, working with employers in Omaha, St Louis, Dayton and South Florida 

to offer network doctors certain incentives for earning NCQA recognition. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org 

202-775-9300 

BTE_02f 

MO Primaris 

Primaris offers primary care physicians free consultation on how to select and 

implement the correct EHR for their office. All we ask in return is your commitment 

within the next 12 to 18 months. If you are already utilizing an EHR, we will show 

you how to achieve full benefit from the system. This includes quality improvement 

and pay for performance functions. 

Sandra Pogones 

800-735-6776 ext. 1158 

Mobile: 573-230-9801 

spogones@moqio.sdps.org 

DOQ_25a 

MO Health Care Excel 

Through this initiative, Health Care Excel (HCE), the Medicare Quality Improvement 

Organization for Indiana, will assist primary care physicians in adopting Electronic 

Health Record (EHR) systems with the ultimate goal of improving office efficiency 

and patient outcomes. This initiative is sponsored by the Centers for Medicare & 

Medicaid Services (CMS). 

Darlene Skelton, 812-234-1499 

573-634-3639 DOQ_25b 

MO Wellpoint eRx or Paper 

Reduction 

WellPoint is spearheading an electronic initiative at a cost of $40 million that 

will reach 19,000 physicians. In California, Georgia, Missouri, and Wisconsin, 

physicians will be given the opportunity to choose from either of two electronic 

packages: a Prescription Improvement Package or a Paperwork Reduction Package. 

Ron J. Ponder, PhD, EVP, 

Information Services, WellPoint or 

Nadia Leather - CGEY 

nadia.leather@capgemini.com 

212-314-8235 

PHIT_02c 

MO Project InfoCare 

Creates a community-wide EMR with integrated clinical decision support that is 

available across the continuum of care including a rural hospital, a home health 

agency, 14 physician clinics, and 5 long-term care facilities. 

Peggy Esch, Citizens Memorial 

Hospital, Bolivar, MO AHRQ_061 

MS McKesson Health Solutions 

Chosen to provide disease management services to Mississippi Medicare feefor-service beneficiaries with heart failure and diabetes. Partnering with Joslin 

Diabetes Center, Boston, MA. Approximately 20,000 beneficiaries will be eligible 

for the program. 

Dr. Sandeep Wadhwa, VP Care 

Management Services, McKesson 

Health Solutions 

CCIP_7 

MS Mississippi Information and 

Quality Healthcare 

Information & Quality Healthcare, IQH, is the Medicare Quality Improvement 

Organization for Mississippi. By serving as a resource to the state’s healthcare 

providers and to the Medicare beneficiaries, IQH seeks to fulfill its vision to be a 

leader in promoting a quality and cost-effective healthcare system. 

601-957-1575 

1-800-633-4227 DOQ_24 

MS Mississippi U Project 

TheraDoc, a Salt Lake City-based vendor of clinical decision support software, 

is installing software at the University of Mississippi Medical Center (UMC) to 

collect and analyze data in real time from information systems in admissions, 

the emergency department, surgical units, the pharmacy, laboratory and other 

departments dealing with infectious diseases. 

Stanley W. Chapman, M.D., Director of 

the Department of Infectious Diseases 

Department of Health, UMC 

HIE_139 

MS 

Creating Online NICU 

Networks to Educate, 

Consult & Team 

Develops, implements, and evaluates a cooperative effort using health IT to 

facilitate a continuum of appropriate medical and developmental care from the 

time infants are admitted to Neonatal Intensive Care Units through the transition 

process to community-based health care services for infants most at-risk for longterm neurodevelopmental problems. 

Jane Siders, The University of 

Southern Mississippi, Hattiesburg, MS AHRQ_059 

MN 

HIT-based Regional 

Medication Management 

Pharmacy System Pharmacy System 

MO Bridges-to-Excellence 

(General)

MO Primaris

MO Health Care Excel

MO

MS McKesson Health Solutions

Mississippi Information and 

Quality Healthcare

MS Mississippi U Project

Ending the Document Game 
153

MS 

Detecting Med Errors in 

Rural Hospitals Using 

Technology 

Implements and evaluates a voluntary system for reporting medical errors and 

adverse drug events in eight small rural hospitals; identifies barriers to technology, 

describes the epidemiology and root causes of the errors, formulates qualityimprovement interventions, and disseminates the results. 

Andrew Brown, University of 

Mississippi, Jackson, MS 

601-984-6850 

abrown@medicine.umsmed.edu 

AHRQ_060 

MT Mountain-Pacific Quality 

Health Foundation 

(No specific DOQ-IT information) Mountain-Pacific Quality Health Foundation is the 

quality improvement organization (QIO) for Montana, Wyoming, Hawaii, and the 

territories of Guam, the Commonwealth of the Northern Marianas and American 

Samoa. The Foundation operates out of offices in Helena, Montana; Cheyenne, 

Wyoming; and Honolulu, Hawaii. 

406-443-4020 

800-497-8232 

montana@mpqhf.org 

DOQ_26 

MT 

Using Health Information 

Exchange to Reduce 

Medication Errors in the 

Rural Healthcare Setting 

This HIE proposes to install a medical management system in a hospital and clinic 

to identify medication errors. This will include the infrastructure for recording 

of medications, clinical decision support tools and prompts, and adverse drug 

interactions and reactions. 

Patricia Jay Coon, MD 

P.O. Box 37000 

Billings, MT 59107 

406-238-2287 

pcoon@billingsclinic.org 

HIE_076 

MT Community Health Access 

Partnership 

The Community Health Access Partnership (CHAP), an alliance of public health 

programs and local hospitals and clinics serving uninsured and indigents, received a 

grant from HRSA to implement a “community medical record” which tracks patient 

demographic data, sodial data, and referrals. The system does not currently track 

other medical information and they are looking to expand and create an electronic 

medical record. They plan to install an “integration engine” to identify information 

that can be entered into a web-based application that will track patients domicile, 

services, medications, and physician office visits. 

Judy Stewart 

P.O. Box 35033 

Billings, MT 59107 

406-247-3290 

judys@ycchd.org 

HIE_077 

MT 

Planning the 

Implementation of HIT in a 

Rural Setting 

Plans the development and implementation of a health IT infrastructure throughout 

three rural counties including high-speed Internet access, CPOE, CDSS, EHR, and 

continuity of care record templates. 

William Reiter, Community Hospital of 

Anaconda, Inc., Anaconda, MT AHRQ_062 

MT 

Decreasing ADEs 

in Montana Frontier 

Critical Access Hospitals 

through HIT 

Assesses opportunities to decrease adverse drug events and medication errors in 

frontier Montana Critical Access Hospitals; identifies appropriate, cost effective 

health IT solutions to challenges in medication use. 

Kipman Smith, Townsend Health 

Systems, Inc., Townsend, MT AHRQ_063 

MT 

Home Heart Failure (HF) 

Care Comparing PatientDriven Technology Models 

Assesses the impact of health IT on clinical and financial outcomes for patients 

with symptomatic congestive heart failure living in a rural area, including 

telemonitoring of vital signs and symptoms, evaluation of Technology Supported 

Case Management, and Technology Support Self Management. 

Lee Goldberg, St. Vincent Healthcare 

Foundation, Billings, MT AHRQ_064 

NC Bridges-to-Excellence 

(General) 

CIGNA HealthCare is licensing the Bridges to Excellence program and is working 

with employers to pursue a pay-for-performance effort. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org 

202-775-9300 

BTE_02i 

NC Medical Review of North 

Carolina (No specific DOQ-IT information) 919-380-9860 800-682-2650 DOQ_33 

NC WNC Health Network This HIE is a collaboration of hospitals to develop an electronic medical information 

system between the hospitals and their affiliated provider organizations. 

Gary Bowers, JD 

WNC Health Network, 501 Biltmore 

Avenue, Asheville, NC 28801 

828-257-2983 

Gary.Bowers@wnchn.org 

HIE_095 

AHRQ_060

Existing Efforts 
154 

NC Perinatal EMR 

This HIE is at the University of North Carolina medical center. It has a standard, 

paper-based prenatal medical tracking record. They propose to develop and 

electronic version of a prenatal medical record, including software that allows 

patient access available over the Internet. 

Dr. Raj Gopalan MD., MSIS 

101 Manning Drive 

Chapel Hill, NC 27514 

919-966-3950 

rgopalan@unch.unc.edu 

HIE_096 

NC 

Patient Safety Net for 

Heart Failure Disease 

Management 

This HIE is based in a hospital and proposes to establish a disease management 

program for congestive heart failure patients. 

Van J. Stitt, Jr., MD, PhD, VP, CMO 

2525 Court Drive 

Gastonia, NC 28053 

704-834-2768 

stittv@gmh.org 

HIE_097 

NC 

North Carolina Health 

Information Exchange 

Consortium (NCHIEC) 

This HIE is a partnership between a health system, medical group practices, the 

State health department, and a software vendor. They have implemented a pilot 

project for health surveillance that has been used to exchange clinical information 

between hospitals in the partnership. They wish to expand the service to study the 

impact on patient safety and public health and to involve other hospitals and health 

systems. 

Judy O’Neal 

3000 New Bern Avenue 

Raleigh, NC 27610 

919-350-8205 

JONeal@wakemed.org 

HIE_098 

NC NC Community Medication 

Management Project 

This HIE is an alliance of hospitals, group practices, health departments, 

employers and other stakeholders that is implementing a web-based medication 

history record, e-prescribing and refill system. 

Holt Anderson 

POB 13048, Research Triangle Park 

NC 27709-3048 

919-558-9258 

holt@nchica.org 

HIE_099 

NC 

Automated Adverse Drug 

Events Detection and 

Intervention 

Establishes an automated surveillance system for detecting, reporting, and 

intervening as well as measuring the incidence and nature of adverse drug events 

suffered by patients. 

Peter Kilbridge, Duke University 

Durham, NC AHRQ_074 

NC 

Showing Health Information 

Value in a Community 

Network 

Assesses the costs and benefits of health IT in an established community-wide 

network of academic, private and public healthcare facilities created to share 

clinical information for the purpose of population-based care management of 

Medicaid beneficiaries. 

David Lobach, Duke University 

Durham, NC AHRQ_075 

ND North Dakota Health Care 

Review 

NDHCRI is participating in Doctors’ Office Quality Information Technology (DOQ-IT) 

with small-to-medium sized physician offices. This initiative promotes the adoption 

of electronic health record (EHR) systems and information technology (IT). The 

vision is to enhance access to patient information, decision support, and reference 

data, as well as improving patient-clinician communications. 

1-800-472- 2902 

701-852-4231 

lmalchose@ndqio.sdps.org 

DOQ_34 

NE Bridges-to-Excellence 

(General) 

In July 2004, United Healthcare became the first health care company to license the 

BTE model, working with employers in Omaha, St Louis, Dayton and South Florida 

to offer network doctors certain incentives for earning NCQA recognition. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org 

202-775-9300 

BTE_02e 

NE CIMRO of Nebraska (No specific DOQ-IT information) 

1-800-458-4262 

402-476-1399 

webmaster@cimronebraska.org 

DOQ_27 

NE 

Nebraska Panhandle 

Regional Health Record 

Planning 

This RHIO is a collaboration between the Rural Healthcare Cooperative Network, 

Panhandle Partnership for Health and Human Services, Panhandle Public Health 

District, and the University of Nebraska Public Policy Center. It is implementing the 

infrastructure for an electronic health record to serve the region. The infrastructure 

will use existing networks that connect hospitals, clinics, providers, and other 

health stakeholders in a rural area. 

Joan Frances, Executive Director 

Rural Healthcare Cooperative 

Network, 601 High School Street 

Kimball NE 69145 

308-235-4211 

pphhsvision@earthlink.net 

HIE_078 

NC Perinatal EMR

NC

Patient Safety Net for 

Heart Failure Disease 

Management

North Carolina Health 

Information Exchange 

Consortium (NCHIEC)

NC Community Medication NC

NC 

NC 

North Dakota Health Care North Dakota Health Care 

Bridges-to-Excellence Bridges-to-Excellence 

(General)

NE CIMRO of Nebraska

NE

Ending the Document Game 
155

NE Behavioral Health MIS 

Integration Project 

This HIE proposes acquisition of hardware and software to link information system 

among behavioral health providers in the county. 

Wende Baker, Executive Director 

P.O. Box 30205 

Lincoln, NE 68503 

402-441-8144 

HIE_079 

NE 

HIT Plan for Region V 

Behavioral Health Care 

Providers 

Plans, develops, and implements a methodology for behavioral health care 

providers to standardize core shared data elements; designs an integrated 

management information system for the sharing of health care data and 

information among rural and urban health care providers; connects rural providers 

to urban providers; and develops messaging capabilities between primary care and 

behavioral health care providers. 

Wende Baker, Heartland Health 

Alliance, Holbrook, NE AHRQ_065 

NE Regional Health Records for 

Frontier Communities 

Plans for the implementation of a regional health record system within established 

networks of rural hospitals, clinics, public health providers, behavioral health 

providers, and others across a 14,000 sq mile remote area. 

Nancy Shank, Chadron Community 

Hospital, Lincoln, NE AHRQ_066 

NH Northeast Health Care 

Quality Foundation 

(No specific DOQ-IT information) Mission is to encourage and promote improvement 

in health care for the Medicare beneficiaries in our service region. We provide 

educational materials and tools for identified quality improvement projects, and 

conduct reviews to ensure quality of care for beneficiaries and protect the Medicare 

Trust Fund. 

1-800-772-0151 

603-749-1641 

info@nhcqf.org 

DOQ_29 

NH Electronic Communications 

Across Provider Settings 

Deane Morrison, Concord Hospital, 

Concord, NH AHRQ_067 

NJ Medication Information 

Network Exchange, (MINE) 

The HIE is set up to establish a medication management system among the 

participants that will reduce errors. It will also give providers access to 

patients’ histories. 

HIE_081 

NJ NJ Primary Care 

Association EMR Project 

This HIE is a collaboration of federally qualified health centers proposing to 

develop a state-wide medical record data repository tying together all health 

centers in the State. 

Katherine Grant-Davis 

14 Washington Road, Building Two 

Princeton Junction, NJ 8550 

609-275-8886 

njpca2@aol.com 

HIE_082 

HIE_079

NH 

Furthering User-Friendly 

Systems for Informatics and 

Patient Online. (FUSION) 

This HIE has an established, web-based patient portal allowing appointment 

scheduling requests, medication refills, emails to providers, updating patient and 

insurance information, and downloading forms. They are proposing to link the 

patient portal with existing electronic medical record systems at three separate 

provider locations. 

Barbara Walters, DO MBA 

Dartmouth Hitchcock Clinic 

1 Bedford Farms, Bedford, NH 03110 

603-629-1101 

Barbara.A.Walters@Hitchcock.org 

HIE_080 

Integrates an office-based EMR within an acute care hospital, rural community 

health centers, a community mental health center, a family medicine residency, 

private physician practices, and a home nursing service to improve use of the EMR 

as a clinical tool, integrate clinical data, and increase access to the data. 

NJ Peer Review Organization 

of NJ 

PRONJ Role: • Sponsor recruitment activities for physicians interested in 

participating in DOQ-IT project, • Select participating physicians 

• Work with physician office staff to conduct an assessment of the practice to 

identify barriers and opportunities, and develop a business case for successful EHR 

implementation, • Launch continuous quality improvement (QI) activities, based on 

EHR capabilities and data reporting 

• Help identify EHR systems that meet practice needs 

Carolyn Hezekiah Hoitela, MLS 

732-238-5570 ext. 2012 DOQ_30 

Linda Woods, CIO 

727 North Beers Street 

Holmdel, NJ 07733 

732-739-5957 

linda.woods@bchs.com 

Existing Efforts 
Healthcare 

156

Virtua Health, GE NJ Healthcare

Virtua Health is a multi-hospital healthcare system. Hospitals will be digitally 

based with complete electronic medical records, computerized patient rooms 

featuring technologies such as beds that monitor patient vital signs and the ability 

to convert from a medical room to an intensive care room and back without ever 

having to move the patient. In 2004 Virtua partnered with General Electric to 

position itself at the forefront of technology and the delivery of high quality care. 

The comprehensive strategic alliance with GE Healthcare encompasses technology 

optimization, leadership development, and clinical and operational excellence. 

Richard P. Miller, president and CEO of PHIT_11 Virtua Health, 888-Virtua-3 

NJ NJ Department of Banking 

and Insurance 

The NJ Department of Banking and Insurance launched an effort Wednesday to 

create a statewide electronic medical records system. The system would allow 

physicians to share patients’ medical records statewide. The Department and 

Healthcare Information Networks and Technologies (HINT) and Health Insurance 

Portability and Accountability Act (HIPAA) Task Force will spearhead the project. 

Donald Bryan, Acting Commissioner 

NJ Dept of Banking and Insurance 

20 West State St., Trenton, NJ 08625 

commissioner@dobi.state.nj.us 

PHIT_12 

NJ Horizon Blue Cross Blue 

Shield of NJ 

Horizon will be rolling out a similar, albeit smaller, [electronic] initiative by the 

end of the year. The Horizon initiative earmarks $5 million for providers to receive 

a free desktop computer or PDA. The Horizon effort will also have multipayer 

abilities, so that other health plans’ formularies, and patient eligibility data are 

available to the provider for review. 

Jay Patel, Horizon BCBS, Horizon 

Healthcare of New Jersey 

P.O. Box 820, Newark, NJ 07101 

1-800-355-2583 

PHIT_13 

NM New Mexico Medical 

Review Association (No specific DOQ-IT information) under development 

Marcia Tarasenko, RN, BSN, MBA/HC/ 

Quality Improvement Manager-DOQ-IT 

Project, 505-998-9735, 

1-800-663-6351

 mtarasenko@nmqio.sdps.org 

DOQ_31 

NM eMS Health 

This is a consortium of multiple sclerosis centers around the country that have 

established the eMS project as a telehealth program designed to better educate 

health professionals, patients and their caregivers by allowing remote access 

to information. 

Peggy Swoveland, Ph.D. 

1438 Fischer Road 

Las Cruces, NM 88007 

505-541-5955 

ptswo@aol.com 

HIE_083 

NM 

Project ECHO—Extension 

for Community Healthcare 

Outcomes 

Connects urban medical center disease experts with rural general practitioners 

and community health representatives over a telehealth network to effectively 

treat patients with chronic, common and complex diseases who do not have direct 

access to specialty healthcare providers. 

Sanjeev Arora 

University of New Mexico, 

Albuquerque, NM 

SArora@salud.unm.edu 

AHRQ_068 

NM New Mexico Health 

Information Collaborative 

Develops a community-wide HIE collaborative in a rural area that will give patients 

and providers access to comprehensive clinical data on the Internet; develops 

disease-management prototypes on diabetes, pediatric asthma, depression, and 

low back pain and evaluates the development, implementation, and outcomes of 

the collaborative. 

Martin Hickey, Lovelace Clinic 

Foundation, Albuquerque, NM AHRQ_069 

NV HealthInsight 

HealthInsight is a private, non-profit QIO whose mission is to be a catalyst in 

the transformation and improvement of the health care system. In our thirtyyear history, HealthInsight staff has worked with the health care community on 

initiatives to improve the quality of care delivered in Nevada and Utah. The goal 

being to: Educate physician offices on EHR system solutions and alternatives, 

Provide implementation and quality improvement assistance, Assist physician 

offices in migrating from paper-based health records to EHR systems that suit 

their clinics’ needs, Assist those currently using an EHR in using their system 

more effectively. 

Sharon Donnelly (Medicare 

Beneficiaries) 

http://www.healthinsight.org/ 

contact.html 

702-385-9933 

http://www.healthinsight.org/ 

contact.html 

DOQ_28 

NY Bridges-to-Excellence 

(General) (POL, DCL, CCL) 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org

 202-775-9300 

BTE_02k 

NJ Department of Banking 

and Insurance

Horizon Blue Cross Blue 

Shield of NJ 

NM

NM

for Community Healthcare 

Outcomes

NM New Mexico Health 

Information Collaborative

NV HealthInsight

NY

Ending the Document Game 
157

NY UnitedHealthcare Services 

UHS was chosen to provide DM in NY area. They will identify how to most 

effectively and efficiently improve performance measurement, data aggregation 

and reporting in the ambulatory care setting. 

www.unitedhealthcare.com CCIP_8 

NY IPRO (No specific DOQ-IT information) 

Alan Silver, MD, MPH, Medical Officer 

Susan Hollander, Assistant Director 

516-326-7767 

asilver2@nyqio.sdps.org 

shollander@nyqio.sdps.org 

DOQ_32 

NY 

Western New York 

Emergency Department 

Triage Surveillance Project 

(WNYEDTSP) 

David G. Ellis, MD 

ECMC, 462 Grider Street 

Buffalo, NY 14215 

716-898-5347 

dellis@ecmc.edu 

HIE_085 

NY 

Taconic Health Information 

Network and Community 

(THINC) 

This HIE is based in an IPA with 500 physician practices. Their existing information 

exchange system has been in service for three years and networks physicians with 

a common set of services. Their proposed expansion would increase the number of 

physician practices, hospitals, clinical labs, and payer and use a standard electronic 

health record, email messaging, e-prescribing, and other services. 

A. John Blair, III, MD, CEO / THINC 

Project Director 

One Summit Court, Suite 200 

Fishkill, NY 12524 

845-897-6359 

jblair@taconicipa.com 

HIE_086* 

RHIO_086 

NY AMI Online Network 

(AMION) 

The HIE is an alliance of health stakeholders serving an unserved population in 

a rural area. They propose an electronic information exchange to allow provider 

access to medical information and educational resources using teleconferencing. 

Future expansion is envisioned to allow patient, employer and public health 

agency access. 

Patricia L. Hale Ph.D., M.D., F.A.C.P. 

P.O. Box 452 

Glens Falls, NY 12801 

518-743-1993 

screengem9@aol.com 

HIE_087 

NY NYC Syndromic 

Surveillance 

This HIE is a collaboration between the New York City health department, hospital 

association, and Quest Diagnostics that has implemented a health syndrome 

surveillance system. They plan to expand and enhance the system to include 

standardized architecture and emergency departments. 

HIE_089 

NY 

Anti-Coagulation Lab 

results through Open 

standards Technology 

(ACLOT) 

This HIE is a collaboration among health systems and academic medical centers 

to demonstrate a model for sharing clinical information with patients and 

practitioners. They are using a “federated,” or peer-to-peer model of system 

interconnectivity and data sharing. 

David Liss, Vice President, 

Govt. Relations & Strategic Initiatives 

161 Fort Washington Avenue 

New York, NY 10032 

212-305-1190, david.liss@nyp.org 

HIE_090 

CCIP_8

NY 

Implementing the EMR into 

the Pediatric Subspecialty 

areas of the Ambulatory 

Health Network. 

This HIE has an adult, outpatient electronic medical record installed using the 

NextGen product, which they are expanding to serve their pediatric clinics and 

physician practices. 

Joan Evanzia 

MIS Dept, 1045 39th Street 

Brooklyn, New York 11219 

718-283-1892 

jevanzia@maimonidesmed.org 

HIE_084 

This HIE is a consortium of health departments, academic medical centers, 

and hospitals that has developed a health surveillance system for emergency 

departments that reports infectious disease and other illnesses useful for 

biodefense and other epidemiology projects. In addition to public health 

information, the system is designed to provide eligibility, benefits, and 

claims information. 

NY 

Continuum Health Partners 

- MedMined Virtual 

Surveillance Project 

This HIE is a consortium of hospitals and medical group practices to establish 

the infrastructure for clinical support, biosurveillance, quality improvement, 

and outcomes measurement using proprietary data mining and artificial 

intelligence technology. 

Beth Raucher, MD 

1st Ave at 16th St 

New York, NY 10003 

212-420-2853 

braucher@bethisraelny.org 

HIE_088 

Farzad Mostashari 

125 Worth Street, Rm 315, CN-6 

New York, NY 10013 

212-788-5384 

fmostash@health.nyc.gov 

Existing Efforts 
NY 

158

Advancing Therapeutics in 

Parkinson’s (APT) 

This HIE is a Parkinson’s-specific disease community to increase participation 

and retention in clinical trials. They are also proposing to develop a disease 

management program for their target population, including distance learning and 

a central repository to acquire and distribute content. 

Lucy Sargent 

710 West 168th Street 

New York, NY 10032 

800-457-6676 

lsargent@pdf.org 

HIE_091 

NY Community Health Center 

HIE Consortium 

This HIE is a consortium of health systems and safety net providers focusing on 

development of an EMR serve community health centers in New York and New 

Mexico. They envision an EMR that would allow use by all parties involved in care 

of health center patients, and decision support tools to educate on medical errors 

and best practices. They also will create a disease management program 

for diabetes, asthma, and hypertension. 

Feygele Jacobs 

555 West 57th Street 

NY, NY 10019 

212-939-9192 

fjacobs@rchn.org 

HIE_092 

NY Rochester HealthNet 

This HIE is a collaboration between medical group practices, payers, and 

health systems to develop a patient registry for population tracking and quality 

improvement using evidence-based decision support tools for small and large 

medical practices, and educational materials for patients. 

Albert Charbonneau 

1150 University Avenue 

Rochester, NY 14607 

585-442-0030 

ac@rhealth.org 

HIE_093 

NY Health-e-Access 

This HIE is a collaboration between pediatric medical practices, health plans, 

academic medical centers, and preschool child care services to provide access to 

resources for disadvantaged and underserved preschool children. This will expand 

the existing Health-e-Access model for large child care facilities into smaller and 

home-based facilities. They will us a number of different methods, including mobile 

telehealth units. 

Kenneth McConnochie, MD, MPH 

601 Elmwood Avenue 

Pediatrics Box 777 

Rochester, NY 14642 

585-273-4119 

Ken_McConnochie@urmc.rochester.edu 

HIE_094 

NY 

University Physicians 

at Stony Brook (UPSB) 

and PatientKeeper 

ePrescription(TM) 

(Powered by DrFirst) 

University Physicians at Stony Brook, the coordinating entity for a faculty practice 

of 500 physicians in Stony Brook, New York, is implementing PatientKeeper 

ePrescription (Powered by DrFirst) on behalf of its Practices as part of a mobile 

healthcare initiative to improve quality of care and patient safety. UPSB doctors are 

already using PatientKeeper Charge Capture to streamline the charge capture and 

billing processes. Electronic charge capture is a major advance over a paper system 

in recording the services and procedures the physicians provide to their patients. 

Stephen S. Hau, PatientKeeper 

shau@patientkeeper.com 

617-987-0304 or Ellen Dank Cohen 

ellen.cohen@stonybrook.edu 

631-444-2055 

PHIT_14 

NY 

Taconic Health Information 

Network and Community 

(THINC). Partners included: 

MedAllies, Taconic IPA, 

Healthvision, SureScripts, 

NextGen, Allscripts 

Healthcare Solutions, IBM 

The Taconic Health Information Network and Community (THINC) is a multistakeholder, community-wide data exchange among community physicians, 

hospitals, reference laboratories, pharmacies, payers, employers, and consumers. 

Unique to THINC is the local, ongoing support provided by MedAllies, which 

provides training and support to community clinicians and their office staff 

to drive adoption. Project Participants: The Taconic IPA, a 2,300 independent 

practice association (IPA), is the lead organization of the THINC initiative. Other 

stakeholders include: Benedictine Hospital, Kingston Hospital, LabCorp, St. Francis 

Hospital, and Vassar Brothers Medical Center. 

A. John Blair, III, MD 

845-897-6359 

jblair@taconicipa.com 

PHIT_15 

NY Taconic IPA (TIPA) and 

MVP Health Plan 

MVP Health Plan teamed with one exclusively contracted IPA, TIPA, which has 

strong provider group relationships and expertise in the local physician market. 

Taconic IPA (TIPA) operates a combined quality and HIT incentive program in which 

bonus payments are based on daily technology usage and patient outcomes. 

Physicians’ bonuses are determined by their performance per member per month, 

and are based on 40% HIT usage and 60% quality outcomes. Shared a common 

desire— to change care from an organization-centric model to a communityoriented model through improvements in continuity of care and connectivity across 

providers. The two groups created MedAllies, a separate organization, providing 

general technical assistance, training, and IT and local vendor support to physician 

groups to move towards a highly integrated community data exchange. 

Jerry Salkowe, MD 

Senior Medical Director 

for Quality Improvement 

jsalkowe@taconicipa.com 

John Blair, MD, President & CEO 

Taconic IPA, Inc. 

PHIT_16 

NY Advancing Therapeutics in 

Parkinson’s (APT)

NY Community Health Center 

HIE Consortium

Rochester HealthNet

Health-e-Access

NY

Network and Community 

(THINC). Partners included: 

NextGen, Allscripts 

Healthcare Solutions, IBM

NY Taconic IPA (TIPA) and 

MVP Health Plan 

Ending the Document Game 
159

NY Excellus BlueCross 

BlueShield health plan 

Excellus health plan in New York operates a program similar to MedAllies in that 

it brings together a coalition including the health plan, an IPA, and an independent 

community group to focus on improving quality through the use of bonus payments. 

Under this program, the coalition pays out incentive bonuses to individual providers 

for their performance in meeting community-wide clinical guidelines for chronic 

conditions including diabetes, asthma, and coronary artery disease. 

Kathleen Curtin, VP, Q & I 

Excellus Health Plan 

205 Park Club Lane 

Buffalo, NY 14221 

716-857-6204 

Kathleen.Curtin@Excellus.com 

PHIT_17 

NY Empire Blue Cross Blue 

Shield 

Empire Blue Cross Blue Shield of New York paired with four other major, selffunded employers who purchase health care services in the NY area (IBM; Verizon 

Communications; PepsiCo, Inc.; and Xerox Corporation) to reward hospitals that 

adhere to Leapfrog standards around CPOE adoption and intensive care unit (ICU) 

staffing. Rather than directly fund technology investments, financial incentives are 

calculated based on hospital claims. 

Deborah Bohren 

Empire BCBS, VP of Public Affairs 

212-476-3552 

PHIT_18 

NY 

New York-Presbyterian 

Hospital Partners With GE 

Medical Systems 

New York-Presbyterian Hospital will implement leading edge tools for improving 

management, service quality and operational effectiveness. Employees will be 

trained in GE’s quality and process improvement programs. This balanced approach 

is comprised of Six Sigma statistical methodologies, change-management 

strategies (Change Acceleration Process) and team-based problem solving 

techniques (Work-OutTM). 

Dr. Michael Berman, EVP and hospital 

director of NewYork-Presbyterian 

Hospital, 622 West 168th Street 

New York, NY 10032 

212-305-2500 

PHIT_19 

NY 

Capital District Physicians’ 

Health Plan, Inc. (CDPHP) 

and Community Care 

Physicians, P.C. and 

Northeast Health 

Data Sharing Initiative Improves the Delivery of Health Care Services. Expanding 

its efforts to support physicians by providing real-time patient information essential 

to the delivery of quality care, CDPHP has piloted data sharing initiatives with 

two area leading health care organizations—Community Care Physicians, P.C. and 

Northeast Health. 

William J. Cromie, MD, MBA, 

President and CEO, CDPHP PHIT_20 

NY Mayo Clinic and IBM 

IBM and the Mayo Clinic embarked on a collaboration to realize a shared vision of 

information-based medicine. As a first step, IBM and Mayo Clinic have integrated 

4.4 million patient records that were in non-integrated formats, into a unified 

system based on a standard technology platform that incorporates robust security 

and privacy features. This will allow physicians and researchers access to a 

comprehensive set of records that can be analyzed with the security and privacy 

needed to protect patient confidentiality and meet government standards. 

Matthew McMahon 

IBM 

914-766-4164 

mattm@us.ibm.com 

PHIT_21 

NY Planning Implementation of 

an EMR in a Rural Area 

Researches the implementation of an EMR in the medical community and the use 

of electronic ordering; identifies a system that will allow for the seamless exchange 

of clinical information throughout the medical community. 

Jay Federaman, Adirondack Medical 

Center, Saranac Lake, NY AHRQ_070 

NY Creating an Evidence Base 

for Vision Rehabilitation 

Implements the newly developed Electronic Vision Rehabilitation Record and its 

tools to evaluate the effectiveness of current best practices and help refine practice 

as the evidence indicates. 

Betty Bird, Lighthouse International 

New York, NY 

BBIRD@lighthouse.org 

AHRQ_071 

NY Taconic Health Information 

Network and Community 

Adds a healthcare portal to the existing community-wide electronic data exchange 

which will allow for use of the current electronic messaging system along with 

migration to a full EMR; evaluates physician office efficiency improvement and 

cost reduction, payer return on investment, and safety and quality improvement. 

John Blair III, Taconic IPA, Fishkill, NY 

jblair@taconicipa.com AHRQ_072 

NY Valuation of Primary CareIntegrated Telehealth 

Assesses the impact of a telehealth program on primary care utilization and cost 

for remote assessment and treatment of ill children in childcare and school sites. 

Kenneth McConnochie, University of 

Rochester, Rochester, NY 

ken_mcconnochie@urmc.rochester.edu 

AHRQ_073 

OH Bridges-to-Excellence 

(General) 

In July 2004, United Healthcare became the first health care company to license the 

BTE model, working with employers in Omaha, St Louis, Dayton and South Florida 

to offer network doctors certain incentives for earning NCQA recognition. 

Susan Dorsey, Director NBCH 

1015 18th Street N.W., Suite 730 

Washington, DC 20036 

Sdorsey@nbch.org, 202-775-9300 

BTE_02g 

PHIT_17

Existing Efforts 
160 

OH Bridges-to-Excellence (DCL) 

Enables physicians to achieve one-year or three-year recognition for high 

performance in diabetes care. Qualifying physicians receive up to $80 for each 

diabetic patient covered by a participating employer and plan. In addition, the 

program offers a suite of products and tools to help diabetic patients get engaged 

in their care, achieve better outcomes, and identify local physicians that meet the 

high performance measures. 

NCQA 

2000 L Street, NW, Suite 500 

Washington, DC 20036 

202-955-3500

 Customersupport@ncqa.org 

BTE_03a 

OH Ohio KePRO n/a 

216-447-9604 

1-800-385-5080 

droffice@ohqio.sdps.org 

DOQ_35a 

OH Health Care Excel 

Through this initiative, Health Care Excel (HCE), the Medicare Quality Improvement 

Organization for Indiana, will assist primary care physicians in adopting Electronic 

Health Record (EHR) systems with the ultimate goal of improving office efficiency 

and patient outcomes. This initiative is sponsored by the Centers for Medicare & 

Medicaid Services (CMS). 

Darlene Skelton, 812-234-1499 

614-752-9854 DOQ_35b 

OH HealthBridge 

This HIE is a collaboration of health systems, payers, group practices, employers, 

and other stakeholders who have come together to develop an Internet portal 

for clinical information. Their platform includes secure connections to physician 

practices and hospitals, access to data at hospitals, and a clinical messaging 

system. They are looking to enhance their system by improving the speed of 

delivery of information needed for clinical decision making, aggregation of 

population health data, and cost reduction through use of a single infrastructure. 

Robert Steffel 

11300 Cornell Park Drive Suite 360 

Cincinnati, OH 45242 

513-469-7222 ext. 20 

rsteffel@healthbridge.org 

Keith Hepp, VP of Business 

Development, 513-469-7222 x12 

khepp@healthbridge.org 

HIE_100 

OH Berger Health System CPOE Pickaway County, a rural community served by a single hospital through Berger 

Health System’s is investigating CPOE. 

Andy Chileski 

600 North Pickaway St. 

Circleville, OH 43113 

740-420-8284 

andy.chileski@bergerhealth.com 

HIE_101 

OH Pathways to Medication 

Safety 

The goal of this HIE initiative is improved patient safety and treatment through 

reduction in medication errors. This is a multi-stakeholder group consisting of 

two community based hospitals (RHH and Bedford), an academic medical center 

(UHC) based within an umbrella health care system (UHHS), and a private industry 

sponsor (MDG Medical). They will establish critical metrics to evaluate and 

implement automated medication delivery system designed for small to medium 

size community based hospitals. 

Carol Fedor, ND, CCRC Center for 

Clinical Research 

University Hospitals of Cleveland 

11100 Euclid Avenue, LKSD 1400 

Cleveland, OH 44106 

216-844-5524 

carol.fedor@uhhs.com 

HIE_102 

OH HealthLink Miami Valley 

Increasing access to health and human services is the goal of this HIE. The Center 

for Healthy Communities (CHC) at Wright State University School of Medicine is a 

community academic partnership. 

Katherine L. Cauley, Ph.D. 

140 E. Monument Ave. 

Dayton, OH 45402 

937-775-1114 

katherine.cauley@wright.edu 

HIE_103 

OH Connecting Rural North 

East Ohio For Better Health 

Twin City Hospital will be the focal point of this HIE which seeks to distribute 

real-time information to the network of providers caring for a patient. Partners 

include the Red Cross and local Health Departments. 

Marge Jentes 

819 N. First St. 

Dennison, OH 44621 

740-922-2800 

mjentes@twincityhospital.org 

HIE_104 

OH Women & Children Data 

Exchange 

Women of childbearing age and their newborns are the target of this HIE in Lorain 

County, OH. Having an electronic chart would facilitate all pieces of relevant 

information being accessible at the point of care. This would dramatically enhance 

the effectiveness and the efficiency of health care providers. The HIE will include 

all patients treated by EMH ob/gyns, the ECHD, OB/GYN Clinic, EMH, pediatricians, 

and tertiary care providers (MetroHealth and Fairview) and Home Health. 

Patricia G. Egan 

630 East River Street 

Elyria, OH 44035 

440-329-7591 

PEgan@emhrhs.org 

HIE_105 

OH Bridges-to-Excellence (DCL)

OH Ohio KePRO

OH Health Care Excel

HealthBridge

OH

OH Pathways to Medication 

Safety

OH HealthLink Miami Valley

OH Connecting Rural North 

Ending the Document Game 
161

OH Rural Health Exchange 

This is a system expansion that adds an exchange of clinical information to 

include bar coding of lab specimens, laboratory results reporting, shared patient 

registration demographics, online ordering of lab tests and prescriptions by 

physicians, and electronic signature. 

Walt Newlon, MHSA 

1106 Colegate Drive 

Marietta, OH 45750 

740-568-2262 

wnewlon@selbygeneralhospital.com 

HIE_106 

OH Coordinated Patient Record 

System 

This is a multi-stakeholder, not-for-profit, 501(c)3 organization serving the greater 

Toledo, Ohio area with the focus of improving the quality of healthcare in the 

community. The HIE is both clinically-focused and patient-focused. Key components 

of the system are the consistent identification of each patient across institutional 

boundaries, and the automatic distribution of information between care sites 

according to privacy-protected routing rules. 

Duane Gainsburg, MD 

Chairman, CHANWO 

5600 Monroe Street Suite A101 

Sylvania, OH 43560 

419-882-8401 

dgains@macconnect.com 

HIE_107 

OH Laboratory Information 

System 

This is an integrated Laboratory Information System. It can be used onsite or via 

the Internet for physicians to place orders and look at test results. The hospital lab 

will also use the system to request tests of contracted reference labs for processing 

and as a posting mechanism for results. Lab results from both the hospital and the 

contracted reference labs will be available on a single website. 

Phil Frohriep 

610 West Main Street, P.O. Box 600 

Wilmington, OH 45177 

937-283-9657 

phfroehreip@cmhregional.com 

HIE_108 

OH Radiology Information 

System 

The HIE will be an integrated Radiology Information System and Picture Archiving 

and Communications System accessible from on-site or via Internet for physicians 

to view radiological images or reports. 

Phil Frohriep 

610 West Main Street, P.O. Box 600 

Wilmington, OH 45177 

937-283-9657 

phfroehreip@cmhregional.com 

HIE_109 

OH Kaiser Permanente and 

Epic Systems 

Kaiser’s other regions are preparing to follow Hawaii’s lead on the HealthConnect 

implementation. Ohio, for example, is now implementing the billing and 

appointment scheduling applications. 

Louise Liang, MD, SVP for Quality and 

Clinical Systems Support 

Kaiser Foundation Health Plan 

One Kaiser Plaza, Oakland, CA 94612 

510-271-6317 

PHIT_05b 

OH 

SureScripts and The 

Cleveland Clinic and 

Epic Systems 

SureScripts is working with The Cleveland Clinic’s physician and technology staff 

to connect its EpicCare EMR system with the SureScripts network, allowing the 

Clinic’s nearly 1,000 physicians currently using EpicCare to exchange renewal 

requests and authorizations with pharmacists and process new prescriptions 

completely electronically. 

Michelle Bolek, Cleveland Clinic

 216-444-0333 

bolekm@ccf.org 

PHIT_22 

OH Cleveland Clinic and IBM 

Cleveland Clinic and IBM are collaborating to provide the clinic’s patients with 

more customized treatments by allowing doctors to electronically tap into research 

discoveries at the bedside. IBM and Cleveland Clinic will develop a “translational 

medicine platform,” or infrastructure that ties together patients’ electronic 

health-record data with the clinic’s clinical, genetic, and other research data. The 

work between IBM and Cleveland Clinic follows a similar customized medicine 

collaboration revealed in Aug between IBM and Mayo. 

Mike Svinte, IBM’s VP of informationbased medicine or Michelle Bolek 

Cleveland Clinic, 216-444-0333 

bolekm@ccf.org 

PHIT_23 

OH CCHS-East Huron Hospital 

CPOE Project 

Creates an information management environment that integrates patient care 

data, standardizes practice variation and use of best practices, and supports the 

delivery of a seamless continuum of patient care throughout the health system 

through CPOE. 

Greg Kall, Meridia Health System 

East Cleveland, OH 

KallG@ccf.org 

AHRQ_076 

OH Trial of Decision Support to 

Improve Diabetes Outcomes 

Evaluates the effects of a Web portal-based patient empowerment program and 

EMR system on quality of care, patient safety, and utilization for patients with 

diabetes and physicians in primary care practices. 

Randall Cebul, Case Western Reserve 

University, 216-778-3901 

rdc@case.edu 

AHRQ_077 

OK LifeMasters Supported 

SelfCare 

Deployment of project will begin in Sep 05. Will be using this call center for 

monitoring approx 135,000 members of Bluegrass Family Health. 

Denise Apcar, LifeMasters 

650-829-6217 

dapcar@lifemasters.com 

CCIP_6 

HIE_106

Existing Efforts 
OK Oklahoma Foundation for 

Medical Quality 

162

As part of its commitment to improving health care in our state, OFMQ is helping 

primary care practices understand and use health IT through the Doctor’s Office 

Quality - Information Technology (DOQ-IT) initiative. OFMQ understands that 

different practices have different needs and is offering support to practices 

implementing clinical IT solutions or improving efficiencies of current systems 

through DOQ-IT. 

Lisa Wynn 

405-840-2891 

lwynn@okqio.sdps.org 

DOQ_36 

OK Saint Francis Heart Hospital 

HIE 

The technical foundation of this HIE is the Saint Francis Heart Hospital. The 

cardiovascular network encompasses ambulatory clinics, outpatient diagnostic 

centers, tertiary care centers and independent physician practices. The network will 

capture historical data for cardiovascular-compromised patients, with the objective 

of impacting outcomes in a positive manner by eliminating paper-based problems. 

Tom Cooper 

6585 South Yale Ave Suite 1040 

Tulsa, OK 74136 

918-481-7911 

tcooper@saintfrancis.com 

HIE_110 

OK 

Health Improvement 

Collaboration in Cherokee 

County, Oklahoma 

Creates a plan for developing an integrated, multifunctional, HIPAA-compliant 

Community Health Information Network; developing a telephonic comprehensive 

nurse line service and triage function; and investigating and implementing 

improvements for streamlining of existing appointment systems. 

Mark Jones, Tahlequah City Hospital 

Tahlequah, OK AHRQ_078 

OK INTEGRIS Telewoundcare 

Network 

Demonstrates and evaluates the clinical effectiveness and cost-savings of 

utilizing telehealth technology to reduce the days to healing for chronic wounds by 

improving access to caregivers, point of care processes, and dissemination of best 

practice information. 

Charles Bryant, INTEGRIS Health, Inc. 

Oklahoma City, OK AHRQ_079 

OR 

Oregon Medical 

Professional Review 

Organization (OMPRO) 

During the current pilot phase of the project, OMPRO is working with a small 

number of Oregon medical practices that are currently implementing EHR systems 

or preparing to select a vendor. OMPRO is assisting the practices in evaluating 

vendors and products and in designing improved workflows for documenting patient 

care. OMPRO will work with a larger number of practices when the full DOQ–IT 

project commences in fall 2005. The full project includes quality improvement and 

measurement components. 

Margene Bortel /Quality Improvement 

Specialist 503-382-3963 DOQ_37 

OR Portland Emergency 

Surveillance System 

The proposed HIE is a real time population-based database that includes the 

discharge and admission diagnosis from all major area emergency departments 

in Portland, Oregon. This database is designed to be queried automatically for 

syndromic surveillance. The data will be analyzed according to GIS data and 

diagnosis to detect spatial and temporal clustering of diagnoses. 

Jerris Hedges, MD 

3181 SW Sam Jackson Park Road 

Portland, OR 97201 

503-494-7500 

hedgesj@ohsu.edu 

HIE_111 

OR Oregon Senate 

A plan approved by the Senate Monday, Senate Bill 541, creates a task force to 

make recommendations on implementing a state electronic medical records system 

and address necessary patient security issues. Senate Bill 541 brings together 

hospitals of varying sizes, representatives of physicians’ clinics and vendors that 

can provide electronic medical record services to establish a road map toward 

better information sharing. 

Senator Frank Morse (R-Albany/ 

Corvallis, OR) or Senator Ben Westlund 

(R-Bend, OR) 

PHIT_24 

OR 

Improving the Quality 

of Healthcare in Central 

Oregon 

Develops an integrated health IT to improve rural access to healthcare, and 

identifies key issues to improve patient safety and quality of care, including 

analyzing the cost-benefit of technical solutions. 

Diane Audiss, St. Charles Medical 

Center, Bend, OR 

daudiss@scmc.org 

AHRQ_080 

OR Bay Area Community 

Informatics Project 

Plans the implementation of an HIE using a secure fiber optic connection between 

community care providers to share patient demographic, medical records, 

laboratory results and radiographic images. 

Jeffery Givens, Bay Area Hospital 

Coos Bay, OR AHRQ_081 

OR 

Using IT to Improve 

Medication Safety for 

Rural Elders 

Implements a Patient-Centered Medication Information System (PCMIS) to provide 

secure access to accurate, complete, and current medication information for 

patients, clinicians, pharmacists, and nurses, reconcile differences in medication 

information, and provide a platform for evidence-based decision support; assess 

the benefits and costs of the system. 

Paul Gorman, Samaritan North Lincoln 

Hospital, Lincoln City, OR 

gormanp@ohsu.edu 

AHRQ_082 

OK Oklahoma Foundation for 

Medical Quality

Saint Francis Heart Hospital 

HIE

Health Improvement 

Collaboration in Cherokee 

County, Oklahoma

OK INTEGRIS Telewoundcare 

Network

OR

OR

OR Oregon Senate

OR 

Improving the Quality 

of Healthcare in Central 

Oregon 

OR 

OR 

Ending the Document Game 
AHRQ_083 

163

OR Medication Management: A 

Closed Computerized Loop 

Implements health IT specifically related to medication administration and 

management and assesses the extent to which these technologies contribute to 

measurable and sustainable improvements in patient safety and quality of care. 

Mark Hetz, Three Rivers Community 

Hospital, Grants Pass, OR 

541-608-5960 

OR 

Improving Safety and 

Quality with Integrated 

Technology 

Demonstrates the value of an integrated outpatient and inpatient health 

information system by assessing adherence to evidence-based treatment guidelines 

for women who are group B streptococcus positive including inappropriate 

antibiotic use and screening in the outpatient setting, and cost-benefit analysis. 

Jeanne-Marie Guise, Oregon Health 

and Sciences University, Portland, OR 

503-494-3107 

AHRQ_084 

PA Health Dialog Services 

Corp. 

Health Dialog will demonstrate its approach to chronic care management by 

providing care management services over the next 3 years to at least 20,000 

fee-for-service Medicare beneficiaries in PA with congestive heart failure and/or 

complex diabetes. 

George Bennett, Chairman and CEO 

Health Dialog, Sixty State Street, 

11th Floor, Boston, MA 02109, 

617-406-5200 

CCIP_4 

PA Quality Insights of 

Pennsylvania 

Quality Insights of Pennsylvania is the Medicare Quality Improvement Organization 

(QIO) for the Commonwealth. The Centers for Medicare & Medicaid Services (CMS) 

contract runs from August 1, 2002 to July 31, 2005. Quality Insights: Partnering to 

Achieve Health Care Excellence with Information Technology. 

717-671-5425 

877-346-6180 

http://www.qipa.org/Feedback.asp 

DOQ_38 

PA SVRHP Regional Remote 

Pharmacy System 

This proposal is for the establishment of a fully integrated remote pharmacy system 

between all network members using common clinical application systems. The 

SVRHP is developing a regional rural integrated electronic information system to 

enhance and support local healthcare delivery. By establishing this system, all 

network members will have 24 hour, 7 day a week services of licensed pharmacist. 

Susan Browning, Executive Director 

1020 Thompson Street 

Jersey Shore, PA 17740 

570-321-3000 

sbrowning@shscares.org 

HIE_112 

PA 

HIE to Prevent Blindness 

in four Specific Blinding 

Disorders 

This is a remote imaging HIE in which retinal images are captured, stored 

and forwarded via internet to qualified specialists for analysis. Diagnosis and 

management information is then transmitted to the patient’s managing physician. 

Jay L Federman, MD 

501 N. Essex Ave. 

Narberth, PA 19072 

610-949-9789 

jfederbeck@aol.com 

HIE_113 

PA Mercy Circle of Care 

Exchange Model 

This program will affiliate with churches and neighborhood organizations to do 

insurance outreach and referral to primary care and maintain a shared data system 

to profile and track uninsured individuals over time. Using a web-based information 

management system, “ServicePoint” by Bowman Internet Systems, LLC, they will 

link all of the participating Mercy Circle of Care providers via the Internet and 

will be operated as a web-based, on-line transactional system. The database will 

provide the Mercy Health Partners with the capability of capturing and sharing 

real-time data throughout the network to facilitate patient eligibility, patient 

registration, patient tracking, referrals, and care and outcomes management. 

William Bithoney, MD 

501 South 54th Street 

Philadelphia, PA 19143 

215-748-9420 

wbithoney@mercyhealth.org 

HIE_114 

PA Service Point 

ServicePoint coordinates and electronically automates client intake and screening 

for eligibility in the HealthRight program. ServicePoint also maintains a brief 

history of the client’s medical conditions and medical services provided, allowing 

HealthRight and the participating providers to identify, monitor, and case manage 

appropriate patients to move towards improving their health status. 

Linnette Black 

801 Market St., 7th Floor, Suite 7100 

Philadelphia, PA 19107 

215-413-8591 

lblack@hfedu.org 

HIE_115 

PA The Pittsburgh Health 

Information Network (PHIN) 

The PHIN is designed to be a central repository which will collect claims data on 

diabetic and depressed patients as well as lab test results on 7 datapoints related 

to diabetes care. This central database can then be accessed by physicians ondemand and at the point of care in order to easily track available data on treatment 

for these chronic diseases from a single source no matter what health insurance 

coverage a patient has. 

Ed Harrison 

Centre City Tower, Suite 2150 

650 Smithfield St. 

Pittsburgh, PA 15222 

412-535-0292 x 107 

eharrison@prhi.org 

HIE_116 

AHRQ_083

Existing Efforts 
164 

PA Patient/Physician 

Information Exchange (P2P) 

UPMC’s proposal model is to provide tools that are integrated into the physician 

workflow that enable communication (physician to physician, patient to physician 

and physician to patient). The Patient/Physician Information Exchange is a secured 

interactive suite of software tools that enable a variety of communication paths 

with physicians and patients. It supports bi-directional communication to the 

patient and physician with all available modalities. 

Robert J. Schwartz, MD, MPH

 Medical Director, UPMC HS 

Office of Physician Relations 

200 Lothrop Street 

Pittsburgh, PA 15213 

412-647-7346 

schwartzrj@upmc.edu 

HIE_117 

PA Scranton Temple HIE 

(STHIE) 

STRP Inc.goal is to plan and implement a feasible, sustainable and effective HIE 

system in the community that will allow authorized providers and consumers timely 

and efficient access to complete patient health information. 

Robert E. Wright, MD 

746 Jefferson Avenue 

Scranton, PA 18510 

570-343-2383 

rwrigth@mhs-nepa.com 

HIE_118 

PA IBM and the University of 

Pittsburgh Medical Center 

IBM and the University of Pittsburgh Medical Center have announced that they 

will spend at least $50 million over eight years to develop computer technology 

for health care, the Pittsburgh Post-Gazette reports. Officials hope the computer 

infrastructure will serve as a model for other hospitals that want to develop 

electronic health records, creating commercial opportunities for IBM and UPMC. 

UPMC President Jeffrey Romoff 

200 Lothrop St. 

Pittsburgh, PA 15213-2582 

800-533-8762 

PHIT_25 

PA 

Geisinger Health System 

and Central Penn Health 

Information Collaborative 

A group of 24 community hospitals from across central and eastern Pennsylvania 

began May 11, 2005 an initiative to create a system for sharing electronic patient 

records between the hospitals. Mount Nittany Medical Center, and Philipsburg and 

Tyrone hospitals are part of the Central Penn Health Information Collaborative. The 

effort being spearheaded by Geisinger includes hospitals from across the state, 

including Altoona, Huntingdon, Scranton, Wilkes-Barre, Montrose and Lewistown. 

The initiative doesn’t have the heavy financial backing others nationwide have had. 

It does have a $200,000 federal grant and has applied for an additional $3 million 

in funding. 

Jim Walker, CMIO 

Geisinger Health System 

jmwalker@geisinger.edu 

570-271-6750 

PHIT_26 

PA Highmark Blue Cross 

Blue Shield (PA) 

Highmark Blue Cross Blue Shield (PA) also operates a similar program [to the 

Bridges for Excellence model] which awards tiered bonuses based on performance 

and IT implementation for physicians in at least the 50th percentile. 

Highmark 

Fifth Avenue Place 

120 Fifth Avenue 

Pittsburgh, PA 15222-3099 

412-544-7000 

PHIT_27 

PA CapMed PHR and NextGen 

Healthcare 

The PHR will work in conjunction with NextGen® EMR to enable the secure 

communication of health information between patients and providers. The PHR 

allows patients to keep personal health data electronically on their personal 

computer and exchange data with their physicians and other care providers. 

Wendy Angst, CapMed 

wangst@capmed.com 

267-757-3315 

PHIT_33 

PA Regional Approach for 

THQIT in Rural Settings 

Conducts a formal clinical information and technical needs assessment to identify 

the optimal technical model for information sharing as well as actions required to 

overcome barriers; develops a project plan that will promote implementation of 

cost-effective clinical information services. 

James Walker, Geisinger Clinic 

Danville, PA AHRQ_085 

PA 

Enhancing Patient Safety 

through a Universal EMR 

System 

Implements an EMR system that allows 24-hour data sharing across 7 rural health 

care delivery sites for clinicians to access current and complete patient information 

using either Personal Digital Assistants or a Web portal. 

Thomas Johnson, Dubois Regional 

Medical Center, DuBois, PA AHRQ_086 

PR 

Quality Improvement 

Professional Research 

Organization (QIPRO) 

n/a n/a DOQ_52 

RI 

State and Regional 

Demonstrations in Health 

Information Technology 

Contract that plans, develops, implements, and evaluates a Master Patient Index 

to facilitate interoperability and sharing patient data between public and private 

health care sectors. 

Project Director: Patricia Nolan 

State of Rhode Island, Providence, RI AHRQ_087 

Patient/Physician 

Information Exchange (P2P)

PA Scranton Temple HIE 

(STHIE)

PA IBM and the University of 

Pittsburgh Medical Center 

PA

PA

PA

Regional Approach for 

THQIT in Rural Settings

Enhancing Patient Safety Enhancing Patient Safety 

PA through a Universal EMR 

System

PR

RI

Ending the Document Game 
165

RI Quality Partners 

of Rhode Island (No specific DOQ-IT information) 

Lauren Pond /Physician Office 

401-528-3204 

lpond@riqio.sdps.org 

DOQ_39 

RI Rhode Island/HealthAlliant 

Project 

RIQI is implementing a statewide initiative in cooperation with SureScripts, Inc., 

a collaborative effort of independent and chain pharmacies across the nation to 

implement state-wide electronic connectivity between all retail pharmacies and 

all prescribers in the state. 

Laura Adams 

One Union Station 

Providence, RI 02903 

401-274-4564 

ladams@riqi.org 

HIE_119 

SC Carolina Medical Review (No specific DOQ-IT information) 803-731-8225 

800-922-3089 DOQ_40 

SD South Dakota Foundation 

for Medical Care (No specific DOQ-IT information) 605-336-3505 800-658-2285 DOQ_41 

SD Sioux Valley Clinical 

Information System 

Sioux Valley Hospitals and Health System has developed a plan for implementing 

a Clinical Information system across its entire health system. These clinical 

Information systems will form an electronic medical record that will be used to 

share appropriate clinical information between clinicians across the health system. 

Arlyn Broekhuis 

1305 W. 18th Street 

Sioux Falls, SD 57117-5039 

605-333-7329 

broekhua@siouxvalley.org 

HIE_120 

TN XL Health 

XL Health chosen to provide disease management services in Tennessee. 

Responsible for recruiting and offering DM services to Medicare fee-for-service 

beneficiaries in Tennessee with diabetes, congestive heart failure and all related 

co-morbidities. 

XLHealth, The Warehouse 

at Camden Yards 

351 West Camden Street, Suite 100, 

Baltimore, MD 21201 

CCIP_9 

TN Center for Healthcare 

Quality 

QSource, the Medicare Quality Improvement Organization for Tennessee, is 

embarking on a project to provide support to small and medium primary care 

practices in implementing EHRs. We are not a vendor of EHR products, nor do we 

endorse any vendor. What we do is help you and your staff identify which of the 

existing systems would best meet your practice’s needs, look at what needs to 

be put in place to successfully implement it into your office structure, and what 

changes need to occur in your office’s workflow to ensure that the EHR functions in 

such a way as to be effective and not to cause unnecessary issues or duplication 

of work. 

Jennifer McAnally /EHR 

Implementation Advisor 

1-800-528-2655 (2635) 

DOQ_42 

TN Tri-Cities TN-VA Care Data 

Exchange Project 

Our HIE is diverse collaboration of health service institutions which seek to improve 

health outcomes for patients through linkage of their health information. The 

HIE will be a peer to peer network allowing existing EMR systems to retain and 

maintain data while a search interface handles security, record identification, 

and distribution. 

Liesa Jo Jenkins 

P.O. Box 980 

Kingsport, Tennessee 37662 

423-246-2017 

ljenkins@kingsporttomorrow.org 

HIE_121* 

RHIO_121 

TN Volunteer eHealth Initiative 

Designed to establish regional data-sharing agreements and to implement clinical 

data exchange, the Volunteer eHealth Initiative will provide a framework for 

hospitals, physician groups, clinics, health plans and other healthcare stakeholders 

to work together. It focuses initially on Shelby, Fayette and Tipton counties. 

Vanderbilt Center for Better Health 

3401 West End Avenue, Suite 290 

Nashville, TN 

615-343-1528 

HIE_123 

DOQ_39

TN 

Memphis Metro Area 

Technology Collaborative 

for Health (MATCH) 

MATCH is a technical infrastructure for a common enterprise-wide master patient 

index (eMPI), becoming the foundation for a regional health information exchange 

network and electronic medical record system. The system will be designed so 

that authorized healthcare providers at any facility will have the ability to log on, 

find the correct patient, and immediately access all relevant health information 

including transcribed reports, laboratory, radiology, etc. 

Chuck Fitch, Vice President and Chief 

Information Officer / Co-PIs: Karen Fox 

and Mary McCain 

66 N. Pauline Street, Suite 232 

Memphis, TN 38105 

901-448-6683 

Chuck.Fitch@utmg.org 

HIE_122 

Mark Frisse, MD 

Mark.Frisse@Vanderbilt.edu 

Existing Efforts 
166 

TN Williamson-Wired Health 

Exchange for Kids 

This HIE program will enroll parents of underinsured kids through school and church 

outreach, educate them via classes, assign a caregiver for web-based coaching, link 

the children’s health to providers in the Mercy Children’s Clinic and to community 

based providers, and monitor improvements in health outcomes and communitybased care for this population. The “wired” resource network will include schools, 

churches and physicians in the community, with the goal of improving access 

to basic primary care services and, through the use of web-based technology, 

to improve health status in the prevention and treatment of prevalent childhood 

diseases and conditions. 

Paul H. Keckley, Ph.D. 

Executive Director 

MCN D3300 

Nashville, TN 37232 

615-343-3922 

paul.keckley@vandervilt.edu 

HIE_124 

TN 

State and Regional 

Demonstrations in Health 

Information Technology 

Contract that plans, implements, and evaluates a State-based regional data 

sharing and interoperability service interconnecting the health care entities in 

three counties including needs assessment for healthcare improvement and 

reforming TennCare. 

Project Director: Mark E. Frisse 

Vanderbilt University Medical Center 

Nashville, TN 

AHRQ_088 

TN 

Improving the Quality and 

Safety of Regional Surgical 

Patient Care. 

Through the Creation of a Multi-institutional Partnership for the Implementation 

and Support of Perioperative Informatics Tools, this project develops a detailed 

plan for the implementation and support of informatics tools in regional health 

centers including the creation of informatics tools to manage institutional surgical 

care information, creation of a multi-institutional partnership to manage both the 

informatics and surgical quality improvement programs, and the development of an 

economic model related to the business and safety benefits. 

Michael Higgins, Vanderbilt University 

Medical Center, Nashville, TN AHRQ_089 

TN 

Improving Quality Care 

for Children with 

Special Needs 

Develops a database that includes diagnoses, health records, and educational 

information on Children with Special Health Care Needs with emphasis on children 

with genetic conditions and developmental disabilities; makes this information 

available to physicians via a secure Web-based system. 

Carmen Lozzio, University of 

Tennessee Health Sciences Center 

Memphis, TN 

AHRQ_090 

TN 

Technology Exchange for 

Cancer Health Network 

(TECH-Net) 

Implements a systematic care program to improve cancer management in rural 

communities by building upon an innovative approach to total clinical decision 

support to provide access to oncology, hematology, and other specialists through a 

dedicated telehealth network. 

Karen Fox, University of Tennessee 

Health Sciences Center, Memphis, TN 

kfox@utmem.edu 

AHRQ_091 

TX Rural Hospital Collaborative 

for Excellence Using IT 

Implements advanced information technology in rural and small community 

hospitals including Web-based business intelligence tools, Internet connectivity, 

and standardized national measures of patient safety and quality; also provides 

education intervention to support implementation efforts and evaluate its effects 

on patient safety and quality. 

Patricia Dorris, Palo Pinto General 

Hospital, Mineral Wells, TX AHRQ_092 

TX Measuring the Value of 

Remote ICU Monitoring 

Examines the effect of tele-ICU monitoring on mortality, complications, length of 

stay, cost-effectiveness, provider attitudes, and human factors issues in ICUs and 

7 community hospitals. 

Eric Thomas, University of TX-Houston 

Eric.Thomas@uth.tmc.edu AHRQ_093 

TX TX Medical Foundation 

TX Medical Foundation, under contract with the Centers for Medicare & Medicaid 

Services, is providing support for a limited time to small- and medium-sized primary 

care practices in implementing an EHR system through an initiative called Doctor’s 

Office Quality - Information Technology (DOQ-IT). We are not a vendor of EHR 

products and we do not endorse any vendor. 

Tara Frease, 800-725-9216 

tfrease@txqio.sdps.org 

bstephenson@txqio.sdps.org 

DOQ_43 

TX Integrated Clinical 

Information System 

TCH is launching a major initiative to transform multiple, disparate information 

systems into an integrated pediatric information management portal. TCH and its 

other entities and partners are committed to providing an integrated electronic 

medical record; point of care review and capture of vital signs, medication 

administration, and data from biomedical equipment; improved quality of life by 

utilization of telemedicine and remote capture of data from new sources; and data 

warehouse to support clinical research and education. 

David Finn, VP Information Services 

1102 Bates, Suite 650, MC 3-4221 

Houston, TX 77030 

832-824-2062 

dsfinn@texaschildrenhospital.org 

HIE_125 

TN Williamson-Wired Health 

Exchange for Kids

State and Regional 

TN Demonstrations in Health 

Information Technology

Improving the Quality and 

TN Safety of Regional Surgical 

Patient Care. 

TN 

TN 

TX Rural Hospital Collaborative 

for Excellence Using IT 

Measuring the Value of 

Remote ICU Monitoring 

TX TX Medical Foundation

Ending the Document Game 
167

National Data Source TX Connectivity 

PSI is deploying a communication network based on existing technology that 

provides patient-centric clinical information. The network backbone is based 

on a community-driven, patient-centric model. To facilitate expansion of PSI 

nationwide, PSI will offer access to the system through publicly available, openstandard technology. PSI is platform and software independent, making access 

to its inexpensive and trusted network service open to all communities that join 

the network and agree to abide by PSI’s principles. PSI has been designed to be a 

national, rather than regional model. 

TX UHS HIE 

This is a web-based patient health indicator database. The HIE will provide for a 

collection and exchange of patient-monitored health indicators and a sharing of 

these indicators with assigned clinicians. 

Tim Geryk 

4502 Medical Drive 

San Antonio, TX 78229 

210-358-1392 

tim.geryk@uhs-sa.com 

HIE_127 

UT Bridges-to-Excellence (POL) 

CMS is also looking towards the BTE Physician Offi ce Link program as a 

possible element in its forthcoming Medicare Care Management Performance 

Demonstration project, an initiative which will promote the adoption and use of 

health information technology to improve the effi ciency and quality of patient care 

for chronically ill Medicare patients. Doctors who meet or exceed performance 

standards established by CMS in clinical delivery systems and patient outcomes 

will receive performance payments for managing the care of eligible Medicare 

benefi ciaries. The effort, scheduled to begin later this year, will involve hundreds 

of doctors in medical practices in Arkansas, California, Utah and Massachusetts. 

In many of these States, CMS will collaborate with BTE and other private pay-forperformance initiatives. 

Medstat Group 

1-800-224-7161 

bridgestoexcellence@thomson.com 

BTE_01c 

UT HealthInsight 

HealthInsight is a private, non-profi t QIO whose mission is to be a catalyst in 

the transformation and improvement of the health care system. In our thirtyyear history, HealthInsight staff has worked with the health care community on 

initiatives to improve the quality of care delivered in Nevada and Utah. The goal 

being to: Educate physician offi ces on EHR system solutions and alternatives, 

Provide implementation and quality improvement assistance, Assist physician 

offi ces in migrating from paper-based health records to EHR systems that suit 

their clinics’ needs. Assist those currently using an EHR in using their system 

more effectively. 

Sharon Donnelly 

(Medicare Benefi ciaries) 

http://www.healthinsight.org/ 

contact.html 

801-892-6668 

Hotline: 800-483-0932 

801-892-0155 

sdonnelly@healthinsight.org 

DOQ_44 

UT Utah Health Information 

Network (UHIN) 

The Utah Health Information Network (UHIN) is a broad-based coalition of health 

care insurers, providers, and other interested parties, including State government. 

UHIN participants have come together for the common goal of reducing health care 

administrative costs through data standardization of administrative health data and 

electronic commerce (EC). UHIN has a centralized health data transaction system 

and is the hub for this system. 

801-466-7705 

Fax: 801-466-7169 

Washington Building, Suite 320, 

151 East 5600 South 

Murray, UT 84107 

HIE_140 

UT 

Improving Communication 

Between Health Care 

Providers Via a Statewide 

Infrastructure: UHIN 

Contract that expands and enhances current Statewide network for the electronic 

exchange of patient administrative and clinical data and will support the adoption 

of EMRs. 

Project Director: Jan Root, 

Utah Health Information Network 

Murray, UT 

AHRQ_094 

UT 

Nursing Home IT: Optimal 

Medication and Care 

Delivery 

Implements an health IT system with added best-practices decision support 

modules in 7 nursing homes and evaluates the impact on care processes, resident 

health outcomes, and staff effi ciency and satisfaction. 

Susan Horn, International Severity 

Information Systems, Inc. 

Salt Lake City, UT 

AHRQ_095 

UT Rural Trial of Clinic Order 

Entry with Decision Support 

Assesses the value of a computerized clinic order entry tool in rural primary 

care practices for appropriateness of antimicrobial therapy for acute respiratory 

infections, frequency of hemoglobin A1c in diabetics, incidence of outpatient 

adverse drug events, and infl uenza vaccine immunizations. 

Matthew Samore, University of Utah 

Salt Lake City, UT AHRQ_096 

Johnny Walker, PSI CEO / 

Executive Director, 972-444-9800 

jwalker@ptsafety.org 

HIE_126 

Existing Efforts 
168 

VA Virginia Health Quality 

Center 

Through the Doctors’ Office Quality-Information Technology (DOQ-IT) project, 

sponsored by CMS, the VHQC is working to support the adoption and effective use 

of information technology by physicians’ offices in Virginia, along with all Quality 

Improvement Organizations (QIOs) across the nation. 

Project Manager: David Collins, 

M.H.A., CPHQ; Medical Director: Kevin 

Fergusson, M.D., M.S.H.A. 

804-289-5320 dcollins@vaqio.sdps. 

org, kfergusson@vaqio.sdps.org 

DOQ_46a 

VA West Virginia Medical 

Institute (No specific DOQ-IT information) 

804-343-9776 

1-800-951-3530

 http://www.wvmi.org/Feedback.asp 

DOQ_46b 

VA CenVaNet 

Using a common web portal that enables physicians, hospitals, commercial 

laboratories, payers and eventually consumers to communicate in a secure and 

confidential environment, CenVaNet has organized the creation of a communitywide data and information interchange to allow providers to transfer critical clinical 

and administrative data. 

Michael Matthews, CEO 

2001 West Broad St., Suite 202 

Richmond, VA 23220-2022 

804-359-4500 x225 

mmatthews@CVHN.com 

HIE_129 

VA Rural Virginia e-Health 

Collaborative 

Examines automation of the continuity of care record for use in patient referrals, 

hospital admission, and hospital discharge; e-prescribing in physician practices, 

hospital discharge medications, and long-term care facilities with links to 

community pharmacies; and disease registries for managing preventive care 

interventions and chronic diseases. 

Michael Matthews, Rappahannock 

General Hospital, Kilmarnock, VA AHRQ_099 

VI Virgin Islands Medical 

Institute (No specific DOQ-IT information) 340-712-2400 askvimi@viqio.sdps.org DOQ_53 

VT Northeast Health Care 

Quality Foundation 

(No specific DOQ-IT information) Mission is to encourage and promote improvement 

in health care for the Medicare beneficiaries in our service region. We provide 

educational materials and tools for identified quality improvement projects, and 

conduct reviews to ensure quality of care for beneficiaries and protect the Medicare 

Trust Fund. 

1-800-772-0151 

603-749-1641 

info@nhcqf.org 

DOQ_45 

VT Community Electronic 

Health Record 

Goal is to create a patient record integrated with CVH’s EMR and to make it 

available immediately to all providers in the 25-physician primary care offices. 

Russell Davignon 

P.O. Box 547 

Barre, VT 05641 

802-371-4100 

russell.davignon@hitchcock.org 

HIE_128 

VT Improving Rural Healthcare 

with Technology 

Utilizes existing health IT standards to integrate the current stand-alone databases 

and information systems of a consortium of three rural healthcare systems as the 

basis for creating a comprehensive electronic health record for patient care. 

C. Frederick Lord, Mt. Ascutney 

Hospital and Health Center 

Windsor, VT 

AHRQ_097 

VT 

Improving Healthcare 

Quality via Information 

Technology 

Implements an integrated electronic patient medical record, electronic medication 

administration record, computerized physician order entry (CPOE), and clinical 

decision support software that will be accessible at all participating facilities which 

include an acute care hospital, home health care agency, ambulatory clinics, a 

rehab facility, and to the patient/resident from home. 

Robert Pezzulich, Southwestern 

Vermont Health, Bennington, VT AHRQ_098 

WA Qualis Health 

Practices that participate in DOQ-IT will receive free assistance to select, 

implement, and optimize IT systems such as EHRs, e-prescribing, and registries. 

CMS has contracted with Qualis Health to provide DOQ-IT services to participating 

physicians in Washington, Idaho, and Alaska. 

Andrea Sciaudone, RN CPHQ 

800-949-7536, ext. 2030 

andreas@qualishealth.org 

DOQ_47 

WA 

e-Prescribing: 

Strengthening Countywide Health Information 

Exchange 

The HIE will assist in checking for allergies, drug-drug-conflicts, duplicate drugs, 

and drug-disease contraindications. 

Lori Nichols 

715 West Orchard Drive, Suite 4 

Bellingham, WA 98225 

360-671-6800 

lnichols@hinet.org 

HIE_130* 

RHIO_130 

VA Virginia Health Quality 

Center

West Virginia Medical VA est Virginia Medical 

Institute

VA CenVaNet

VA Rural Virginia e-Health 

Collaborative

VI

VT

VT

VT Improving Rural Healthcare 

with Technology 

Improving Healthcare 

Quality via Information Quality via Information 

Technology 

WA

WA

Ending the Document Game 
169

WA 

Community-Based Diabetes 

Health Information 

Exchange Project 

This HIE is built upon an existing EMR. It will allow tracking of inpatient and 

outpatient data related to diabetes, which will be collected via standardized 

messaging from independent sources into the Electronic Medical Record (EMR) 

of the primary care provider. The EMR will also use a web tool to allow diabetes 

patients to access health education and enter health monitoring information. 

Jac Davies 

157 S. Howard St., Suite 500 

Spokane, WA 99201 

509-232-8120 

daviesjc@inhs.org 

HIE_131 

WA 

HealthKey, & 

the Electronic Laboratory 

Based Reporting System 

(ELBRS) 

HealthKey was developed to create a replicable model for Public Key Infrastructure 

(PKI) and other secure infrastructure models for the health care industry. In addition 

to CHITA’s role in HealthKey, the organization facilitates troubleshooting and 

assistance around HIPAA standards for data exchange, privacy and security, and 

hosts a number of workgroups around standards for administrative and claims data. 

Michael Taylor, 206-682-2811 x10 

administration@qualityhealth.org HIE_145 

WA Kaiser Permanente and Epic 

Systems 

The next regions to implement the patient records component will be those with 

previous clinical IT experience, such as Kaiser’s Northwest region, where facilities 

have used other Epic systems for years. 

Louise Liang, MD, SVP for Quality and 

Clinical Systems Support 

Kaiser Foundation Health Plan 

One Kaiser Plaza, Oakland, CA 94612 

510 271-6317 

PHIT_05d 

WA Microsoft: Digital Pharma 

Initiative 

Microsoft Announces Digital Pharma Initiative, Providing Comprehensive Solutions 

Framework to Drive Business Efficiency and Speed-to-Insight in the Pharmaceutical 

Industry. More Than 18 Leading Companies Are Developing or Supporting Solutions 

Based on the Digital Pharma Initiative; Pfizer and Merck Are Among a Number 

of Customers That Have Deployed Microsoft-Based Solutions. The companies 

include Accenture, Covansys Corp., DataLabs Inc., HP, Immedient Corp., Manhattan 

Associates Inc., Meridio, Merit Solutions Software, Motion Computing Inc., 

OnSphere Corp., OSIsoft Inc., OutlookSoft Corp., ProClarity Corp., Project Assistants 

Inc., Proscape Technologies Inc., QUMAS, Siebel Systems Inc. and Tectura Corp. 

Tim Smokoff, Managing Director 

Microsoft Healthcare and 

Life Sciences 

PHIT_28 

WA 

Evaluating the Impact of 

an ACPOE/CDS System on 

Outcomes 

Implements an ambulatory computer physician order entry (ACPOE) system with 

clinical decision support capabilities in an ambulatory, community-based, integrated 

health-system; evaluates the impact of the system both internally, on organizational 

processes and human factors, and externally, on patient safety as measured by 

medication errors and adverse drug events. 

Sean Sullivan, University of 

Washington, Seattle, WA 

sdsull@u.washington.edu 

AHRQ_100 

WA 

A Rural HIT Cooperative 

to Promote Clinical 

Improvement 

Demonstrates the value of health IT in improving quality of inpatient care 

for community-acquired pneumonia and emergency care of acute myocardial 

infarctions in rural hospitals. 

Elizabeth Floersheim, Rural Healthcare 

Quality Network, Davenport, WA 

206-216-2550 

AHRQ_101 

WI MetaStar n/a Jesi Wang, 608-441-8269 

800-362-2320 jwang@metastar.com DOQ_49 

WI Wisconsin Health 

Informaton Exchange 

WHIE will incorporate the building blocks of an HIE from several underutilized 

networks to form a system that has a patient index, standards-based data storage/ 

transmission, security, redundancy, and consumer access. 

Seth Foldy, M.D. 

c/o NIMI-MW 

1251 Glen Oaks Lane 

Mequon, WI 53092-3378 

414-906-0036 

sfoldy@sbcglobal.net

 HIE_135* 

RHIO_135 

WI Wellpoint eRx or Paper 

Reduction 

WellPoint is spearheading an electronic initiative at a cost of $40 million that 

will reach 19,000 physicians. In California, Georgia, Missouri, and Wisconsin, 

physicians will be given the opportunity to choose from either of two electronic 

packages: a Prescription Improvement Package or a Paperwork Reduction Package. 

Ron J. Ponder, PhD, EVP, Information 

Services, WellPoint or 

Nadia Leather, CGEY 

nadia.leather@capgemini.com 

212-314-8236 

PHIT_02d 

WI 

Planning for a Rural 

Prescription Medication 

Network 

Develops a shared electronic repository for patient-level prescription medication 

data that enables real-time access for patients receiving healthcare services and 

plans a model system design to electronically link prescription medication data 

across hospitals and physician practices. 

Robert Gribble, St. Joseph’s Hospital 

Marshfield, WI AHRQ_102 

HIE_131

Existing Efforts 
Appendix B

AHIC Charter

W

170

WI Developing Shared EHR 

Infrastructure in Wisconsin 

Plans the implementation of a common infrastructure for an integrated EHR 

and CPOE to enhance access to clinical data, develops a workable model/plan 

for standards-based data sharing to allow multiple providers using disparate 

information systems to access patient information, and creates a quality 

measurement and enhancement tool that would measure improvements in quality 

and patient care. 

Tim Size 

Reedsburg Area Medical Center, 

Reedsburg, WI 

AHRQ_103 

WI 

Improving Patient 

Safety/Quality with HIT 

Implementation 

Implements an Epic health IT system and diffuses the system community-wide; 

identifies the prevalence of medication errors, near misses, and preventable 

adverse drug events; assesses costs and customer satisfaction both before and 

after implementation. 

John Reiling 

St. Joseph’s Community Hospital 

West Bend, WI 

AHRQ_104 

WI CPOE Implementation in 

ICU’s 

Assesses the implementation of CPOE systems in 6 intensive care units (ICUs) 

and evaluates the value and outcomes of patient safety involving medication errors; 

quality of care; end users’ job tasks, perceptions, and attitudes; and 

financial impact. 

Pascale Carayon, University of 

Wisconsin, Madison, WI AHRQ_105 

WV est Virginia Medical 

Institute (No specific DOQ-IT information) 

304-346-9864 

800-642-8686 

http://www.wvmi.org/Feedback.asp 

DOQ_48 

WV West Virginia Patient 

Safety Project 

The West Virginia Patient Safety Project is designed around a Web-based incident 

reporting system to enhance the hospital’s capacity to detect, analyze, and correct 

systemic problems that could produce errors in patient care. 

Patricia Ruddick, RN, MSN 

3001 Chesterfield Place 

Charleston, WV 25304 

304-346-9864 

pruddick@wvmi.org 

HIE_134 

WV West Virginia University 

School of Medicine 

Dr. Julian Bailes, chairman of the Department of Neurosurgery at the West Virginia 

University School of Medicine, has been tapped to oversee a statewide working 

group studying implementation of electronic medical records technology. Will most 

likely include West Virginia State Medical Association, West Virginia Hospital 

Association, government health care providers and other health care groups. 

Dr. Julian Bailes, chairman of the 

Department of Neurosurgery, WVU 

School of Medicine 

PHIT_29 

WV Boone County Community 

Care Network 

Designs a county-wide health information system that will allow health information 

sharing and permit real-time order placement by hospitals, health departments, 

private physicians’ offices, clinics, and long-term care facilities. 

Robert Atkins, Boone Memorial 

Hospital, Madison, WV AHRQ_106 

WV Partnering to Improve 

Patient Safety in Rural WV 

Expands the reporting of medical errors and near misses, monitors safety event 

reporting, and develops a learning network among small, rural hospitals and their 

associated ambulatory care facilities, long-term care facilities, and home health 

agencies. 

Gail Bellamy, West Virginia Medical 

Institute, Charleston, WV AHRQ_107 

WY Mountain-Pacific Quality 

Health Foundation 

(No specific DOQ-IT information) Mountain-Pacific Quality Health Foundation is the 

quality improvement organization (QIO) for Montana, Wyoming, Hawaii, and the 

territories of Guam, the Commonwealth of the Northern Marianas and American 

Samoa. The Foundation operates out of offices in Helena, Montana; Cheyenne, 

Wyoming; and Honolulu, Hawaii. As a QIO, we receive funding from the federal 

government to enact programs that help ensure people with Medicare receive 

appropriate, high-quality care. We also hold contracts with other government 

agencies and private insurance companies. 

307-637-8162 

877-810-6248 

wyoming@mpqhf.org 

DOQ_50 

WY Wyoming RHIO 

Wyoming is studying and planning for development of a sustainable, interoperable 

health care information and communication technology system to support the 

effective, efficient and secure exchange of health information across the spectrum 

of medical care stakeholders. 

n/a HIE_142 

WI Developing Shared EHR 

Infrastructure in Wisconsin

WI 

Improving Patient 

Safety/Quality with HIT 

Implementation 

WI CPOE Implementation in 

ICU’s

WV West Virginia Medical 

Institute

WV

WV

WV Boone County Community 

Care Network

WV Partnering to Improve 

Patient Safety in Rural WV

Mountain-Pacific Quality WY Health Foundation 

WY

Ending the Document Game 
Commissioner Biographies 

171

Appendix A

Commissioner Biographies 

Appendix A: Appendix A: Commissioner Biographies
172 

CHAIR:

ScottWallace, J.D., M.B.A.

President & CEO 

The National Alliance for Health InformationTechnology 

Scott Wallace was appointed as the first president and CEO of 

The National Alliance for Health Information Technology (Alliance) in 

2003. During his time at the Alliance, the organization has made great 

strides in ensuring, on behalf of its members, that healthcare IT issues 

are addressed thoughtfully and fairly, with solutions built around the 

consensus positions that the Alliance has helped the field to reach. 

Scott previously was the principal owner of Great Lakes Capital, a financial, 

commercial, and business development consulting firm with a major focus in 

technology. Prior to starting Great Lakes Capital, Scott led several technologybased companies. He served as president and CEO of PowerClip Co, a wireless 

products company; president and CEO of Eichrom Industries, an advanced 

materials and specialty chemical company that earned a spot on Inc. magazine’s 

1996 list of the 500 fastest growing companies in America, and vice president and 

general counsel for GCI, a venture capital fund. 

Scott earned a jurist doctorate from the University of Chicago Law School, 

a master’s degree with honors in business administration from the University of 

Chicago Graduate School of Business, and has a bachelor’s degree in economics 

from Duke University. He started his career practicing corporate and transactional 

law at Kirkland & Ellis in Chicago. 

He was recently named to Modern Healthcare’s 100 Most Powerful. 

Ending the Document Game 
Commissioner Biographies 

173

Simon P. Cohn, M.D., M.P.H., F.A.C.E.P., F.A.C.M.I.

Associate Executive Director, Health Information Policy 

Kaiser Permanente 

Simon P. Cohn, M.D., M.P.H. is the Associate Executive Director, 

Health Information Policy for Kaiser Permanente. Kaiser Permanente 

is the nation’s largest nonprofit integrated healthcare delivery system 

serving 8.4 million members in nine states and the District of Columbia. 

Dr. Cohn is a nationally recognized expert on issues related to 

HIPAA Administrative Simplification, healthcare data management, clinical and 

administrative classifications, and the electronic transmission of healthcare data. 

He has been a leader in Kaiser Permanente’s efforts to develop comprehensive 

health information systems to support both the delivery of healthcare and 

health research. 

Dr. Cohn is Chair of the National Committee onVital and Health Statistics 

(NCVHS), the main public advisory committee to U. S. Department of Health 

and Human Services on health information policy, HIPAA, and the national 

health information infrastructure. Additionally, he is a member of the AMA 

Common Procedural Terminology (CPT) Editorial Panel and the National 

Uniform Claims Committee (NUCC). He was a member of the Institute of 

Medicine’s Committee on Data Standards for Patient Safety. In 2002, Dr. Cohn 

was a recipient of the President’s Award from the American Medical Informatics 

Association for his contributions to the field and was also elected a Fellow of the 

American College of Medical Informatics. 

He is board certified in Emergency Medicine and a Fellow of the American 

College of Emergency Physicians. 

Appendix A: Appendix A: Commissioner Biographies
174 

Don E. Detmer, M.D., M.A., F.A.C.M.I.

President and CEO 

American Medical Informatics Association 

Don E. Detmer, M.D., M.A., is President and Chief Executive Officer 

of the American Medical Informatics Association. He is also Professor 

Emeritus and Professor of Medical Education in the Department of 

Health Evaluation Sciences at the University of Virginia and Senior 

Associate of the Judge Institute of Management, University of 

Cambridge. He is a trustee of the Nuffield Trust of London, co-chair of the 

Blue Ridge Academic Health Group, and research director of the J&J Centre 

for Advancing Health Information, based in Brussels. 

Dr. Detmer is a lifetime Associate of the National Academies, and a fellow of 

AAAS,Academy Health, and the American Colleges of Medical Informatics, 

Surgeons, and Sports Medicine. From 1999-2003 he was the Dennis Gillings 

Professor of Health Management and Director, Cambridge University Health at 

the Judge Institute of Management, Cambridge’s business school. Prior to the 

years in England, he wasVice President for Health Sciences at the Universities 

of Virginia and Utah and on the faculty at the University of Wisconsin-Madison. 

He is immediate past chairman of the Board on Health Care Services of the IOM 

as well as the National Committee onVital and Health Statistics. He has also 

chaired the Board of Regents of the National Library of Medicine. 

Dr. Detmer’s education includes a medical degree from the University of Kansas 

with subsequent training at the National Institutes of Health, the Johns Hopkins 

Hospital, Duke University Medical Center, the Institute of Medicine, and Harvard 

Business School. His M.A. is from the University of Cambridge. Dr. Detmer’s 

research interests include contributions to national health information policy, 

quality improvement, administrative medicine, vascular surgery, sports medicine, 

and master’s level educational programs for clinician-executives. 

Ending the Document Game 
Commissioner Biographies 

175

Vicky B. Gregg, R.N.

President and CEO 

BlueCross BlueShield ofTennessee 

Vicky B. Gregg became CEO of BlueCross BlueShield of Tennessee in 

February 2003. BlueCross BlueShield headquarters is in Chattanooga, 

Tennessee, and is the state’s largest provider of healthcare services. 

The company was instrumental in assisting the state in the implementation of the TennCareSM program, a Medicaid expansion program that 

currently provides healthcare coverage to 25 percent of the State’s population. 

BlueCross BlueShield of Tennessee also provides Medicare intermediary 

services in 46 states including Part A operations in Tennessee and New Jersey. 

The not-for-profit company has over 4,000 employees and annualized paid 

claims of over $14 billion. 

Before becoming CEO, Mrs. Gregg served as President and Chief Operating 

Officer at BlueCross BlueShield of Tennessee overseeing all aspects of the 

company’s day-to-day operations. A nurse by education, Mrs. Gregg has over 

25 years of experience in diverse healthcare environments including clinical care, 

hospital administration, long term care, and healthcare benefits and financing. 

She served as President and CEO of Volunteer State Health Plan, a subsidiary of 

BlueCross BlueShield of Tennessee and one of the largest Medicaid Health 

Maintenance Organizations in the country. Prior to joining BlueCross, 

Mrs. Gregg served as aVice President for Humana with responsibility for 

Kentucky, Ohio, and Indiana. In her role she managed all models of managed 

care, including preferred provider, staff, group, and academic models. She has 

been a noted speaker on healthcare market evolution, implications of managed 

care for academic medicine, Medicaid managed care, rural healthcare delivery, 

and healthcare reform policy implications related to the uninsured. 

Mrs. Gregg serves on numerous boards including the BlueCross BlueShield 

Association, Council for Affordable Quality Healthcare (CAQH), University 

of Tennessee Chattanooga Foundation, Chattanooga State Community College 

Foundation,The Enterprise Center, Nashville Healthcare Council,Tennessee 

Healthcare Consortium for Nursing,Allied Arts of Chattanooga, United Way 

of Chattanooga, the Women’s Leadership Institute, and the National Institute for 

Health Care Management. She is an adjunct faculty member of East Tennessee 

State University Department of Nursing and has served on numerous appointed 

Appendix A: Appendix A: Commissioner Biographies
176 

commissions including the Governor’s Roundtable for TennCare. Mrs. Gregg 

was named one of two appointees by Senator Frist to be a member of the 

National Commission on Systemic Interoperability. 

C. Martin Harris, M.D., M.B.A.

CIO 

Cleveland Clinic Foundation 

C. Martin Harris, M.D., M.B.A., is the Chief Information Officer and 

Chairman of the Information Technology Division of The Cleveland 

Clinic Foundation in Cleveland, Ohio. Additionally, Dr. Harris is 

Executive Director of e-Cleveland Clinic, a series of e-health clinical 

programs offered over the Internet. 

Dr. Harris’ interest and expertise in the area of improving the practice of medicine 

through the innovative application of information technology, is reflected in his 

numerous appointments to national technology organizations including: 

• Chairman, Regional Health Information Organization (RHIO) Task Force 

of the Healthcare Information and Management Systems Society (HIMSS); 

• Past Chairman, Foundation Board for the e-Health Initiative, a public 

policy and advocacy group established to encourage the interoperability of 

information technology in healthcare; and 

• Advisor to the Director of the National Institutes of Health. 

Dr. Harris received his undergraduate and medical degrees from the University of 

Pennsylvania in Philadelphia. His residency training in general internal medicine 

was completed at The Hospital of the University of Pennsylvania. He completed 

a Robert Wood Johnson Clinical Scholar fellowship in General Internal Medicine 

at The University of Pennsylvania School of Medicine and holds a Masters in 

Business Administration in Healthcare Management from The Wharton School 

of the University of Pennsylvania. 

Ending the Document Game 
Commissioner Biographies 

177

Gary A. Mecklenburg, M.B.A.

President and CEO 

Northwestern Memorial HealthCare 

Gary A. Mecklenburg is president and CEO of Northwestern 

Memorial HealthCare in Chicago. He joined the organization in 

1985 as President and CEO of Northwestern Memorial Hospital after 

five years as president of St. Joseph’s Hospital and Franciscan Health 

Care, Inc. in Milwaukee. Mr. Mecklenburg began his career in 1970 at 

the University of Wisconsin Hospitals, and from 1977-1980 served as administrator 

of Stanford University Hospital and Clinics. 

Mr. Mecklenburg is a nationally recognized leader in the healthcare field. Under 

his leadership, Northwestern Memorial has become one of the nation’s leading 

teaching hospitals with a reputation for both clinical and management excellence. 

He is a frequent speaker and guest lecturer and serves on the Advisory Board for 

the Kellogg Graduate School of Management of Northwestern University. 

Among his many professional activities, Mr. Mecklenburg is a past chairman 

of the board of trustees of the American Hospital Association and of the Illinois 

Hospital Association. He is currently chairman of the board of the Health Forum 

and of the Healthcare Research and Development Institute; and he was founding 

chairman of the National Alliance for Health Information Technology. 

Mr. Mecklenburg serves on the boards of directors of the Institute for Healthcare 

Improvement; the National Center for Healthcare Leadership; Becton, Dickinson 

and Company; Regency Hospital Company; and Cogent Healthcare. 

Mr. Mecklenburg received his Bachelor of Arts degree from Northwestern 

University and a Master of Business Administration degree from the University 

of Chicago. 

Appendix A: Appendix A: Commissioner Biographies
178 

Herbert Pardes, M.D.

President and CEO 

NewYork Presbyterian Hospital 

Herbert Pardes, M.D., President and CEO of NewYork-Presbyterian 

Hospital, has an extensive background in healthcare and academic 

medicine. His origins are in the field of psychiatry, and he chaired 

three departments of psychiatry before becomingVice President for 

Health Sciences and Dean of the Faculty of Medicine at the College 

of Physicians & Surgeons of Columbia University. He is nationally recognized for 

his broad expertise in education, research, clinical care, and health policy, and as 

an ardent advocate of support for academic medicine. As President and CEO of 

NewYork-Presbyterian, Dr. Pardes has embraced a clinical mission to provide each 

patient with the highest quality care delivered in the most compassionate manner. 

Dr. Pardes served as Director of the National Institute of Mental Health (NIMH) 

and U.S.Assistant Surgeon General during the Carter and Reagan Administrations 

(1978-84). He has also served as President of the American Psychiatric 

Association (1989). 

Dr. Pardes left NIMH in 1984 to become Chairman of the Department of 

Psychiatry at Columbia University’s College of Physicians & Surgeons and in 

1989 was also appointedVice President for Health Sciences for Columbia 

University and Dean of the Faculty of Medicine at the College of Physicians 

& Surgeons. 

He served as Chairman of the Association of American Medical Colleges 

(AAMC) for 1995-96 and was Chairman of the AAMC’s Council of Deans for 

1994-95. In addition, he served two terms as Chairman of the NewYork 

Association of Medical Schools. 

Dr. Pardes received his medical degree from the State University of NewYorkDownstate Medical Center (Brooklyn) in 1960. He received his Bachelor 

of Science degree summa cum laude from Rutgers University in 1956. He 

completed his internship and residency training in psychiatry at Kings County 

Hospital in Brooklyn and also did psychoanalytic training at the NewYork 

Psychoanalytic Institute. 

Dr. Pardes chaired the Intramural Research Program Planning Committee of the 

NIH from 1996-1997, served on the Presidential Advisory Commission on 

Ending the Document Game 
Commissioner Biographies 

179

Consumer Protection and Quality in the Healthcare Industry, and is President of 

the Scientific Council of the National Alliance for Research on Schizophrenia and 

Depression. He serves on numerous editorial boards, has written over 130 articles 

and chapters on mental health and academic medicine topics, and has negotiated 

and conducted international collaborations with a variety of countries including 

India, China, and the former Soviet Union. 

Dr. Pardes has earned numerous honors and awards, including election to the 

Institute of Medicine of the National Academy of Sciences (1997), the Sarnat 

International Prize in Mental Health (1997), and the U.S.Army Commendation 

Medal (1964) and elected to the American Academy of Arts and Sciences (2002). 

Thomas M. Priselac, M.P.H.

President and CEO 

Cedars-Sinai Health System 

Thomas M. Priselac is President and Chief Executive Officer of 

the Cedars-Sinai Health System—a position he has held since 

January 1994. 

Mr. Priselac has been associated with Cedars-Sinai since 1979. 

Prior to being named President and CEO, he was ExecutiveVice President from 

1988 to 1993. Before joining Cedars-Sinai, he was on the executive staff of 

Montefiore Hospital in Pittsburgh. 

He has served on many boards in the healthcare field over the years and 

currently serves as Chair-Elect of the Association of American Medical Colleges, 

as well as the Los Angeles Chamber of Commerce where he chairs the Health 

Care Committee. A past member of the American Hospital Association Board 

of Directors, he also formerly chaired the Hospital Association of Southern 

California, the California Healthcare Association, and the Association of American 

Medical Colleges Council of Teaching Hospitals. He also serves as an adjunct 

Faculty member of the UCLA School of Public Health. 

A native of Pennsylvania, Mr. Priselac obtained a bachelor’s degree in Biology 

from Washington and Jefferson College in Pennsylvania, and a master’s in 

Public Health, Health Services Administration and Planning from the 

University of Pittsburgh. 

Appendix A: Appendix A: Commissioner Biographies
180 

Ivan Seidenberg, M.B.A.

Chairman and CEO 

Verizon Communications

Ivan Seidenberg is chairman of the Board and chief executive 

officer forVerizon. On November 6, 2003,Verizon announced that 

Mr. Seidenberg would become chairman of the Board effective 

January 1, 2004. He has served as the sole CEO since April 1, 2002. 

As chief executive of Bell Atlantic, and previously of NYNEX, Ivan Seidenberg 

was instrumental in reshaping the communications industry through two of the 

largest mergers in its history: the merger of Bell Atlantic and NYNEX in 1997 

and the Bell Atlantic merger with GTE in 2000. He also led efforts in September 

1999 to formVerizon Wireless, the nation’s largest cellular business composed of 

the wireless assets of Bell Atlantic, GTE, andVodafone Airtouch.

Mr. Seidenberg began his communications career more than 38 years ago as 

a cable splicer’s assistant. His career has encompassed numerous operations 

and engineering assignments, including various leadership positions at AT&T 

and NYNEX.

He has a long-standing commitment to education and is a strong proponent of 

connecting students and teachers to technology. He championed a special rate 

for schools and libraries to connect to the Internet. Mr. Seidenberg’s activism to 

provide electronic access to young people led to his involvement with The New 

York Hall of Science and Pace University, on whose boards he serves.

Mr. Seidenberg also champions diversity both within and outside the company.

Under his leadership, the company has made great strides in increasing minority 

employment and initiated a partnership with the U.S. Small Business Administration

to increase the company’s purchasing from minority suppliers. Verizon’s 

commitment to diversity has been widely recognized, with the company being 

cited by Fortune magazine in its list of “The 50 Best Companies for Minorities.”

Besides his directorships at The Hall of Science and Pace University,

Mr. Seidenberg serves on the board of directors of Honeywell, the Museum of 

Television and Radio, theVerizon Foundation, and Wyeth.

He earned a Bachelor of Arts degree in mathematics from City University of 

NewYork and a master’s degree in business administration and marketing from 

Pace University. Ending the Document Game 
Commissioner Biographies 

181

FredrickW. Slunecka, F.A.C.H.E.

Regional President 

Avera McKennan 

Fredrick W. Slunecka has been CEO of Avera McKennan Hospital & 

University Health Center, a 490-bed acute care facility affiliated with 

Avera Health System since 1989. He is responsible to a local board of 

trustees and the Avera Health Board of Directors for the operation of a 

$600 million organization with nearly 5,000 employees and a medical 

staff of 500 physicians. Major services offered include invasive cardiology, orthopedics, neurosciences, oncology including bone marrow transplant, nephrology 

including kidney and pancreas transplant, neonatology, obstetrics/gynecology, 

pediatrics, behavioral health services, inpatient rehabilitation, trauma services, 

helicopter and fixed wing ambulance services, home health, hospice, durable 

medical equipment, a 90-bed skilled nursing facility, a 100 apartment unit retirement community, and a fitness center. Residency and teaching programs in family 

practice, internal medicine, psychiatry, and adolescent psychiatry are offered with 

the University of South Dakota School of Medicine. Avera McKennan has been 

a national leader in telemedicine services and provides e-ICU services to several 

rural hospitals. Avera McKennan has received numerous accolades including 

Most Wired,Top 100 in Cardiology, Distinguished Hospital by Healthgrades, and 

Magnet Status for Nursing Care. 

Mr. Slunecka is a fellow of the American College of Healthcare Executives and is 

involved in many civic organizations. 

He received his master’s degree in hospital administration from the University of 

Minnesota and his bachelor’s degree in political science from the University of 

South Dakota. 

Appendix A: Appendix A: Commissioner Biographies
182 

WilliamW. Stead, M.D.

Director, Informatics Center 

Associate Vice-Chancellor for Health Affairs 

Professor, Medicine and Biomedical Informatics 

Vanderbilt University Medical Center 

William W. Stead, M.D., is Professor of Medicine and Biomedical 

Informatics, Director of the Informatics Center and AssociateViceChancellor for Health Affairs atVanderbilt University Medical Center. 

The Informatics Center brings together research and education in 

biomedical informatics with provision of the Medical Center’s 

operation and decision support infrastructure. In addition to serving as the 

Medical Center’s Chief Information Officer, Dr. Stead is Chief Information 

Architect forVanderbilt University and Chairman of theVanderbilt Center for 

Better Health. The Center for Better Health was established in June 2002 to help 

accelerate change in healthcare through optimal use of information technology. 

Dr. Stead received his B.A. and M.D. from Duke University where he also served 

residencies in Internal Medicine and Nephrology. As an undergraduate in the 

1960s, he was a member of the team that developed the Cardiology Databank, 

one of the first clinical epidemiology projects to change practice by linking outcomes to process. As a faculty member in Nephrology, he was the physician in 

the physician-engineer partnership that developed The Medical Record (TMR), 

one of the first practical computer-based patient record systems. He helped Duke 

build one of the first patient-centered hospital information systems. He has led (as PI) 

two prominent academic health centers, Duke in the 1980s, andVanderbilt in the 

1990s, through both planning and implementation phases of large-scale, Integrated 

Advanced Information Management System (IAIMS) projects. AtVanderbilt, 

his team has been successful in creating informatics techniques for linking information into clinical workflow, in overcoming the cultural barriers to changing 

practice to take advantage of these techniques, and in reducing the cost and time 

required to implement enterprise-wide information technology infrastructure. 

Dr. Stead is a Founding Fellow of both the American College of Medical 

Informatics and the American Institute for Engineering in Biology and 

Medicine, and a member of the Institute of Medicine of the National Academies. 

He is currently Chairman of the Board of Regents of the National Library of 

Medicine and serves on the Computer Science and Telecommunication Board 

of the National Research Council. He was the founding Editor-in-Chief of the 

Journal of the American Medical Informatics Association, and served as President 

Ending the Document Game 
Commissioner Biographies 

183

of the American Association for Medical Systems and Informatics and the 

American College of Medical Informatics. 

In October 2004, Dr. Stead was appointed to the Commission on Systemic 

Interoperability. 

In addition to his academic responsibilities, Dr. Stead is a Director of HealthStream 

and Director of NetSilica. 

DESIGNATED FEDERAL OFFICIAL:

Donald A.B. Lindberg, M.D.

Director 

National Library of Medicine 

Donald A.B. Lindberg, M.D., is a scientist who has pioneered applying 

computer technology to healthcare beginning in 1960 at the 

University of Missouri. In 1984, he was appointed Director of the 

National Library of Medicine, the world’s largest biomedical library 

(annual budget $275 million; 690 career staff). From 1992-1995 he 

served in a concurrent position as founding Director of the National Coordination 

Office for High Performance Computing and Communications (HPCC) in the 

Office of Science and Technology Policy, Executive Office of the President. 

In 1996, he was named by the HHS Secretary to be the U.S. Coordinator for 

the G-7 Global Health Applications Project. 

In addition to an eminent career in pathology, Dr. Lindberg has made notable 

contributions to information and computer activities in medical diagnosis, 

artificial intelligence, and educational programs. Before his appointment as NLM 

Director, he was Professor of Information Science and Professor of Pathology at 

the University of Missouri-Columbia. He has current academic appointments as 

Clinical Professor of Pathology at the University ofVirginia and Adjunct Professor 

of Pathology at the University of Maryland School of Medicine. 

Dr. Lindberg was elected the first President of the American Medical Informatics 

Association (AMIA). As the country’s senior statesman for medicine and 

computers, he has been called upon to serve on many boards including the 

Computer Science and Engineering Board of the National Academy of Sciences, 

the National Board of Medical Examiners, and the Council of the Institute of 

Medicine of the National Academy of Sciences. 

Appendix A: Appendix A: Commissioner Biographies
184 

Dr. Lindberg graduated Magna cum Laude from Amherst College and received his 

M.D. degree from the College of Physicians and Surgeons, Columbia University. 

Among the honors he has received are Phi Beta Kappa, Simpson Fellow of 

Amherst College, Markle Scholar in Academic Medicine, Surgeon General’s 

Medallion, recipient of the First AMA Nathan Davis Award for outstanding 

Member of the Executive Branch in Career Public Service, the Walter C.Alvarez 

Memorial Award of the American Medical Writers Association, the Presidential 

Senior Executive Rank Award, Founding Fellow of the American Institute of 

Medical and Biological Engineering, the Outstanding Service Medal of the 

Uniformed Services University of the Health Sciences, Federal Computer Week’s 

Federal 100 Award, Computers in Healthcare Pioneer Award,Association of 

Minority Health Professions Schools Commendation, RCI High Performance 

Computing Industry Recognition Award, U.S. National Commission on Libraries 

and Information Science Silver Award, Council of Biology Editors Meritorious 

Award, HHS Meritorious Service Award, Medical Library Association President’s 

Award, Fellow of the American Association for the Advancement of Science, and 

honorary doctorates from Amherst College, the State University of NewYork at 

Syracuse, and the University of Missouri-Columbia. 

DIRECTOR:

Dana Haza

Director, Commission on Systemic Interoperability 

National Library of Medicine 

Dana Haza received a Presidential appointment to be the Director of 

the Commission on Systemic Interoperability early in January of 2005. 

It is the goal of this commission to produce a comprehensive report 

by the end of October, identifying the strategy necessary to foster the 

development of accessible electronic health information to provide 

optimal health and healthcare for every American. Dana is also currently 

co-authoring a monograph with Dr.Andy von Eschenbach, Director of the 

National Cancer Institute, describing the breakthroughs in cancer research that 

will ultimately result in much of cancer evolving into a chronic disease by 2015. 

Dana is passionate in her pursuit of health and wholeness for every American. 

This commitment is a testimony to her continual personal development and 

renewal as a leader in health and healthcare thinking and reform. 

Ending the Document Game 
Commissioner Biographies 

185

Prior to her appointment, Dana was the Director of Policy for Newt Gingrich 

at the American Enterprise Institute for Public Policy Research (AEI), one of 

America’s largest and most respected think tanks. In her capacity as Director of 

Policy, Dana worked closely with a variety of federal agencies and branches of the 

government on such projects as the 2003 Medicare bill, patient safety issues, 

electronic health records, as well as with the National Cancer Institute on 

creating a model of eliminating suffering and death by cancer by 2015. She has 

co-authored the book, Saving Lives & Saving Money, with Newt Gingrich and 

Anne Woodbury. Dana has served on a congressional panel for the AcademyHealth and Friend of AHRQ. She serves as a consultant to the Gingrich Group 

and the Center for Health Transformation. As a speaker, Dana regularly gives 

presentations on transformation, strategic thinking and 21st century health, and 

healthcare system reform to a variety of conferences, hospital boards, state health 

and professional societies, managed care organizations, pharmaceutical companies, 

as well as guest lecturing for graduate level health classes. 

Dana brings to the public policy arena 15 years of healthcare experience. 

She was the Director of Managed Care and the Director of a 250-physicianhospital organization (PHO), an HCA facility in Augusta, GA. She has been 

an office manager for a variety of health specialties, and a physician recruiter. 

She has also served on the Boards of the Georgia Hospital Association, and 

Georgia Society for Managed Care, as well as in other advisory and teaching 

capacities. Dana formerly held the position of Special Projects Director and 

District Director for Georgia Congressman, Charlie Norwood. She graduated 

from Mercer University with a major in journalism. 

After serving as the Director of the Commission on Systemic Interoperability, 

Dana will act as the Interim Director for the Office of Programs and 

Coordination in the Office of the National Coordinator for Health 

Information Technology. 

Appendix A: Appendix A: Commissioner Biographies
186 

Ending the Document Game 
American Health Information Community Charter 

187

Appendix B

American Health Information Community Charter 

Appendix B: Appendix B: American Health Information Community Charter
188 

American Health Information Community Charter

DRAFT 

1. Purpose 

On April 27, 2004, the President signed Executive Order (EO) 13335 

announcing his commitment to the promotion of health information technology 

(health IT) to lower costs, reduce medical errors, improve quality of care, and 

provide better information for patients and physicians. In particular, the President 

called for widespread adoption of electronic health records (EHRs) and for 

health information to follow patients throughout their care in a seamless and 

secure manner. 

In the EO, the President enunciated a vision to provide leadership for the 

development and national implementation of an interoperable health IT infrastructure that: (a) ensures appropriate information to guide medical decisions is 

available at the time and place of care; (b) improves health care quality, reduces 

medical errors, and advances the delivery of appropriate, evidence-based medical 

care; (c) reduces health care costs resulting from inefficiency, medical errors, 

inappropriate care, and incomplete information; (d) promotes a more effective 

marketplace, greater competition, and increased choice through the wider 

availability of accurate information on health care costs, quality, and outcomes; 

(e) improves the coordination of care and information among hospitals, laboratories, physician offices, and other ambulatory care providers through an effective 

infrastructure for the secure and authorized exchange of healthcare information; 

and (f) ensures patients’ individually identifiable health information is secure 

and protected. 

Ending the Document Game 
American Health Information Community Charter 

189

The EO directed the Secretary of the Department Health and Human Services 

(HHS) to establish within the Office of the Secretary the position of National 

Health Information Technology Coordinator (National Coordinator). 

Recognizing the need for public and private sector collaboration to achieve 

these goals, the EO charged the National Coordinator, to the extent permitted 

by law, to coordinate outreach and consultation by the relevant branch agencies 

(including Federal commissions) with public and private parties of interest, 

including consumers, providers, payers, and administrators. 

As a part of this collaboration, the Secretary of HHS (Secretary) hereby creates 

the American Health Information Community (AHIC) to: 1) advise the Secretary 

and recommend specific actions to achieve a common interoperability framework 

for health IT; and 2) serve as a forum for participation from a broad range of 

stakeholders to provide input on achieving interoperability of health IT. 

2. Authority 

42 U.S.C. Sec. 217a, Sec. 222 of the Public Health Service Act, as amended. 

The AHIC is governed by the provisions of Public Law 92-463, as amended, 

(5 U.S.C.Appendix 2), which sets forth standards for the formation and use of 

federal advisory committees. 

3. Function 

The AHIC shall advise the Secretary concerning efforts to develop information 

technology standards and achieve interoperability of health IT so the President’s 

health IT goals can be achieved. At the Secretary’s request, the AHIC may provide 

advice on related matters pertaining to health IT. 

The AHIC shall operate in a manner that is consistent with the EO, including 

not assuming or relying upon additional federal resources or spending to 

accomplish adoption of interoperable health information technology. 

Appendix B: Appendix B: American Health Information Community Charter
190 

The AHIC shall, among other things, advance and develop recommendations 

for the following issues: 

• Protection of health information through appropriate privacy and 

security practices; 

• Ongoing harmonization of industry-wide health IT standards; 

• Achievement of an Internet-based nationwide health information network 

that includes information tools, specialized network functions, and security 

protections for interoperable health information exchange; 

• Acceleration of interoperable EHR adoption across the broad spectrum of 

health care providers; 

• Compliance certification and inspection processes for EHRs, including 

infrastructure components through which EHRs interoperate; 

• Identification of health IT standards for use by the National Institute for 

Standards and Technology (NIST) in a Federal Information Processing 

Standards (FIPS) process relevant to Federal agencies; 

• Identification and prioritization of specific use cases for which health IT 

is valuable, beneficial and feasible, such as adverse drug event reporting, 

electronic prescribing, lab and claims information sharing, public health, 

bioterrorism surveillance, and advanced research; and 

• Succession of AHIC by a private-sector health information 

community initiative. 

4. Structure 

The AHIC shall not exceed 17 voting members, including the Chair, and members 

shall be appointed by the Secretary. Membership shall include officials from HHS 

and its component agencies, and other appropriate federal agencies, including, 

but not limited to, the Department of Veterans Affairs, Office of Personnel Management, Department of Commerce, Department of Treasury, and the Department 

of Defense. The federal members may be represented by alternates. At least one 

Ending the Document Game 
American Health Information Community Charter 

191

member shall be an expert on matters pertaining to privacy and security protections of individually identifiable health information. The Secretary shall select 

other members from persons knowledgeable in the field of health IT, or in fields 

applicable or related thereto, including physicians, health care providers, patients, 

payers, purchasers, public health experts, research scientists, and a State official. 

Non-federal members of the AHIC will be Special Government Employees, 

unless classified as representatives. The Secretary shall be the Chair and may designate an Acting Chair for any meeting or portion of a meeting, as the Secretary 

deems appropriate. 

Members shall serve 2-year terms, except that any member appointed to fill a 

vacancy for an unexpired term shall be appointed for the remainder of such term. 

A member may serve for up to 180 days after the expiration of the member’s term 

or until a successor has taken office. 

The National Coordinator shall provide management and support services for the 

AHIC. 

Less than the full AHIC may convene to gather information; conduct research; 

analyze relevant issues and facts in preparation for a meeting; or draft position 

papers for deliberation by the AHIC. 

Less than the full AHIC may convene to discuss administrative matters of the 

AHIC or to receive administrative information from a Federal official or agency. 

5. Meetings 

AHIC meetings may be held up to 12 times per year, at the call of the Chair or 

Acting Chair, who shall also provide the meeting agenda. A quorum shall be 

required for any meeting; the majority of those members appointed to the AHIC 

as of the date of the meeting shall constitute a quorum. Meetings shall be open to 

the public except when closure is specifically allowed by law, and meetings may be 

closed to the public only after all statutory and regulatory requirements for doing 

so have been met. The Secretary, or other official to whom the authority has been 

delegated, shall make such determinations. Notice of all meetings shall be given 

to the public in accordance with applicable laws. 

Appendix B: Appendix B: American Health Information Community Charter
_____________________________ _________________________________________________

192

All meetings shall be conducted, and records of the proceedings kept, as required 

by applicable laws and HHS regulations. 

6. Compensation 

Members who are not full-time Federal employees shall be paid at the rate of 

$250 per day, plus per diem and travel expenses in accordance with Standard 

Government Travel Regulations. 

7. Annual Cost Estimate 

Estimated annual cost for operating the AHIC, including compensation and 

travel expenses for members but excluding staff support, is $3 million. Estimated 

annual person-years of staff support required is four, at an estimated annual cost 

of $700,000. 

8. Reports 

In the event a portion of a meeting is closed to the public, a report shall be 

prepared which shall contain, at a minimum, a list of members and their business 

addresses, the committee activities, and recommendations made during the fiscal 

year. A copy of the report shall be provided to the Department Committee 

Management Office. 

9. Termination Date 

Unless renewed by appropriate action prior to its expiration, the AHIC shall 

terminate two years from the date this charter is approved. However, the 

maximum term of operation for the AHIC shall be five years. 

Approved:

Date Secretary 

Ending the Document Game 
_____________________________ _________________________________________________

American Health Information Community Charter 

193

THE SECRETARY OF HHS STATIONERY

FORMAL DETERMINATION 

I determine, after appropriate consultation between this Department and General 

Services Administration, that formation of the American Health Information 

Community is in the public interest in connection with the performance of duties 

imposed on the Department by law, and that such duties can best be performed 

through the advice and counsel of such a group. 

I deem that it is not feasible for the Department or any of its existing committees 

to perform these duties, and that a satisfactory plan for appropriate balance of 

committee membership has been submitted. 

Date Secretary 

Appendix B: Appendix B: American Health Information Community Charter
194 

Ending the Document Game 
Appendix C: 

195

Appendix C

Past Recommendations 

Appendix C: Appendix C: Past Recommendations
nd

196

Recommendations from Past Reports

On Healthcar On Healthcare, Information Technology, Patient Saf atient Safety, Privacy, National Secur National Security,

Computerized Medical Records, Standards, and Interoperability 

Compiled May 17, 2005

Table of Contents

197 Records, Computers and the Rights of Citizens: Report of the Secretary’s Advisory Committee 

on Automated Personal Data Systems (1973) 

200 Medical Records: Problems of Confidentiality and Privacy (1978) 

200 Health Data in the Information Age: Use, Disclosure and Privacy (1994) 

203 Standards for Medical Identifiers, Codes, and Messages Needed to Create an Efficient 

Computer-stored Medical Record (1994) 

205 For the Record: Protecting Electronic Health Information (1997) 

206 The Computer-Based Patient Record: An Essential Technology for Health Care (1991, 1997) 

207 To Err Is Human: Building a Safer Health System (2000) 

209 Networking Health: Prescriptions for the Internet (2000) 

211 NCVHS Report to the Secretary on Uniform Standards for Patient Medical Record 

Information (2000) 

212 Crossing the Quality Chasm: A New Health System for the 21st Century (2001) 

215 Final Report National Health Information Infrastructure (NHII) - Information for Health: 

A Strategy for Building the National Health Information Infrastructure (2001) 

218 Fostering Rapid Advances in Health Care: Learning from System Demonstrations (2002) 

219 The Future of the Public’s Health in the 21st Century (2002) 

224 Information Technology for Counterterrorism: Immediate Actions and Future Possibilities (2003) 

225 Patient Safety: Achieving a New Standard for Care (2004) 

228 Letter to HHS Secretary Tommy G. Thompson from John R. Lumpkin, Chairman, 

National Committee on Vital and Health Statistics: First Set of Recommendations on 

E-Prescribing Standards (2004) 

231 Letter to HHS Secretary Mike Leavitt from Simon P. Cohn, Chairman, 

National Committee on Vital and Health Statistics: Second Set of Recommendations on 

E-Prescribing Standards (2005) 

233 Quality Through Collaboration: The Future of Rural Health (2005) 

234 Summary of Nationwide Health Information Network (NHIN) Request for Information 

(RFI) Responses (2005) 

234 Health Information Technology (HIT) Leadership Panel Final Report (2005) 

Ending the Document Game 
y, 

Appendix C: Past Recommendations 

er means are appropriate. 

ending the enactment of a code of f

utions within reach of their authorit y, 

eguard requirements are applied to all other systems within 

stems, and (ii) assure, 

e damages, in individual or class actions. It should also 

ees and other costs of litigation incur

197

Recommendations from Past Reports

From Records, Computers and the Rights of Citizens: Report of the Secretary’s Advisory 

Committee on Automated Personal Data Systems (July 1973) 

RECOMMENDATIONS

Under current law, a person’s privacy is poorly protected against arbitrary or abusive record-keeping 

practices. For this reason, as well as because of the need to establish standards of record-keeping 

practice appropriate to the computer age, the report recommends the enactment of a Federal 

“Code of Fair Information Practice” for all automated personal data systems. The Code rests on 

five basic principles that would be given legal effect as “safeguard requirements” for automated 

personal data systems. 

• There must be no personal data record-keeping systems whose very existence is secret. 

• There must be a way for an individual to find out what information about him is in a record 

and how it is used. 

• There must be a way for an individual to prevent information about him that was obtained 

for one purpose from being used or made available for other purposes without his consent. 

• There must be a way for an individual to correct or amend a record of identifiable information 

about him. 

• Any organization creating, maintaining, using, or disseminating records of identifiable personal 

data must assure the reliability of the data for their intended use and must take precautions to 

prevent misuse of the data. 

We recommend the enactment of legislation establishing a Code of Fair Information practice for all 

automated personal data systems. 

• The Code should define “fair information practice” as adherence to specified 

safeguard requirements. 

• The Code should prohibit violation of any safeguard requirement as an 

“unfair information practice.” 

• The Code should provide that an unfair information practice be subject to both civil 

and criminal penalties. 

• The Code should provide for injunctions to prevent violation of any safeguard requirement. 

• The Code should give individuals the right to bring suits for unfair information practices 

to recover actual, liquidated, and punitive damages, in individual or class actions. It should also e damages, in individual or class actions. It should also 

provide for reco or reco or recovery of reasonable at y of reasonable at y of reasonable attorneys’ fees and other costs of litigation incur ees and other costs of litigation incurred by 

individuals who bring successful suits. 

Pending the enactment of a code of f ending the enactment of a code of fair inf air information practice, w ormation practice, we recommend that all F e recommend that all Federal agencies ederal agencies 

(i) apply the safeguard requirements, by administrative action, to all Federal systems, and (ii) assure, 

through formal rule making, that the safeguard requirements are applied to all other systems within stems within 

reach of the F h of the F h of the F h of the F h of the F h of the F h of the F h of the F h of the F h of the Federal go ederal go ederal go ederal go ederal go ederal go ederal go ederal go ederal go ederal go ederal government’ ernment’ ernment’ ernment’ ernment’ ernment’ ernment’ ernment’ ernment’ ernment’ ernment’s authorit s authorit s authorit s authorit s authorit s authorit s authorit s authorit s authorit s authorit s authority. Pending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of f ending the enactment of a code of fair inf air inf air inf air inf air inf air inf air inf air inf air inf air inf air information ormation ormation ormation ormation ormation ormation ormation ormation ormation ormation 

practice, w practice, we urge that St e urge that St e urge that St e urge that State and local go ate and local go ate and local go ate and local governments, the instit ernments, the instit ernments, the instit ernments, the institutions within reac utions within reac utions within reac utions within reach of their authorit h of their authorit h of their authorit h of their authority, 

and all priv and all priv and all private organizations adopt the saf ate organizations adopt the saf ate organizations adopt the safeguard requirements b eguard requirements b eguard requirements by whate y whate y whatever means are appropriate. er means are appropriate. er means are appropriate. er means are appropriate. 

Appendix C: Appendix C: Past Recommendations
198 

ws or regulations af

ained, and those pro

1 8

Existing laws or regulations affording individuals greater protection than the safeguard requirements eguard requirements 

should be retained, and those providing less protection should be amended to meet the basic viding less protection should be amended to meet the basic 

standards set b andards set by the saf y the safeguards. In particular eguards. In particular, we recommend: e recommend: 

• That the Freedom of Information Act be amended to require an agency to obtain the consent of 

an individual before disclosing in personally identifiable form exempted category data about him, 

unless the disclosure is within the purposes of the system as specifically required by statute. 

• That pending such amendment of the Act, all Federal agencies provide for obtaining the consent 

of individuals before disclosing individually identifiable exempted-category data about them under 

the Freedom of Information Act. 

• That the Fair Credit Reporting Act be amended to provide for actual, personal inspection by an 

individual of his record along with the opportunity to copy its contents, or to have copies made; 

and that the exceptions from disclosure to the individual now authorized by the Fair Credit 

Reporting Act for medical information and sources of investigative information be omitted. 

In light of our inquiry into the statistical-reporting and research uses of personal data in administrative 

record-keeping systems, we recommend that steps be taken to assure that all such uses are carried 

out in accordance with five principles: 

First, when personal data are collected for administrative purposes, individuals should under 

no circumstances be coerced into providing additional personal data that are to be used 

exclusively for statistical reporting and research. When application forms or other means of 

collecting personal data for an administrative data system are designed, the mandatory or 

voluntary character of an individual’s responses should be made clear. 

Second, personal data used for making determinations about an individual’s character, 

qualifications, rights, benefits, or opportunities, and personal data collected and used for 

statistical reporting and research, should be processed and stored separately. 

Third, the amount of supplementary statistical-reporting and research data collected and stored 

in personally identifiable form should be kept to a minimum. 

Fourth, proposals to use administrative records for statistical reporting and research should be 

subjected to careful scrutiny by persons of strong statistical and research competence. 

Fifth, any published findings or reports that result from secondary statistical-reporting and 

research uses of administrative personal data systems should meet the highest standards of 

error measurement and documentation. 

In addition, we recommend that all personal data in such systems be protected by statute from 

compulsory disclosure in identifiable form. Federal legislation protecting against compulsory disclosure 

should include the following features: 

• The data to be protected should be limited to those used exclusively for statistical reporting 

or research. Thus, the protection would apply to statistical-reporting and research data derived 

from administrative records, and kept apart from them, but not to the administrative records 

themselves. 

• The protection should be limited to data identifiable with, or traceable to, specific individuals. 

When data are released in statistical form, reasonable precautions to protect against “statistical 

disclosure” should be considered to fulfill the obligation not to disclose data that can be traced to 

specific individuals. 

• The protection should be specific enough to qualify for non-disclosure under the Freedom of 

Information Act exemption for matters “specifically exempted from disclosure by statute.” 

5 U.S.C. 552(b)(3). 

Ending the Document Game 
Appendix C: Past Recommendations 

er he deems it in his interest 

ormed of his rights and responsibilities relativ

viding his SSN, nor should his SSN be used without his 

oregoing principles, 

xisting requirements should be continued, repealed, or modifi

orm to the three f

199

• The protection should be available for data in the custody of all statistical-reporting and research 

systems, whether supported by Federal funds or not. 

• Either the data custodian or the individual about whom data are sought by legal process should 

be able to invoke the protection, but only the individual should be able to waive it. 

• The Federal law should be controlling; no State statute should be taken to interfere with the 

protection it provides. 

Use of the Social Security Number 

We take the position that a standard universal identifier (SUI) should not be established in the United 

States now or in the foreseeable future. By our definition, the Social Security Number (SSN) cannot 

fully qualify as an SUI; it only approximates one. However, there is an increasing tendency for the 

Social Security number to be used as if it were an SUI. There are pressures on the Social Security 

Administration to do things that make the SSN more nearly an SUI. 

We believe that any action that would tend to make the SSN more nearly an SUI should be taken 

only if, after careful deliberation, it appears justifiable and any attendant risks can be avoided. We 

recommend against the adoption of any nationwide, standard, personal identification format, with 

or without the SSN, that would enhance the likelihood of arbitrary or uncontrolled linkage of records 

about people, particularly between government and government-supported automated personal 

data systems. 

We believe that until safeguards against abuse of automated personal data systems have become 

effective, constraints should be imposed on use of the Social Security number. After that the question 

of SSN use might properly be reopened. 

As a general framework for action on the Social Security number, we recommend that Federal policy 

with respect to use of the SSN be governed by the following principles: 

First, uses of the SSN should be limited to those necessary for carrying out requirements 

imposed by the Federal government. 

Second, Federal agencies and departments should not require or promote use of the SSN 

except to the extent that they have a specific legislative mandate from the Congress to do so. 

Third, the Congress should be sparing in mandating use of the SSN, and should do so only after 

full and careful consideration preceded by well advertised hearings that elicit substantial public 

participation. Such consideration should weigh carefully the pros and cons of any proposed use, 

and should pay particular attention to whether effective safeguards have been applied to 

automated personal data systems that would be affected by the proposed use of the SSN. 

(Ideally, Congress should review all present Federal requirements for use of the SSN and 

determine whether these existing requirements should be continued, repealed, or modified.) 

Fourth, when the SSN is used in instances that do not conf ances that do not conform to the three f orm to the three foregoing principles, oregoing principles, oregoing principles, 

no individual should be coerced into providing his SSN, nor should his SSN be used without his viding his SSN, nor should his SSN be used without his 

consent. 

Fifth, an individual should be fully and fairly inf airly informed of his rights and responsibilities relativ ormed of his rights and responsibilities relative

to uses of the SSN, including the right to disclose his SSN whenever he deems it in his interest er he deems it in his interest 

to do so. 

Appendix C: Appendix C: Past Recommendations
200 

In accordance with these principles, w

0

In accordance with these principles, we recommend specifi e recommend specific, preemptiv c, preemptive Federal legislation pro ederal legislation providing: viding: 

(1) That an individual has a legal right to refuse to disclose his SSN to any person or y person or 

organization that does not have specific authority provided by Federal statute to request it; 

(2) That an individual has the right to redress if his lawful refusal to disclose his SSN results in the 

denial of a benefit, or the threat of denial of a benefit; and that, should an individual under threat 

of loss of benefits supply his SSN under protest to an unauthorized requestor, he shall not be 

considered to have forfeited his right to redress; and 

(3) That any oral or written request made to an individual for his SSN must be accompanied by a 

clear statement indicating whether or not compliance with the request is required by Federal 

statute, and, if so, citing the specific legal requirement. 

In addition, we recommend 

(4) That the Social Security Administration undertake a positive program of issuing SSNs to ninthgrade students in schools, provided (a) that no school system be induced to cooperate in such 

a program contrary to its preference; and (b) that any person shall have the right to refuse to be 

issued an SSN in connection with such a program, and such right of refusal shall be available both 

to the student and to his parents or guardians. 

From Medical Records: Problems of Confidentiality and Privacy (February, 1978) 

RECOMMENDATIONS

• The individual’s right to control, use, and access his health care records, while obtaining requisite 

services and benefits, requires further consideration. 

From Health Data in the Information Age: Use, Disclosure, and Privacy (1994) 

RECOMMENDATION 2.1 ACCURACY AND COMPLETENESS

To address these issues, the committee recommends that health database organizations take responsibility for assuring data quality on an ongoing basis and, in particular, take affirmative steps to ensure: 

(1) the completeness and accuracy of the data in the databases for which they are responsible and (2) 

the validity of data for analytic purposes for which they are used. 

Part 2 of this recommendation applies to analyses that Health Database Organizations (HDOs) conduct. They cannot, of course, police the validity of data when used by others for purposes over which 

the HDOs have no a priori control. 

RECOMMENDATION 2.2 COMPUTER-BASED PATIENT RECORD

Accordingly, the committee recommends that health database organizations support and contribute to 

regional and national efforts to create computer-based patient records. 

RECOMMENDATION 3.1 CONDUCTING PROVIDER-SPECIFIC EVALUATIONS

The committee recommends that health database organizations produce and make publicly available 

appropriate and timely summaries, analyses, and multivariate analyses of all or pertinent parts of their 

databases. More specifically, the committee recommends that health database organizations regularly 

produce and publish results of provider-specific evaluations of costs, quality, and effectiveness of care. 

Ending the Document Game 
Appendix C: Past Recommendations 

ense to legal actions based 

ed parties to sue; 

able remedies, and 

ormation P

a, and patient priv

y and protection of priv

e legislation that will: 

201

RECOMMENDATION 3.2 DESCRIBING ANALYTIC METHODS

The committee recommends that a health database organization report the following for any analysis it 

releases publicly: 

• general methods for ensuring completeness and accuracy of their data; 

• a description of the contents and the completeness of all data files and of the variables in each 

file used in the analyses; 

• information documenting any study of the accuracy of variables used in the analyses. 

RECOMMENDATION 3.3 MINIMIZING POTENTIAL HARM

The committee recommends that, to enhance the fairness and minimize the risk of unintended harm 

from the publication of evaluative studies that identify individual providers, each HDO should adhere to 

two principles as a standard procedure prior to publication: (1) to make available to and upon request 

supply to institutions, practitioners, or providers identified in an analysis all data required to perform an 

independent analysis, and to do so with reasonable time for such analysis prior to public release of the 

HDO results; and (2) to accompany publication of its own analyses with notice of the existence and 

availability of responsible challenges to, alternate analyses of, or explanation of the findings. 

RECOMMENDATION 3.4 ADVOCACY OF DATA RELEASE: PROMOTING WIDE 

APPLICATIONS OF HEALTH-RELATED DATA

To foster the presumed benefits of widespread applications of HDO data, the committee recommends 

that health database organizations should release non-person-identifiable data upon request to other 

entities once those data are in analyzable form. This policy should include release to any organization 

that meets the following criteria: 

• it has a public mission statement indicating that promoting public health or the release of 

information to the public is a major goal; 

• it enforces explicit policies regarding protection of the confidentiality and integrity of data; 

• it agrees not to publish, redisclose, or transfer the raw data to any other individual 

or organization; and 

• it agrees to disclose analyses in a public forum or publication. 

The committee also recommends, as a related matter, that health database organizations make public 

their own policies governing the release of data. 

RECOMMENDATION 4.1 PREEMPTIVE LEGISLATION

The commit he commit he committee recommends that the U tee recommends that the U tee recommends that the U.S. Congress mo . Congress mo . Congress move to enact preemptiv e to enact preemptiv e to enact preemptive legislation that will: e legislation that will:

• establish a unif ablish a unif ablish a uniform requirement f orm requirement f orm requirement for the assurance of confi or the assurance of confi or the assurance of confidentialit dentialit dentiality and protection of priv y and protection of privacy

rights f rights for person-identifi or person-identifiable health dat able health data and specify a Code of F a and specify a Code of Fair Health Inf air Health Information Practices ractices 

that ensures a proper balance among required disclosures, use of data, and patient privacy; 

• impose penalties for violations of the act, including civil damages, equitable remedies, and able remedies, and 

attorney’s fees where appropriate; 

• provide for enforcement b orcement b orcement b orcement by the go y the go y the go y the government and permit priv ernment and permit priv ernment and permit priv ernment and permit private aggrie ate aggrie ate aggrie ate aggrieved parties to sue; ed parties to sue; ed parties to sue; 

• establish that compliance with the act’ ablish that compliance with the act’ ablish that compliance with the act’s requirements w s requirements w s requirements would be a def ould be a def ould be a defense to legal actions based ense to legal actions based ense to legal actions based ense to legal actions based 

on charges of improper disclosure; and 

Appendix C: Appendix C: Past Recommendations
202 

empt health dat

process with respect to person-identifi

2 2

• exempt health database organizations from public health reporting la abase organizations from public health reporting laws and compulsor ws and compulsory 

process with respect to person-identifiable health dat able health data except for compulsor or compulsory process initiated y process initiated 

by record subjects. y record subjects. 

RECOMMENDATION 4.2 DATA PROTECTION UNITS

The committee recommends that health database organizations establish a responsible administrative 

unit or board to promulgate and implement information policies concerning the acquisition and dissemination of information and establish whatever administrative mechanism is required to implement 

these policies. Such an administrative unit or board should: 

• promulgate and implement policies concerning data protection and analyses based on such data; 

• develop and implement policies that protect the confidentiality of all person-identifiable 

information, consistent with other policies of the organization and relevant state and federal law; 

• develop and disseminate educational materials for the general public that will describe in 

understandable terms the analyses and their interpretation of the rights and responsibilities of 

individuals and the protections accorded their data by the organization; 

• develop and implement security practices in the manual and automated data processing and 

storage systems of the organization; and 

• develop and implement a comprehensive employee training program that includes instruction 

concerning the protection of person-identifiable data. 

RECOMMENDATION 4.3 RELEASE OF PERSON-IDENTIFIED DATA

The committee recognizes that there must be release of patient-identified data related to the 

processing of health insurance claims. The committee recommends, however, that a health 

database organization not release person-identifiable information in any other circumstances 

except the following: 

• to other HDOs whose missions are compatible with and whose confidentiality and security 

protections are at least as stringent as their own; 

• to individuals for information about themselves; 

• to parents for information about a minor child except when such release is prohibited by law; 

• to legal representatives of incompetent patients for information about the patient; 

• to researchers with approval from their institution’s properly constituted Institutional 

Review Board; 

• to licensed practitioners with a need to know when treating patients in life-threatening situations 

who are unable to consent at the time care is rendered; and 

• to licensed practitioners when treating patients in all other (non-life-threatening) situations, 

but only with the informed consent of the patient. 

Otherwise, the committee recommends that health database organizations not authorize access to, 

or release of, information on individuals with or without informed consent. 

Ending the Document Game 
f

Appendix C: Past Recommendations 

erent kinds of communications, depending upon the subject 

w applications in

erent published 

olving 

ernment care agencies should use published health 

er to a practical number), 

or the long haul. 

A) consider using alphanumeric 

203

RECOMMENDATION 4.4 RESTRICTING EMPLOYER ACCESS

The committee recommends that employers not be permitted to require receipt of an individual’s data 

from a health database organization as a condition of employment or for the receipt of benefits. 

The committee recommends that an HDO report the following for any analysis it releases publicly: 

• general methods for ensuring completeness and accuracy of data; 

• a description of the contents and the completeness of all data files and of the variables in each 

file used in the analyses; 

• information documenting any study of the accuracy of variables used in the analyses 

(Recommendation 3.2). 

THE FOLLOWING IS THE SAME AS RECOMMENDATION 4.1 

The committee recommends that the U.S. Congress move to enact preemptive legislation that will: 

• establish a uniform requirement for the assurance of confidentiality and protection of privacy 

rights for person-identifiable health data and specify a Code of Fair Health Information Practices 

that ensures a proper balance among required disclosures, use of data, and patient privacy; 

• impose penalties for violations of the act, including civil damages, equitable remedies, and 

attorney’s fees where appropriate; 

• provide for enforcement by the government and permit private aggrieved parties to sue; 

• establish that compliance with the act’s requirements would be a defense to legal actions based 

on charges of improper disclosure; and 

• exempt health database organizations from public health reporting laws and compulsory process 

with respect to person-identifiable health data except for compulsory process initiated by record 

subjects (Recommendation 4.1).

From Standards for Medical Identifiers, Codes, and Messages Needed to Create 

an Efficient Computer-stored Medical Record (1994) 

RECOMMENDATIONS

1. The American Medical Informatics Association (AMIA) recommends the use of the SSN as the 

patient identifier at the present time. In addition, we recommend the addition of a self-check 

digit to the SSN to reduce errors of identification whenever the number is hand-entered by an 

operator. Other options f . Other options for patient identifi or patient identifiers should be e ers should be explored f xplored for the long haul.

2. We suggest that the Health Care Financing e suggest that the Health Care Financing Administration (HCF dministration (HCFA) consider using alphanumeric A) consider using alphanumeric 

codes (to reduce the number of key strokes needed to enter the identifier to a practical number), er to a practical number), 

and that the Univ and that the Universal Ph ersal Physician Identifi sician Identifier Number (UPIN) be e er Number (UPIN) be expanded to include all health care xpanded to include all health care xpanded to include all health care xpanded to include all health care 

providers for the purpose of provider identification. 

3. For the ne or the ne or the next five years, all priv ears, all priv ears, all private and go ate and go ate and government care agencies should use published health ernment care agencies should use published health 

care inf care inf care inf care informatics message st ormatics message st ormatics message st ormatics message st ormatics message st ormatics message st ormatics message standards as a st andards as a st andards as a st andards as a st andards as a st andards as a st andards as a starting point f arting point f arting point f arting point f arting point f arting point f arting point f arting point for all ne or all ne or all ne or all ne or all ne or all ne or all ne or all new applications in w applications in w applications in w applications in w applications in w applications in w applications involving 

applicable internal and external health care inf xternal health care information transmissions. Dif ormation transmissions. Different published erent published

standards w andards would apply to dif ould apply to different kinds of communications, depending upon the subject erent kinds of communications, depending upon the subject erent kinds of communications, depending upon the subject 

matter and kind of communication as described below.

Appendix C: Appendix C: Past Recommendations
204 

AMIA recommends that HL7 be used f

ations, and clinical dat

2 4

4. AMIA recommends that HL7 be used for within-institution transmission of orders, clinical observations, and clinical data (including test results); admission, transf a (including test results); admission, transfer, and disc , and discharge records; and harge records; and 

charge and billing information.

5. ASTM E1238 should be used for most interchanges of clinical data between institutions. HL7, 

which is a practical superset of ASTM E1238, is an alternative when tighter linkages are desired. 

6. ACR-NEMA should be used for the transmission of radiologic images and for message 

transmissions within PACS. 

7. AMIA recommends the use of ASTM E1394 for communication of information from 

laboratory instruments to computer systems. 

8. AMIA suggests that the NCPDP be used for communication of prescription billing 

information and eligibility information between the community pharmacies and third-party payers. 

9. AMIA suggests the use of ASC X12’s standards for billing and remittance transactions between a 

health care provider and a third-party payer. 

10. AMIA recommends its (ASTM E1460, or “Arden Syntax”) use for the transmission of 

medical logic modules. 

11. AMIA recommends its (ASTM E1467) use for the transmission of such EEG and 

EMG signals. 

12. ANSI Z39.50 is a draft standard for transmitting requests for bibliographic information 

to bibliographic retrieval systems. AMIA recommends that it be considered for all such 

communications. 

13. AMIA recommends that during the initial five years of standards development, the federal 

government invest in efforts to integrate and extend these standards to all health care messages. 

Furthermore, we suggest that the federal government build public-domain translators between 

the current message systems to permit future integration of systems. The translators should be 

submitted as ANSI and/or IS0 standards, and would be based on the object modeling framework 

being developed by the joint working group created by the HISPP Message Standards Developers Subcommittee (MSDS) and coordinated by IEEE MEDIX for modeling. 

14. With advice from AHCPR and CPRI, and in coordination with ANSI HISPP and the message 

standards developers, they should have the formal responsibility for developing these standards. 

15. Codes are needed to address (at least, the following) subject domains: 

• Drugs (e.g., penicillin V) 

• Diagnoses (e.g., pneumonia, heart failure) 

• Symptoms and findings (e.g., fatigue, swollen ankle) 

• Anatomic sites (e.g., right lower lobe of lung) 

• Microbes and etiologic agents (e.g., E. coli) 

• Clinical observations (e.g., blood pressure, oral intake, physical examination of heart) 

• Patient outcome variables and functional status (e.g., SF-36, Hamilton depression score, 

Inter-Study TYPE variables) 

• Medical devices (e.g., hip implant, tongue blades) 

• Units of measure 

Ending the Document Game 
Appendix C: Past Recommendations 

vide consumers with a visible, centralized point of 

 ce of Consumer 

ormation need dat

udies to determine the e

205

• Diagnostic study results (e.g., blood glucose, chest, x-ray, cardiac MUGA) 

• Procedures (e.g., triple bypass surgery, endoscopy, skin care) 

From For the Record: Protecting Electronic Health Information (1997) 

RECOMMENDATIONS

1. All organizations that handle patient-identifiable health care information—regardless of size— 

should adopt the set of technical and organizations policies, practices, and procedures described 

below to protect such information. 

2. Government and the health care industry should take action to create the infrastructure 

necessary to support the privacy and security of electronic health information. 

2.1 The Secretary of Health and Human Services should establish a standing health information 

subcommittee within the National Committee on Vital and Health Statistics to develop and 

update privacy and security standards for all users of health information. Membership should 

be drawn from existing organizations that represent the broad spectrum of users and subjects 

of health information. 

2.2 Congress should provide initial funding for the establishment of an organization for the healthcare industry to promote greater sharing of information about security threats, incidents, and 

solutions throughout the industry. 

3. The federal government should work with industry to promote and encourage an informed public 

debate to determine an appropriate balance between the privacy concerns of patients and the 

information needs of various users of health information. 

3.1 Organizations that collect, analyze, or disseminate health information should adopt a set of fair 

information practices similar to those contained in the federal Privacy Act of 1974. 

3.2 The Department of Health and Human Services should work with state and local governments, 

health care researchers, and the health care industry to establish a program to promote 

consumer awareness of health privacy issues and the value of health information for patient 

care, administration, and research. It should also conduct studies that will develop a series of 

recommendations for improving the level of consumer awareness of health data flows. 

3.3 Professional societies and industry groups (i.e., the American Hospital Association, American 

Medical Informatics Association, American Health Management Association, College of Health 

Information Management Executives, Healthcare Information and Management Systems Society, 

Computer-based Patient Records Institute, and American Medical Association, etc.) should continue to expand their leadership roles in educating members about privacy and security issues in 

their conference discussions and publications. 

3.4 The Department of Health and Human Ser he Department of Health and Human Services should conduct st vices should conduct studies to determine the extent 

to whic to which—and the conditions under whic h—and the conditions under which—users of health inf h—users of health information need dat ormation need data containing 

patient identities. 

3.5 The Department of Health and Human Ser he Department of Health and Human Services should w vices should work with the US Of ork with the US Office of Consumer 

Affairs to determine appropriate w airs to determine appropriate w airs to determine appropriate w airs to determine appropriate w airs to determine appropriate ways to pro s to pro s to pro s to pro s to provide consumers with a visible, centraliz vide consumers with a visible, centraliz vide consumers with a visible, centraliz vide consumers with a visible, centralized point of ed point of ed point of ed point of 

contact regarding privacy issues (a privacy ombudsman). 

Appendix C: Appendix C: Past Recommendations
206 

ort to de

h an identifi

2 6

4. Any effort to develop a univ elop a universal patient identifi ersal patient identifier should w er should weigh the presumed adv eigh the presumed advantages of ages of 

such an identifier against potential priv er against potential privacy concerns. acy concerns. Any method used to identify patients and to y method used to identify patients and to 

link patient records in a health care environment should be evaluated against the privacy criteria acy criteria 

listed below. 

1. The method should be accompanied by an explicit policy framework that defines the nature 

and character of linkages that violate patient privacy and specifies legal or other sanctions 

for creating such linkages. That framework should derive from the national debate advocated in Recommendation 3. 

2. It should facilitate the identification of parties that link records so that those who make 

improper linkages can be held responsible for their creation. 

3. It should be unidirectional to the degree that is technically feasible: it should facilitate the 

appropriate linking of health records given information about the patient or provided by the 

patient (such as the patient’s identifier), but prevent a patient’s identity from being easily 

deduced from a set of linked health records or from the identifier itself. 

5. The federal government should take steps to improve information security technologies for health 

care applications. 

5.1 To facilitate the exchange of technical knowledge on information security and the transfer of 

information security technology, the Department of Health and Human Services should establish 

formal liaisons with relevant government and industry working groups. 

5.2 The Department of Health and Human Services should support research in those areas listed 

below that are of particular importance to the health care industry, but that might not otherwise 

be pursued. 

• Methods of identifying and linking patient records. 

• Anonymous care and pseudonyms. 

• Audit tools. 

• Tools for rights enforcement and management. 

5.3 The Department of Health and Human Services should fund experimental testbeds that explore 

different approaches to access control that hold promise for being inexpensive and easy to 

incorporate into existing operations and that allow access during emergency situations. 

From The Computer-Based Patient Record: An Essential Technology for Health Care 

(1991, 1997) 

SUMMARY OF THE RECOMMENDATIONS OF THE INSTITUTE OF MEDICINE COMMITTEE ON 

IMPROVING THE PATIENT RECORD

The committee recommends the following: 

1. Health care professionals and organizations should adopt the computer-based patient record 

(CPR) as the standard for medical and all other records related to patient care. 

2. To accomplish Recommendation No. 1, the public and private sectors should join in establishing 

a Computer-based Patient Record Institute (CPRI) to promote and facilitate development, 

implementation, and dissemination of the CPR. 

Ending the Document Game 
Appendix C: Past Recommendations 

stem, the Department of Health and Human Services 

ormation, analyz

 a state c

e it and conduct 

hoose not to 

ablish or adapt their cur

ormation on a defi

aining a core set of reporting st

or reporting; 

y Measurement and R

207

3. Both the public and private sectors should expand support for the CPR and CPR system 

implementation through research, development, and demonstration projects. Specifically, 

the committee recommends that Congress authorize and appropriate funds to implement the 

research and development agenda outlined herein. The committee further recommends that 

private foundations and vendors fund programs that support and facilitate this research and 

development agenda. 

4. The CPRI should promulgate uniform national standards for data and security to facilitate 

implementation of the CPR and its secondary databases. 

5. The CPRI should review federal and state laws and regulations for the purpose of proposing and 

promulgating model legislation and regulations to facilitate the implementation and dissemination 

of the CPR and its secondary databases and to streamline the CPR and CPR systems. 

6. The costs of CPR systems should be shared by those who benefit from the value of the CPR. 

Specifically, the full costs of implementing and operating CPRs and CPR systems should be 

factored into reimbursement levels or payment schedules of both public and private sector 

third-party payers. In addition, users of secondary databases should support the costs of 

creating such databases. 

7. Health care professional schools and organizations should enhance educational programs for 

students and practitioners in the use of computers, CPRs, and CPR systems for patient care, 

education, and research. 

From To Err Is Human: Building a Safer Health System (2000) 

RECOMMENDATIONS

4.1 Congress should create a Center for Patient Safety within the Agency for Healthcare Research 

and Quality. This center should 

• Set the national goals for patient safety, track progress in meeting these goals, and issue an 

annual report to the President and Congress on patient safety; and 

• Develop knowledge and understanding of errors in health care by developing a research 

agenda, funding Centers of Excellence, evaluating methods for identifying and preventing 

errors, and funding dissemination and communication activities to improve patient safety. 

5.1 A nationwide mandatory reporting system should be established that provides for the collection 

of standardized information by state governments about adverse events that result in death or 

serious harm. Reporting should initially be required of hospitals and eventually be required of 

other institutional and ambulatory care delivery settings. Congress should 

• Designate the National F Designate the National F Designate the National Forum for Health Care Qualit or Health Care Qualit or Health Care Quality Measurement and R y Measurement and Reporting as the eporting as the eporting as the 

entity responsible f y responsible for promulgating and maint or promulgating and maintaining a core set of reporting st aining a core set of reporting standards to be andards to be andards to be 

used by states, including a nomenclat ates, including a nomenclature and t ure and taxonomy for reporting;

• Require all health care organizations to report st equire all health care organizations to report standardiz andardized information on a defi ned list of ned list of 

adverse events; 

• Provide funds and tec vide funds and tec vide funds and technical e hnical e hnical expertise f xpertise f xpertise for state governments to est ernments to est ernments to establish or adapt their cur ablish or adapt their current er rent error reporting sy ror reporting sy ror reporting sy ror reporting systems to collect the st stems to collect the st stems to collect the st stems to collect the standardiz andardiz andardiz andardized information, analyz ormation, analyz ormation, analyz ormation, analyze it and conduct e it and conduct e it and conduct e it and conduct 

follow-up action as needed with health care organizations. -up action as needed with health care organizations. -up action as needed with health care organizations. -up action as needed with health care organizations. -up action as needed with health care organizations. -up action as needed with health care organizations. -up action as needed with health care organizations. -up action as needed with health care organizations. Should a state choose not to hoose not to hoose not to hoose not to hoose not to hoose not to hoose not to hoose not to hoose not to 

implement the mandatory reporting sy y reporting system, the Department of Health and Human Ser stem, the Department of Health and Human Services 

should be designated as the responsible entity; and 

Appendix C: Appendix C: Past Recommendations
208 

Designate the Center f

8

• Designate the Center for Patient Saf atient Safety to:

1) convene states to share inf ates to share information and e ormation and expertise, and to e xpertise, and to evaluate alternativ aluate alternative 

approaches taken for implementing reporting programs, identify best practices for 

implementation, and assess the impact of state programs; and 

2) receive and analyze aggregate reports from states to identify persistent safety issues 

that require more intensive analysis and/or a broader-based response (e.g., designing 

prototype systems or requesting a response by agencies, manufacturers or others). 

5.2 The development of voluntary reporting efforts should be encouraged. The Center for Patient 

Safety should 

• Describe and disseminate information on external voluntary reporting programs to encourage greater participation in them and track the development of new reporting systems as 

they form; 

• Convene sponsors and users of external reporting systems to evaluate what works and 

what does not work well in the programs, and ways to make them more effective; 

• Periodically assess whether additional efforts are needed to address gaps in information to 

improve patient safety and to encourage health care organizations to participate in voluntary 

reporting programs; and 

• Fund and evaluate pilot projects for reporting systems, both within individual health care 

organizations and collaborative efforts among health care organizations. 

6.1 Congress should pass legislation to extend peer review protections to data related to patient 

safety and quality improvement that are collected and analyzed by health care organizations for 

internal use or shared with others solely for purposes of improving safety and quality. 

7.1 Performance standards and expectations for health care organizations should focus greater 

attention on patient safety. 

• Regulators and accreditors should require health care organizations to implement meaningful patient safety programs with defined executive responsibility. 

• Public and private purchasers should provide incentives to health care organizations to 

demonstrate continuous improvement in patient safety. 

7.2 Performance standards and expectations for health professionals should focus greater attention 

on patient safety. 

• Health professional licensing bodies should 

1) implement periodic re-examinations and re-licensing of doctors, nurses, and other 

key providers, based on both competence and knowledge of safety practices; and 

2) work with certifying and credentialing organizations to develop more effective 

methods to identify unsafe providers and take action. 

• Professional societies should make a visible commitment to patient safety by establishing 

a permanent committee dedicated to safety improvement. This committee should 

1) develop a curriculum on patient safety and encourage its adoption into training and 

certification requirements; 

2) disseminate information on patient safety to members through special sessions at 

annual conferences, journal articles and editorials, newsletters, publications and 

web sites on a regular basis; 

Ending the Document Game 
Appendix C: Past Recommendations 

ed under the Ne

209

3) recognize patient safety considerations in practice guidelines and in standards related 

to the introduction and diffusion of new technologies, therapies and drugs; 

4) work with the Center for Patient Safety to develop community-based, collaborative 

initiatives for error reporting and analysis and implementation of patient safety 

improvements; and 

5) collaborate with other professional societies and disciplines in a national summit on 

the professional’s role in patient safety. 

7.3 The Food and Drug Administration (FDA) should increase attention to the safe use of drugs in 

both pre- and post-marketing processes through the following actions: 

• Develop and enforce standards for the design of drug packaging and labeling that will 

maximize safety in use; 

• Require pharmaceutical companies to test (using FDA-approved methods) proposed drug 

names to identify and remedy potential sound-alike and look-alike confusion with existing 

drug names; and 

• Work with physicians, pharmacists, consumers, and others to establish appropriate 

responses to protect the safety of patients. 

8.1 Healthcare organizations and the professionals affiliated with them should make continually 

improved patient safety a declared and serious aim by establishing patient safety programs with 

defined executive responsibility. Patient safety programs should 

• Provide strong, clear and visible attention to safety; 

• Implement non-punitive systems for reporting and analyzing errors within 

their organizations;

• Incorporate well-understood safety principles, such as standardizing and simplifying 

equipment, supplies, and processes; and 

• Establish interdisciplinary team training programs for providers that incorporate proven 

methods of team training, such as simulation. 

8.2 Healthcare organizations should implement proven medication safety practices. 

From Networking Health: Prescriptions for the Internet (2000) 

RECOMMENDATIONS

1.1 The health communit he health communit he health communit he health community should ensure that tec y should ensure that tec y should ensure that tec y should ensure that technical capabilities suit hnical capabilities suit hnical capabilities suit hnical capabilities suitable for health and biomedical or health and biomedical or health and biomedical or health and biomedical 

applications are incorporated into the testbed network being deplo ork being deployed under the Next Generation xt Generation xt Generation 

Internet initiative and eventually into the Internet. 

Appendix C: Appendix C: Past Recommendations
210 

o ensure that the Internet e

health communit

2 0

1.2 To ensure that the Internet evolves in w es in ways supportiv s supportive of health needs o e of health needs over the long term, the er the long term, the 

health community should w y should work with the net ork with the networking communit orking community to de y to develop impro elop improved network 

technologies that are of particular importance to health applications of the Internet.

• More readily scalable techniques to guarantee bandwidth on demand. 

• Stronger forms of authentication. 

• Symmetric or dynamically reconfigurable broadband technologies for the last mile. 

• Hardened quality-of-service guarantees. 

• Disaster operations. 

1.3 The National Library of Medicine should forge stronger links between the health and networking 

research communities to ensure that the needs of the health community are better addressed in 

network research, development, and deployment. 

1.4 The National Institutes of Health and its component agencies should fund information technology 

research that will develop the complementary technologies that are needed if the health 

community is to take advantage of the improved networking technologies that can be expected 

in the future. 

2.1 The Department of Health and Human Services should fund pilot projects and larger demonstration programs to develop and demonstrate interoperable, scalable Internet applications for linking 

multiple health organizations. 

2.2 Federal agencies such as the Department of Veterans Affairs, the Department of Defense, the 

Health Care Financing Administration, the National Institutes of Health, and the Indian Health 

Service should serve as role models and testbeds for the health industry by deploying Internetbased applications for their own purposes. 

2.3 Health organizations in industry and academia should continue to work with the Department 

of Health and Human Services to evaluate various health applications of the Internet in order 

to improve understanding of their effects, the business models that might support them, and 

impediments to their expansion. 

2.4 Public and private health organizations should experiment with networks based on Internet 

protocols and should incorporate the Internet into their future plans for new networked 

applications and into their overall strategic planning. 

3.1 Professional associations with expertise in health issues and information technology should work 

with health care organizations to develop and promulgate guidelines for safe, effective use of the 

Internet in clinical settings. 

3.2 Government, industry, and academia should work together with professional associations with 

experience in health and information technology to educate the broader health care communities 

about the ways the Internet can benefit them. 

3.3 The Department of Health and Human Services should commission a study of the health 

information technology workforce to determine whether the supply of such workers balances 

the demand for them, to identify the kinds of training and education that workers at different 

levels will need, and to develop recommendations for ensuring an adequate supply of people 

with training at the intersections of information technology and health. 

4.1 The Department of Health and Human Services should more aggressively address the broad 

set of policy issues that influence the development, deployment, and adoption of Internet-based 

applications in the health sector. 

Ending the Document Game 
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Appendix C: Past Recommendations 

or adoption under HIP

y and w

AA 

orking 

h as GCPR 

eloping healthcare 

211

From the National Committee on Vital and Health Statistics (NCVHS) Report to the 

Secretary on Uniform Standards for Patient Medical Record Information (2000) 

RECOMMENDATIONS

This Report reflects the belief that significant quality and cost benefits can be achieved in healthcare 

if clinically specific data are captured once at the point of care and that all other legitimate data needs 

are derived from those data. The standards for patient medical record information that will result from 

the recommendations in this Report will be consistent and compatible with the HIPAA financial and 

administrative transaction standards, including the upcoming claims attachment standards. 

In consideration of broad industry testimony on these key issues, the NCVHS recommends that the 

Secretary of HHS: 

1. Adopt the Guiding Principles for Selecting PMRI Standards as the criteria to select uniform data 

standards for patient medical record information (PMRI). These Guiding Principles are based on 

those published in the notice of proposed rulemaking for selecting financial and administrative 

transaction standards, which have been modified by adding characteristics and attributes that 

specifically address interoperability, data comparability, and data quality. 

2. Consider acceptance of forthcoming NCVHS recommendations for specific PMRI standards. 

The first set of these recommendations will be delivered to the secretary eighteen months 

following submission of this Report and will include suggested implementation timeframes that 

consider industry readiness for adoption. For each recommendation for PMRI standards, NCVHS 

encourages the Secretary to provide an open process to give the public an opportunity to comment on the PMRI standards proposals before final rules are adopted. 

3. Provide immediate funding to accelerate the development and promote early adoption of PMRI 

standards. This should take the form of support for: 

a. government membership and participation in standards development organizations 

b. broader participation of expert representation in standards development 

c. enhancement, distribution, and maintenance of clinical terminologies that have the potential to 

be PMRI standards through:

(1) government-wide licensure or comparable arrangements so these terminologies are 

available for use at little or no cost. 

(2 ) augmentation of the national Library of Medicine’s Unified Medical Language System 

(UMLS) to embody enhanced mapping of medical vocabularies and classifications. 

(3) development and testing of quality measures and clinical practice guidelines, such as 

published in the Agency for Healthcare Research and Quality (AHRQ) clearinghouses, and 

patient saf patient safety measures f y measures f y measures for their compatibilit or their compatibilit or their compatibility with e y with e y with existing and de xisting and de xisting and developing healthcare eloping healthcare

terminologies. 

(4) development and testing in multi-agency projects, such as GCPR 

(Government Computer-based Patient Record) framework project.

d. coordination of dat coordination of data elements among all st a elements among all standards selected f andards selected for adoption under HIP or adoption under HIPAA 

through the development and maintenance of an open met elopment and maintenance of an open met elopment and maintenance of an open meta-data registr a registr a registry and w y and working 

conferences to harmonize message format and vocabulary standards.

Appendix C: Appendix C: Past Recommendations
v

212

ement of dr

2

e. improv ement of drug data capture and use b ure and use by:

(1) requiring the F requiring the Food and Dr ood and Drug Administration (FD dministration (FDA) to mak A) to make publicly a e publicly available its National ailable its National 

Drug Codes (NDC) database registry information. 

(2) requiring the FDA to develop a drug classification system based on active ingredients 

so that all drugs that fall into a given category can be identified by the name of that 

category. 

(3) encouraging the FDA to participate in private sector development and ongoing 

maintenance of a reference terminology for drugs and biologics that promotes the 

ability to share clinically specific information. 

f. early adoption of PMRI standards within government programs to provide broadened feedback 

to the standards development community. 

4. For each standard recommended by NCVHS, commit funding for development of a uniform 

implementation guide, development of conformance testing procedures, and ongoing government licensure of, or comparable arrangements for, healthcare terminology standards. 

5. Support demonstration of the benefits and measurement of the costs of using uniform data 

standards for PMRI that provide for interoperability, data comparability, and data quality. 

6. Support increases in funding for research, demonstration, and evaluation studies on clinical data 

capture systems and other healthcare informatics issues. 

7. Accelerate development and implementation of a national health information infrastructure. HHS 

should work in collaboration with other federal components, state governments, and the private 

sector on demonstration and evaluation projects and test beds. 

8. Promote United States’ interest in international health data standards development through HHS 

participation in international healthcare informatics standards development organizations and, in 

cooperation with the Secretary of the Department of Commerce, through monitoring the activity 

of U.S. healthcare information system vendors abroad. 

9. Promote the equitable distribution of the costs for using PMRI standards among all major 

beneficiaries of PMRI. This may take the form of incentives for submission of data using the 

PMRI standards that can support [[text out]] 

10. Encourage enabling legislation for use and exchange of electronic PMRI, including: 

a. comprehensive federal privacy and confidentiality legislation. This would ensure that all health 

information in any medium, used for any purpose, and disclosed to any entity receives equal 

privacy protection under law. 

b. uniform recognition by all states of electronic health record keeping; and national standards for 

PMRI retention and electronic authentication (digital signatures). 

From Crossing the Quality Chasm: A New Health System for the 21st Century (2001) 

RECOMMENDATIONS

1. All health care organizations, professional groups, and private and public purchasers should adopt 

as their explicit purpose to continually reduce the burden of illness, injury, and disability, and to 

improve the health and functioning of the people of the United States. 

Ending the Document Game 
Appendix C: Past Recommendations 

rence, health burden, and resource use. 

er than 15 priority 

utions should actively collaborate and 

ormation and coordination of care. 

aste resources or 

stem should anticipate patient needs, rather than 

, e

213

2. All healthcare organizations, professional groups, and private and public purchasers should 

pursue six major aims; specifically, health care should be safe, effective, patient-centered, timely, 

efficient, and equitable. 

3. Congress should continue to authorize and appropriate funds for, and the Department of Health 

and Human Services should move forward expeditiously with the establishment of monitoring 

and tracking processes for use in evaluating the progress of the health system in pursuit of the 

above-cited aims of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. 

The Secretary of the Department of Health and Human Services should report annually to 

Congress and the President on the quality of care provided to the American people. 

4. Private and public purchasers, healthcare organizations, clinicians, and patients should work 

together to redesign healthcare processes in accordance with the following rules: 

• Care based on continuous healing relationships. Patients should receive care whenever 

they need it and in many forms, not just face-to-face visits. This rule implies that the healthcare system should be responsive at all times (24 hours a day, every day) and that access to 

care should be provided over the Internet, by television, and by other means in addition to 

face-to-face visits. 

• Customization based on patient needs and values. The system of care should be designed 

to meet the most common types of needs, but have the capability to respond to individual 

patient choices and preferences. 

• The patient as the source of control. Patients should be given the necessary information 

and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should be able to accommodate differences in 

patient preferences and encourage shared decision-making. 

• Shared knowledge and the free flow of information. Patients should have unfettered access 

to their own medical information and to clinical knowledge. Clinicians and patients should 

communicate effectively and share information. 

• Evidence-based decision making. Patients should receive care based on the best available 

scientific knowledge. Care should not vary illogically from clinician to clinician or from place 

to place. 

• Safety as a system property. Patients should be safe from injury caused by the care 

system. Reducing risk and ensuring safety require greater attention to systems that help 

prevent and mitigate errors. 

• The need for transparency. The health care system should make information available to 

patients and their families that allows them to make informed decisions when selecting a 

health plan, hospital, or clinical practice, or choosing among alternative treatments. This 

should include inf should include inf should include information describing the sy ormation describing the sy ormation describing the sy ormation describing the sy ormation describing the system’s performance on saf ormance on saf ormance on saf ormance on saf ormance on safety, evidence-based vidence-based vidence-based vidence-based vidence-based 

practice, and patient satisfaction. 

• Anticipation of needs. The health system should anticipate patient needs, rather than stem should anticipate patient needs, rather than 

simply reacting to events.

• Continuous decrease in waste. The health system should not waste resources or 

patient time. 

• Cooperation among clinicians. Clinicians and instit Clinicians and institutions should activ utions should actively collaborate and ely collaborate and ely collaborate and 

communicate to ensure an appropriate exchange of inf hange of information and coordination of care. ormation and coordination of care.

5. The Agency f gency f gency f gency for Health Care R or Health Care R or Health Care R or Health Care Research and Qualit h and Qualit h and Qualit h and Quality should identify not f y should identify not f y should identify not f y should identify not fewer than 1 er than 1 er than 15 priorit 5 priorit 5 priority 

conditions, taking into account frequency of occurrence, health burden, and resource use. rence, health burden, and resource use. 

Appendix C: Appendix C: Past Recommendations
214 

In collaboration with the National Qualit

including purc

2 4

In collaboration with the National Quality Forum, the agency should con um, the agency should convene stakeholders, eholders, 

including purchasers, consumers, healthcare organizations, professional groups, and others, to essional groups, and others, to 

develop strategies, goals, and action plans f elop strategies, goals, and action plans for achieving subst ving substantial impro antial improvements in qualit ements in quality in 

the next 5 years for each of the priority conditions. 

6. Congress should establish a Healthcare Quality Innovation Fund to support projects targeted at 

(1) achieving the six aims of safety, effectiveness, patient-centeredness, timeliness, efficiency, 

and equity; and/or (2) producing substantial improvements in quality for the priority conditions. 

The fund’s resources should be invested in projects that will produce a public-domain portfolio 

of programs, tools, and technologies of widespread applicability. 

7. The Agency for Healthcare Research and Quality and private foundations should convene a series 

of workshops involving representatives from health care and other industries and the research 

community to identify, adapt, and implement state-of-the-art approaches to addressing the 

following challenges: 

• Redesign of care processes based on best practices. 

• Use of information technologies to improve access to clinical information and support 

clinical decision making. 

• Knowledge and skills management. 

• Development of effective terms. 

• Coordination of care across patient conditions, services, and settings over time. 

• Incorporation of performance and outcome measurements for improvement 

and accountability. 

8. The Secretary of the Department of Health and Human Services should be given the 

responsibility and necessary resources to establish and maintain a comprehensive program 

aimed at making scientific evidence more useful and accessible to clinicians and patients. 

In developing this program, the Secretary should work with federal agencies and in collaboration 

with professional and health care associations, the academic and research communities, 

and the National Quality Forum and other organizations involved in quality measurement 

and accountability. 

9. Congress, the executive branch, leaders of health care organizations, public and private 

purchasers, and health informatics associations and vendors should make a renewed national 

commitment to building an information infrastructure to support health care delivery, consumer 

health, quality measurement and improvement, public accountability, clinical and health services 

research, and clinical educations. This commitment should lead to the elimination of most 

handwritten clinical data by the end of the decade. 

10. Private and public purchasers should examine their current payment methods to remove 

barriers that currently impede quality improvement, and to build in stronger incentives for 

quality enhancement. 

11. The Healthcare Financing Administration and the Agency for Healthcare Research and 

Quality, with input from private payers, healthcare organizations, and clinicians, should develop 

a research agenda to identify, pilot test, and evaluate various options for better aligning current 

payment methods with quality improvement goals. 

12. A multidisciplinary summit of leaders within the health professions should be held to discuss 

and develop strategies for (1) restructuring clinical education to be consistent with the principles 

of the 21st-century health system throughout the continuum of undergraduate, graduate, 

and continuing education for medical, nursing, and other professional training programs; and 

Ending the Document Game 
v

f e 

Appendix C: Past Recommendations 

or misuses and abuses of 

y of personal health inf

or clinically necessar f e 

ormation, the 

y and ef ectiv 

erarching 

andards; and promote consumer/patient control of personal 

y of health inf

y of care; promote the 

andards issues related to the NHII. 

215

(2) assessing the implications of these changes for provider credentialing programs, funding,

and sponsorship of education programs for health professionals. 

13. The Agency for Healthcare Research and Quality should fund research to evaluate how the 

current regulatory and legal systems (1) facilitate or inhibit the changes needed for the 

21st-century health care delivery system, and (2) can be modified to support health care 

professionals and organizations that seek to accomplish the six aims set forth in Chapter 2. 

From the Final Report National Health Information Infrastructure (NHII)—Information 

for Health: A Strategy for Building the National Health Information Infrastructure (2001) 

RECOMMENDATIONS FOR THE NATIONAL HEALTH INFORMATION INFRASTRUCTURE (NHII)

Federal Government

1. The Secretary of Health and Human Services should create a senior position to provide strategic 

national leadership for the development of the NHII and set the agenda for NHII investments, 

policymaking, and integration with ongoing health and healthcare activities inside and outside of 

Government. 

2. Other HHS agencies/offices with missions and activities in NHII-related areas should designate 

an office or individual to participate in NHII strategic planning and ensure coordination within the 

agency/office and with the central NHII office. 

3. Congress should provide new or expanded funding for programs that support the personal 

health, healthcare provider, and population health dimensions individually and jointly, with special 

attention to areas for which the Federal Government has a leading or exclusive role and areas 

already mandated by HIPAA. Examples of funding include support for 

• Development of State and local population health information capacities. 

• Professional training programs for the Federal, State, and local public health work force, and 

for the private healthcare work force, in information technology skills. 

• Technology centers that bring together interdisciplinary teams to explore issues related to 

the NHII, with an emphasis on activities that link the three dimensions. 

• Healthcare providers for investments in interoperable linked systems that support health 

related information flows across plans and providers. 

• Federal information technology research and development activities to stimulate research in 

health and healthcare applications. 

• Pilot projects that integrate data from the healthcare provider and personal health 

dimensions into the population health dimension at the State and local levels.

Congress should supplement HIPAA to address st AA to address standards issues related to the NHII. A “Health “Health “Health 

Information P ormation P ormation P ormation P ormation Portability and Continuit y and Continuit y and Continuit y and Continuit y and Continuit y and Continuity Act” should pro ct” should pro ct” should pro ct” should pro ct” should pro ct” should provide for the port or the port or the port or the port or the port or the portability of health inf y of health inf y of health inf y of health inf y of health information ormation ormation ormation ormation ormation 

across information systems, plans, and providers to ensure continuity of care; promote the y of care; promote the 

adoption of clinical data standards; and promote consumer/patient control of personal andards; and promote consumer/patient control of personal 

health information.

Congress should pass national laws and identify regulatory responsibilities for overarching

issues that apply to the NHII, such as the confi h as the confi dentialit dentialit dentiality of personal health inf y of personal health information, the ormation, the ormation, the 

securit security of health inf y of health inf y of health inf y of health information sy ormation sy ormation sy ormation systems, reimbursement f stems, reimbursement f stems, reimbursement f stems, reimbursement for clinically necessar or clinically necessar or clinically necessar or clinically necessary and ef y and ef y and ef y and effective

electronically delivered health ser ered health services, and consumer protection f vices, and consumer protection for misuses and abuses of or misuses and abuses of or misuses and abuses of 

health information.

Appendix C: Appendix C: Past Recommendations
216 

ederal health dat

andards organizations to de

2 6

4. Federal health data agencies should collaborate with St a agencies should collaborate with State and local go ate and local government agencies and ernment agencies and 

standards organizations to develop common dat elop common data reporting f a reporting formats and st ormats and standardiz andardized methods ed methods 

of transmission of all pertinent health data. These activities should build upon CDC NEDSS, the 

Health Care Service (837) Data Reporting Guide and upon efforts to develop public health data 

conceptual models, extending these beyond communicable diseases. This effort also should be 

coordinated with the United States Health Information Knowledgebase or metadata registry 

operated by the ANSI Healthcare Informatics Standards Board. 

Other Stakeholders

Although the Committee was told that the Federal Government should assume leadership, it also 

heard that the Federal Government cannot build the NHII alone. Its ability to lead and coordinate rests 

on the assumption that many other stakeholders in the public and private sectors will play key roles 

within their own areas and will work together. 

State and Local Government 

1. Each State should establish a mechanism to provide strategic leadership and coordination of 

activities related to the NHII. This mechanism, which may be a new office, preferably located in 

the Office of the Governor, Office of the State Health Officer, or other combined health and 

human services agency, should have broad oversight of the integration of NHII components into 

the public health and healthcare programs in their States. The functions of the leadership would 

be to solicit input from all relevant stakeholders, including consumers, about the development 

and uses of the NHII and to oversee personal health information privacy issues and activities. 

2. State and local data agencies should collaborate with Federal agencies and standards organizations to develop common data reporting formats and standardized methods of transmission for 

all pertinent health data. 

3. State and local health agencies should invest in the collection and analysis of population health 

data to permit real-time, small-area analysis of acute public health problems and to understand 

health issues related to new or rapidly growing populations and health disparities, and they 

should combine health data sources for population analysis. 

Healthcare Providers 

1. Each healthcare professional and provider membership and trade organization should establish 

a mechanism to provide strategic leadership on issues related to NHII development and implementation. The functions of the leadership would include representing the membership or trade 

organization in meetings convened by HHS and collaborative activities with other stakeholders, 

promoting internal review of organizational practices and systems for consistency with the NHII 

and developing timetables for needed revisions and enhancements, and overseeing personal 

health information privacy issues and activities. 

2. Healthcare provider organizations. Each individual healthcare provider organization should 

establish a mechanism to provide strategic leadership and coordination on issues related to NHII 

development and implementation. The leadership would be responsible for overseeing personal 

health information privacy and security issues and activities and ensuring that stakeholders from 

the personal health and population health dimensions can provide appropriate input into plans 

and decisions. The leadership should identify representatives with diverse backgrounds to 

participate actively in the work of standards development organizations. 

Healthcare Plans and Purchasers 

1. Each healthcare plan and purchaser should establish a mechanism to provide strategic leadership 

and coordination on issues related to NHII development and implementation. These responsibilities could be assigned to the Chief Information Officers of their organizations. A designated 

Ending the Document Game 
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Appendix C: Past Recommendations 

hange 

hange health data. 

viders, health plans, and public health entities. 

hasers, and public health organizations to promote and f

ocacy groups should participate in NHII-related commit

vider organizations, and in st

217

individual should represent the organization in meetings convened by HHS and collaborative 

activities with other stakeholders and oversee personal health information issues and activities.

2. Healthcare plans and purchasers should examine their practices and systems for consistency 

with the NHII and set timetables for needed revisions and enhancements. They should ensure 

that stakeholders from the personal health and population health dimensions provide appropriate 

input into NHII plans and decisions. 

3. Healthcare plans and purchasers should identify representatives with diverse backgrounds to 

participate actively in the work of standards development organizations. 

Standards Development Organizations 

1. Standards development organizations should develop new or modified standards as requirements become known. 

2. Standards development organizations should ensure participation by consumer representatives. 

3. Standards development organizations should identify mechanisms to accelerate the standards 

development process and improve the coordination of standards development across standard 

setting bodies and consistent with the direction of the NHII. 

4. Standards development organizations should promote cooperation with standards being 

developed internationally for population health, patient care, or data-security purposes. 

Information Technology Industry 

1. Information technology organizations and trade groups should designate internal representatives 

to provide strategic leadership and coordination on issues related to NHII development and 

implementation. Representatives should participate in meetings convened by HHS and 

collaborative activities with other stakeholders. 

2. The information technology industry should develop and promote cost-effective healthcare 

software and technologies that comply with national standards so that they can support the 

appropriate sharing of electronic information for healthcare providers, consumers/patients, and 

public health agencies and the improved delivery of clinical and public health services. 

Consumer and Patient Advocacy Groups 

1. Consumer and patient advocacy groups should promote policies that encourage the use of electronic technologies in healthcare organizations and by healthcare providers to improve the quality 

of services, to decrease rates of adverse effects, and to increase access to on-line/wireless 

health information and services for consumers, patients, and clients. They should advocate for 

privacy protections for consumers, patients, and clients when they exchange health information 

electronically and for equal access to technology and information by all population groups. 

2. Consumer and patient adv Consumer and patient advocacy groups should participate in NHII-related commit ocacy groups should participate in NHII-related committees organiz tees organized

by national and St y national and State agencies, and b ate agencies, and by health plan and pro y health plan and provider organizations, and in standards andards andards 

development efforts. 

3. Consumer and patient advocacy groups should collaborate with healthcare provider organizations, health plans and purchasers, and public health organizations to promote and facilitate the ate the 

use of information tec ormation technologies b hnologies by healthcare pro y healthcare providers, health plans, and public health entities. viders, health plans, and public health entities.

Community Organizations 

1. Communit Community organizations should help identify communit y organizations should help identify community health dat y health data needs. a needs.

2. Communit Communit Communit Community organizations should identify necessar y organizations should identify necessar y organizations should identify necessar y organizations should identify necessary partnerships to e y partnerships to e y partnerships to e y partnerships to exchange health dat hange health dat hange health data. 

They also should identify and help reduce bar y also should identify and help reduce bar y also should identify and help reduce barriers to communit riers to communit riers to community level collection and e el collection and e el collection and exchange

of health data. 

Appendix C: Appendix C: Past Recommendations
218 

a to individual and communit

8

3. Communit Community organizations should de y organizations should develop local la elop local laypersons ypersons’ capacities to collect and apply health ’ capacities to collect and apply health 

data to individual and community health improvements.

4. Community organizations should develop programs that address the “digital divide” and promote 

equal access to technology and information by all population groups. 

Academic and Research Organizations 

1. Academic and research organizations should develop research proposals that integrate health 

information infrastructure and applications with other types of information infrastructure 

development (e.g., NGI and Internet2). 

2. Academic and research organizations should develop collaborations with service providers, 

standards development organizations, and their communities to take innovations from research 

to implementation. 

From Fostering Rapid Advances in Health Care: Learning from System Demonstrations 

(2002) 

RECOMMENDATIONS

In response to a request from the Secretary of the Department of Health and Human Services, the 

Institute of Medicine convened a committee to identify possible demonstration projects that might 

be implemented in 2003, with the hope of yielding models for broader health system reform within a 

few years. The committee is recommending a substantial portfolio of demonstration projects: 10-12 

chronic care demonstrations, a primary care demonstration with 40 participating sites, 8-10 information 

and communications technology infrastructure demonstrations, 3-5 state health insurance coverage 

demonstrations, and 4-5 state liability demonstrations. As a set the demonstrations address key 

aspects of the healthcare delivery system and the financing and legal environment in which healthcare 

is provided. The launching of a carefully crafted set of demonstrations is viewed as a way to initiate a 

“building block” approach to health system change. 

These demonstrations should lead to a health care system in which patients’ experiences would be 

very different from today’s norm. For a typical patient with one or more chronic conditions requiring 

ongoing management, as well as preventive and acute care needs, the system should provide a 

continuous relationship with a personal clinician who functions with the support of a multidisciplinary 

team. Patients should be able to access care over the Internet, by telephone, and by other means 

in addition to face-to-face visits. There should be few concerns about safety, but in the event that 

a patient is harmed, the clinician should inform the patient immediately, apologize, and take action 

to mitigate the consequences. Care should not vary illogically from clinician to clinician or place to 

place. Each patient should receive the best that science has to offer, whether for ongoing treatment 

of a chronic condition or care for an acute episode. This does not imply one-size-fits-all care. Patients 

will have different preferences (e.g., watchful waiting versus surgical intervention for prostate cancer), 

differing needs for education and support, and differing constraints (e.g., a need for home care with 

family support versus short-term rehabilitative care). 

For many people, chronic disease could have been avoided or delayed had educational and other 

supportive interventions been provided to assist them in modifying health behaviors. These demonstration projects would involve the following components: 

• Coordinating structure—During the first year, the grant recipient would be responsible for 

establishing a broad-based coordinating structure with participation from all stakeholders. 

• Chronic care management programs—Each demonstration site would establish chronic care 

Ending the Document Game 
Appendix C: Past Recommendations 

essionals and leaders. 

or go

hools of public 

al public 

vide such training

A) to periodically assess the 

orking in public health sy

219

management programs that would provide evidence-based treatment of chronic diseases, 

services to detect and minimize the consequences of common geriatric syndromes, services 

to meet the preventive and acute care needs of the enrolled chronically ill population, and 

extended outreach and coordination with social and environmental services. 

• Information and communications technology—A major component of these demonstrations 

should be the expanded use of Information and Communications Technology (ICT) to improve 

care for the chronically ill.

• Benefits, Co-payments, Provider Payments, and Accountability—Demonstration sites should 

be given the flexibility under Medicare and other insurance programs to innovate in such areas 

as benefits coverage, beneficiary co-payments, provider payments, and accountability.

• Learning collaboratives and community-wide educational efforts—Each demonstration site, 

with assistance from the National Library of Medicine and the Agency for Healthcare Research 

and Quality (AHRQ), should engage in efforts to assist clinicians and patients in gaining access 

to scientific knowledge, practice guidelines, certified protocols, identified best practices, and 

decision support tools.

The 21st-century healthcare system should deliver far greater value than is currently the case. 

Patients have a right to demand—and healthcare leaders have an obligation to act now to ensure 

that they receive—care that is safe, effective, patient-centered, timely, efficient, and equitable. The 

committee believes the proposed demonstration projects would represent a substantial step in that 

direction. 

From The Future of the Public’s Health in the 21st Century (2002) 

RECOMMENDATIONS

1. The Secretary of the Department of Health and Human Services (DHHS), in consultation with 

states, should appoint a national commission to develop a framework and recommendations for 

state public health law reform. In particular, the national commission would review all existing 

public health law as well as the Turning Point Model State Public Health Act and the Model State 

Emergency Health Powers Act; provide guidance and technical assistance to help states reform 

their laws to meet modern scientific and legal standards; and help foster greater consistency 

within and among states, especially in their approach to different health threats. 

2. All federal, state, and local governmental public health agencies should develop strategies to 

ensure that public health workers who are involved in the provision of essential public health 

services demonstrate mastery of the core public health competencies appropriate to their jobs. 

The Council on Linkages between Academia and Public Health Practice should also encourage 

the competency de the competency development of public health prof elopment of public health professionals w essionals working in public health sy orking in public health system 

roles in for-profit and nongovernmental entities. 

3. Congress should designate funds f Congress should designate funds f Congress should designate funds for the Centers f or the Centers f or the Centers for Disease Control and P or Disease Control and P or Disease Control and Prevention (CDC) ention (CDC) ention (CDC) 

and the Health R and the Health R and the Health Resources and Ser esources and Ser esources and Ser esources and Services Administration (HR dministration (HR dministration (HR dministration (HRSA) to periodically assess the A) to periodically assess the A) to periodically assess the 

preparedness of the public health workforce, to document the training necessary to meet basic y to meet basic 

competency e competency expectations, and to advise on the funding necessar ations, and to advise on the funding necessar ations, and to advise on the funding necessary to pro y to pro y to provide suc vide suc vide such training h training h training.

4. Leadership training eadership training eadership training eadership training eadership training eadership training eadership training eadership training eadership training eadership training eadership training, support, and de , support, and de , support, and de , support, and de , support, and de , support, and de , support, and de , support, and de , support, and de , support, and de , support, and development should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priorit elopment should be a high priority for government ernment ernment ernment ernment ernment ernment ernment ernment ernment ernmental public al public al public al public al public al public al public al public al public al public 

health agencies and other organizations in the public health system and f stem and for schools of public hools of public hools of public 

health that supply the public health infrastructure with its professionals and leaders.

Appendix C: Appendix C: Past Recommendations
220 

ormal national dialogue should be initiated to address the issu

credentialing

2 0

5. A formal national dialogue should be initiated to address the issue of public health w e of public health workforce 

credentialing. The Secret he Secretary of DHHS should appoint a national commission on public health y of DHHS should appoint a national commission on public health

workforce credentialing to lead this dialogue. orce credentialing to lead this dialogue. The commission should be c he commission should be charged to determine harged to determine 

if a credentialing system would further the goal of creating a competent workforce and, if applicable, the manner and time frame for implementation by governmental public health agencies at 

all levels. The dialogue should include representatives from federal, state, and local public health 

agencies, academia, and public health professional organizations who can represent and discuss 

the various perspectives on the workforce credentialing debate. 

6. All partners within the public health system should place special emphasis on communication as 

a critical core competency of public health practice. Governmental public health agencies at all 

levels should use existing and emerging tools (including information technologies) for effective 

management of public health information and for internal and external communication. To be 

effective, such communication must be culturally appropriate and suitable to the literacy levels of 

the individuals in the communities they serve. 

7. The Secretary of DHHS should provide leadership to facilitate the development and implementation of the National Health Information Infrastructure (NHII). Implementation of NHII should take 

into account, where possible, the findings and recommendations of the National Committee on 

Vital and Health Statistics (NCVHS) working group on NHII. Congress should consider options for 

funding the development and deployment of NHII (e.g., in support of clinical care, health information for the public, and public health practice and research) through payment changes, tax credits, 

subsidized loans, or grants. 

8. DHHS should be accountable for assessing the state of the nation’s governmental public health 

infrastructure and its capacity to provide the essential public health services to every community 

and for reporting that assessment annually to Congress and the nation. The assessment should 

include a thorough evaluation of federal, state, and local funding for the nation’s governmental 

public health infrastructure and should be conducted in collaboration with state and local officials. 

The assessment should identify strengths and gaps and serve as the basis for plans to develop 

a funding and technical assistance plan to assure sustainability. The public availability of these reports will enable state and local public health agencies to use them for continual self-assessment 

and evaluation. 

9. DHHS should evaluate the status of the nation’s public health laboratory system, including an 

assessment of the impact of recent increased funding. The evaluation should identify remaining 

gaps, and funding should be allocated to close them. Working with the states, DHHS should 

agree on a base funding level that will maintain the enhanced laboratory system and allow the 

rapid deployment of newly developed technologies. 

10. DHHS should develop a comprehensive investment plan for a strong national governmental 

public health infrastructure with a timetable, clear performance measures, and regular progress 

reports to the public. State and local governments should also provide adequate, consistent, and 

sustainable funding for the governmental public health infrastructure. 

11. The federal government and states should renew efforts to experiment with clustering or consolidation of categorical grants for the purpose of increasing local flexibility to address priority health 

concerns and enhance the efficient use of limited resources. 

12. The Secretary of DHHS should appoint a national commission to consider if an accreditation 

system would be useful for improving and building state and local public health agency capacities. If such a system is deemed useful, the commission should make recommendations on how 

it would be governed and develop mechanisms (e.g., incentives) to gain state and local government participation in the accreditation effort. Membership on this commission should include 

representatives from CDC, the Association of State and Territorial Health Officials, the National 

Association of County and City Health Officials, and nongovernmental organizations. 

Ending the Document Game 
Appendix C: Past Recommendations 

ation of plans to 

able 

ates. It is the responsibility of the 

ed without making comprehensive and affordable 

stem as appropriate. 

ould include realistic time lines, an 

 nal goal of instit

es should plan their in

y organizations and coalitions with technical assist

 at all phases of the process. 

221

13. CDC, in collaboration with the Council on Linkages between Academia and Public Health Practice 

and other public health system partners, should develop a research agenda and estimate the 

funding needed to build the evidence base that will guide policy making for public health practice. 

14. The Secretary of DHHS should review the regulatory authorities of DHHS agencies with healthrelated responsibilities to reduce overlap and inconsistencies, ensure that the department’s 

management structure is best suited to coordinate among agencies within DHHS with healthrelated responsibilities, and, to the extent possible, simplify relationships with state and local 

governmental public health agencies. Similar efforts should be made to improve coordination 

with other federal cabinet agencies performing important public health services, such as the 

Department of Agriculture and the Environmental Protection Agency. 

15. Congress should mandate the establishment of a National Public Health Council. This 

National Public Health Council would bring together the Secretary of DHHS and state health 

commissioners at least annually to 

1. Provide a forum for communication and collaboration on action to achieve national health 

goals as articulated in Healthy People 2010; 

2. Advise the Secretary of DHHS on public health issues; 

3. Advise the Secretary of DHHS on financing and regulations that affect governmental public 

health capacity at the state and local levels; 

4. Provide a forum for overseeing the development of an incentive-based federal–state-funded 

system to sustain a governmental public health infrastructure that can assure the availability 

of essential public health services to every American community and can monitor progress 

toward this goal (e.g., through report cards); 

5. Review and evaluate the domestic policies of other cabinet agencies for their impact on 

national health outcomes (e.g., through health impact reports) and on the reduction and 

elimination of health disparities; and 

6. Submit an annual report on their deliberations and recommendations to Congress. 

The Council should be chaired by the Secretary of DHHS and co-chaired by a state health director 

on a rotating basis. An appropriately resourced secretariat should be established in the Office of the 

Secretary to ensure that the Council has access to the information and expertise of all DHHS agencies 

during its deliberations. 

Community 

16. Local governmental public health agencies should support community-led efforts to inventory 

resources, assess needs, formulate collaborative responses, and evaluate outcomes for community health improvement and the elimination of health disparities. Governmental public health 

agencies should provide communit vide community organizations and coalitions with tec y organizations and coalitions with technical assist hnical assistance and ance and ance and 

support in identifying and securing resources as needed and at all phases of the process. at all phases of the process.

17. Government ernment ernmental and priv al and priv al and private-sector funders of communit ate-sector funders of communit ate-sector funders of community health initiativ y health initiativ y health initiatives should plan their in es should plan their investments with a focus on long-lasting change. Such a focus would include realistic time lines, an 

emphasis on ongoing community engagement and leadership, and a final goal of institutionalizing utionalizing 

effective project components in the local communit e project components in the local community or public health sy y or public health system as appropriate. stem as appropriate.

Health Care Delivery System 

18. Adequate population health cannot be ac dequate population health cannot be ac dequate population health cannot be ac dequate population health cannot be ac dequate population health cannot be ac dequate population health cannot be ac dequate population health cannot be ac dequate population health cannot be ac dequate population health cannot be achieved without making comprehensiv ed without making comprehensiv ed without making comprehensiv ed without making comprehensiv ed without making comprehensiv ed without making comprehensiv ed without making comprehensiv ed without making comprehensiv ed without making comprehensive and af e and af e and af e and af e and af e and af e and af e and af e and affordable ordable ordable ordable ordable ordable ordable ordable ordable 

health care a health care a health care available to e ailable to e ailable to e ailable to e ailable to every person residing in the United St y person residing in the United St y person residing in the United St y person residing in the United St y person residing in the United States. It is the responsibilit ates. It is the responsibilit ates. It is the responsibilit ates. It is the responsibility of the y of the y of the y of the 

federal go ederal go ederal go ederal go ederal go ederal go ederal government to lead a national ef ernment to lead a national ef ernment to lead a national ef ernment to lead a national ef ernment to lead a national ef ernment to lead a national ef ernment to lead a national effort to e ort to e ort to e ort to e ort to e ort to e ort to examine the options a xamine the options a xamine the options a xamine the options a xamine the options a xamine the options a xamine the options available to ac ailable to ac ailable to ac ailable to ac ailable to ac ailable to ac ailable to achieve stable 

health care coverage of individuals and families and to assure the implementation of plans to ation of plans to 

achieve that result. 

Appendix C: Appendix C: Past Recommendations
222 

All public and priv

as recommended b

2 2

19. All public and privately funded insurance plans should include age-appropriate pre ately funded insurance plans should include age-appropriate preventive services 

as recommended by the U y the U.S. Preventive Services Task Force and pro orce and provide evidence-based co vidence-based coverage of oral health, mental health, and substance abuse treatment services.

20. Bold, large-scale demonstrations should be funded by the federal government and other major 

investors in health care to test radical new approaches to increase the efficiency and effectiveness of health care financing and delivery systems. The experiments should effectively link 

delivery systems with other components of the public health system and focus on improving 

population health while eliminating disparities. The demonstrations should be supported by 

adequate resources to enable innovative ideas to be fairly tested. 

Businesses and Employers 

21. The federal government should develop programs to assist small employers and employers with 

low-wage workers to purchase health insurance at reasonable rates. 

22. The corporate community and public health agencies should initiate and enhance joint efforts to 

strengthen health promotion and disease and injury prevention programs for employees and their 

communities. As an early step, the corporate and governmental public health community should: 

a. Strengthen partnership and collaboration by: 

• developing direct linkages between local public health agencies and business leaders to 

forge a common language and understanding of employee and community health problems 

and to participate in setting community health goals and strategies for achieving them; and 

• developing innovative ways for the corporate and governmental public health communities 

to gather, interpret, and exchange mutually meaningful data and information, such as the 

translation of health information to support corporate health promotion and health care 

purchasing activities. 

b. Enhance communication by 

• developing effective employer and community communication and education programs 

focused on the benefits of and options for health promotion and disease and injury 

prevention; and 

• using proven marketing and social marketing techniques to promote individual behavioral 

and community change. 

c. Develop the evidence base for workplace and community interventions through greater public, 

private, and philanthropic investments in research to extend the science and improve the effectiveness of workplace and community interventions to promote health and prevent disease 

and injury. 

d. Recognize business leadership in employee and community health by elevating the level of 

recognition given to corporate investment in employee and community health. The Secretaries 

of DHHS and the Department of Commerce, along with business leaders (e.g., chambers of 

commerce and business roundtables), should jointly sponsor a Corporate Investment in Health 

Award. The award would recognize private-sector entities that have demonstrated exemplary 

civic and social responsibility for improving the health of their workers and the community. 

Media 

23. An ongoing dialogue should be maintained between medical and public health officials and 

editors and journalists at the local level and their representative associations nationally. Furthermore, foundations and governmental health agencies should provide opportunities to develop 

and evaluate educational and training programs that provide journalists with experiences that will 

Ending the Document Game 
Appendix C: Past Recommendations 

utions and organizations. 

lation- and communit -based 

.L. 98–551 as w

-initiated proposal 

er the more generous time lines often required b

223

deepen their knowledge of public health subject matter and provide public health workers with a 

foundation in communication theory, messaging, and application.

24. The television networks, television stations, and cable providers should increase the amount 

of time they donate to public service announcements (PSAs) as partial fulfillment of the public 

service requirement in their Federal Communications Commission (FCC) licensing agreements. 

25. The FCC should review its regulations for PSA broadcasting on television and radio to ensure 

a more balanced broadcasting schedule that will reach a greater proportion of the viewing and 

listening audiences. 

26. Public health officials and local and national entertainment media should work together to 

facilitate the communication of accurate information about disease and about medical and 

health issues in the entertainment media. 

27. Public health and communication researchers should develop an evidence base on media 

influences on health knowledge and behavior, as well as on the promotion of healthy 

public policy. 

Academia 

28. Academic institutions should increase integrated interdisciplinary learning opportunities for students in public health and other related health science professions. Such efforts should include 

not only multidisciplinary education but also interdisciplinary education and appropriate incentives 

for faculty to undertake such activities. 

29. Congress should increase funding for Health Resources and Services Administration (HRSA) 

programs that provide financial support for students enrolled in public health degree programs 

through mechanisms such as training grants, loan repayments, and service obligation grants. 

Funding should also be provided to strengthen the Public Health Training Center program to effectively meet the educational needs of the existing public health workforce and to facilitate public 

health worker access to the centers. Support for leadership training of state and local health department directors and local community leaders should continue through funding of the National 

and Regional Public Health Leadership Institutes and distance-learning materials developed by 

HRSA and the Centers for Disease Control and Prevention (CDC). 

30. Federal funders of research and academic institutions should recognize and reward faculty scholarship related to public health practice research. 

31. The committee recommends that Congress provide funds for CDC to enhance its investigator-initiated program for prevention research while maintaining a strong Centers, Institutes, and Offices 

(CIO)-generated research program. CDC should take steps that include: 

• expanding the external peer review mechanism for review of investigator-initiated research; 

• allowing researc wing researc wing researc wing researc wing research to be conducted o h to be conducted o h to be conducted o h to be conducted o h to be conducted over the more generous time lines of er the more generous time lines of er the more generous time lines of er the more generous time lines often required b ten required b ten required b ten required by

prevention research; and 

• establishing a central mec ablishing a central mec ablishing a central mechanism f hanism f hanism for coordination of in or coordination of in or coordination of investigator estigator estigator-initiated proposal -initiated proposal 

submissions.

32. CDC should authoriz CDC should authoriz CDC should authoriz CDC should authoriz CDC should authorize an analy e an analy e an analy e an analy e an analysis of the funding le sis of the funding le sis of the funding le sis of the funding le sis of the funding levels necessar els necessar els necessar els necessar els necessary for effective Prevention R ention R ention R ention R ention Research Center functioning h Center functioning h Center functioning, taking into account the le aking into account the le aking into account the levels authoriz els authoriz els authorized by P.L. 98–551 as w .L. 98–551 as well as the ell as the ell as the 

amount of prevention researc ention research occur h occurring in other instit ring in other institutions and organizations.

33. NIH should increase the portion of its budget allocated to popu NIH should increase the portion of its budget allocated to population- and communit lation- and community-based 

prevention research that: 

Appendix C: Appendix C: Past Recommendations
224 

addresses population-le

4

• addresses population-level health problems;

• involves a defi es a definable population and operates at the le nable population and operates at the level of the whole person; el of the whole person;

• evaluates the application and impacts of new discoveries on the actual health of the 

population; and 

• focuses on the behavioral and environmental (social, economic, cultural, physical) factors 

associated with primary and secondary prevention of disease and disability in populations. 

• furthermore, the committee recommends that the Director of NIH report annually to the 

Secretary of DHHS on the scope of population- and community-based prevention research 

activities undertaken by the NIH centers and institutes. 

34. Academic institutions should develop criteria for recognizing and rewarding faculty scholarship 

related to service activities that strengthen public health practice. 

From InformationTechnology for Counterterrorism: Immediate Actions and 

Future Possibilities (2003) 

Short-Term Recommendation 1: The nation should develop a program that focuses on the communications and computing needs of emergency responders. Such a program would have two essential 

components: 

• Ensuring that authoritative, current-knowledge expertise and support regarding IT are available to 

emergency-response agencies prior to and during emergencies, including terrorist attacks. 

• Upgrading the capabilities of the command, control, communications, and intelligence (C3I) systems of emergency-response agencies through the use of existing technologies. Such upgrades 

might include transitioning from analog to digital systems and deploying a separate emergencyresponse communications network in the aftermath of a disaster. 

Short-Term Recommendation 2: The nation should promote the use of best practices in information 

and network security in all relevant public agencies and private organizations. 

• For IT users on the operational level: Ensure that adequate information-security tools are 

available. Conduct frequent, unannounced red-team penetration testing of deployed systems. 

Promptly fix problems and vulnerabilities that are known. Mandate the use of strong authentication mechanisms. Use defense-in-depth in addition to perimeter defense. 

• For IT vendors: Develop tools to monitor systems automatically for consistency with defined secure configurations. Provide well-engineered schemes for user authentication based on hardware 

tokens. Conduct more rigorous testing of software and systems for security flaws. 

• For the federal government: Position critical federal information systems as models for good security practices. Remedy the failure of the market to account adequately for information security 

so that appropriate market pro-security mechanisms develop. 

Ending the Document Game 
Appendix C: Past Recommendations 

y f

or ensuring the qualit

or distributing 

y of 

y of Medicine should be designated as the responsible entit

elopment

ain a clearinghouse of inf

ormance testing f

225

From Patient Safety: Achieving a New Standard for Care (2004) 

RECOMMENDATIONS

Recommendation 1. Americans expect and deserve safe care. Improved information and data systems are needed to support efforts to make patient safety a standard of care in hospitals, in doctors’ 

offices, in nursing homes, and in every other health care setting. All health care organizations should 

establish comprehensive patient safety systems that: 

• Provide immediate access to complete patient information and decision support tools (e.g., 

alerts, reminders) for clinicians and their patients.

• Capture information on patient safety—including both adverse events and near misses—as a 

by-product of care, and use this information to design even safer care delivery systems.

Recommendation 2. A national health information infrastructure—a foundation of systems, technology, applications, standards, and policies—is required to make patient safety a standard of care. 

• The federal government should facilitate deployment of the national health information infrastructure through the provision of targeted financial support and the ongoing promulgation and 

maintenance of standards for data that support patient safety.

• Health care providers should invest in electronic health record systems that possess the key 

capabilities necessary to provide safe and effective care and to enable the continuous redesign 

of care processes to improve patient safety.

Recommendation 3. Congress should provide clear direction, enabling authority, and financial support 

for the establishment of national standards for data that support patient safety. Various government 

agencies will need to assume major new responsibilities, and additional support will be required. 

Specifically: 

• The Department of Health and Human Services (DHHS) should be given the lead role in establishing and maintaining a public–private partnership for the promulgation of standards for data 

that support patient safety.

• The Consolidated Health Informatics (CHI) initiative, in collaboration with the National Committee 

on Vital and Health Statistics (NCVHS), should identify data standards appropriate for national 

adoption and gaps in existing standards that need to be addressed. The membership of NCVHS 

should continue to be broad and diverse, with adequate representation of all stakeholders, 

including consumers, state governments, professional groups, and standards-setting bodies.

• The Agency for Healthcare Research and Quality (AHRQ) in collaboration with the National Library 

of Medicine and others should

(1) provide administrative and technical support for the CHI and NCVHS efforts; (2) ensure the 

development of implement elopment of implement elopment of implementation guides, certifi ation guides, certifi ation guides, certification procedures, and conf cation procedures, and conf cation procedures, and conformance testing f ormance testing for all 

data standards; (3) pro andards; (3) pro andards; (3) pro andards; (3) pro andards; (3) pro andards; (3) provide financial support and o nancial support and o nancial support and o nancial support and o nancial support and o nancial support and oversight f ersight f ersight f ersight f ersight f ersight for development elopment elopment elopment elopmental activities to fi al activities to fi al activities to fi al activities to fi al activities to fi al activities to fi ll gaps ll gaps ll gaps ll gaps ll gaps ll gaps 

in data standards; and (4) coordinate activities and maint andards; and (4) coordinate activities and maintain a clearinghouse of information in sup- ormation in support of national dat port of national data standards and their implement andards and their implementation to impro ation to improve patient saf e patient safety.

• The National Librar he National Library of Medicine should be designated as the responsible entit y of Medicine should be designated as the responsible entity for distributing or distributing or distributing 

all national clinical terminologies that relate to patient safety and for ensuring the quality of 

terminology mappings.

Appendix C: Appendix C: Past Recommendations
v

v

226

Recommendation 4

6

Recommendation 4. The lack of comprehensive standards for data to support patient safety impedes 

private-sector in ate-sector inv estment in inf estment in information tec ormation technology and other ef hnology and other efforts to impro orts to improve patient saf e patient safety.

The federal go ederal gov ernment should accelerate the adoption of st ernment should accelerate the adoption of standards f andards for such data by pursuing the y pursuing the

following efforts: 

• Clinical data interchange standards. The federal government should set an aggressive agenda 

for the establishment of standards for the interchange of clinical data to support patient safety. 

Federal financial support should be provided to accomplish this agenda. 

° After ample time for provider compliance, federal government health care programs should 

incorporate into their contractual and regulatory requirements standards already approved 

by the secretaries of DHHS, the Veterans Administration, and the Department of Defense 

(i.e., the HL7 version 2.x series for clinical data messaging, DICOM for medical imaging, 

IEEE 1073 for medical devices, LOINC for laboratory test results, and NCPDP Script for 

prescription data). 

° AHRQ should provide support for (1) accelerated completion (within 2 years) of HL7 

version 3.0; (2) specifications for the HL7 Clinical Document Architecture and implementation guides; and (3) analysis of alternative methods for addressing the need to support 

patient safety by instituting a unique health identifier for individuals, such as implementation 

of a voluntary unique health identifier program. 

• Clinical terminologies. The federal government should move expeditiously to identify a core set 

of well-integrated, nonredundant clinical terminologies for clinical care, quality improvement, and 

patient safety reporting. Revisions, extensions, and additions to the codes should be compatible 

with, yet go beyond, the federal government’s initiative to integrate all federal reporting systems. 

° AHRQ should undertake a study of the core terminologies, supplemental terminologies, 

and standards mandated by the Health Insurance Portability and Accountability Act to 

identify areas of overlap and gaps in the terminologies to address patient safety requirements. The study should begin by convening domain experts to develop a process for 

ensuring comprehensive coverage of the terminologies for the 20 IOM priority areas. 

° The National Library of Medicine should provide support for the accelerated completion of 

RxNORM for clinical drugs. The National Library of Medicine also should develop high-quality mappings among the core terminologies and supplemental terminologies identified by 

the CHI and NCVHS. 

• Knowledge representation. The federal government should provide support for the accelerated 

development of knowledge representation standards to facilitate effective use of decision 

support in clinical information systems. 

° The National Library of Medicine should provide support for the development of standards 

for evidence-based knowledge representation. 

° AHRQ, in collaboration with the National Institutes of Health, the Food and Drug Administration, and other agencies, should provide support for the development of a generic guideline 

representation model for use in representing clinical guidelines in a computer-executable 

format that can be employed in decision support tools. 

Recommendation 5. All healthcare settings should establish comprehensive patient safety programs 

operated by trained personnel within a culture of safety. These programs should encompass (1) case 

finding—identifying system failures, (2) analysis—understanding the factors that contribute to system 

failures, and (3) system redesign—making improvements in care processes to prevent errors in the 

future. Patient safety programs should invite the participation of patients and their families and be 

responsive to their inquiries. 

Ending the Document Game 
Appendix C: Past Recommendations 

ents, and (3) patient 

 cation Model—Medical 

actors associated with near

ersion for 

or determining prospectiv

227

Recommendation 6. The federal government should pursue a robust applied research agenda on 

patient safety, focused on enhancing knowledge, developing tools, and disseminating results to 

maximize the impact of patient safety systems. AHRQ should play a lead role in coordinating this 

research agenda among federal agencies (e.g., the National Library of Medicine) and the private sector. 

The research agenda should include the following: 

• Knowledge generation 

° High-risk patients—Identify patients at risk for medication errors, nosocomial infections, 

falls, and other high-risk events. 

° Near-miss incidents—Test the causal continuum assumption (that near misses and adverse 

events are causally related), develop and test a recovery taxonomy, and extend the current 

individual human error/recovery models to team-based errors and recoveries. 

° Hazard analysis—Assess the validity and efficiency of integrating retrospective techniques 

(e.g., incident analysis) with prospective techniques. 

° High-yield activities—Study the cost/benefit of various approaches to patient safety, 

including analysis of reporting systems for near misses and adverse events.

° Patient roles—Study the role of patients in the prevention, early detection, and mitigation of 

harm due to errors. 

• Tool development 

° Early detection capabilities—Develop and evaluate various methods for employing datadriven triggers to detect adverse drug events, nosocomial infections, and other high-risk 

events (e.g., patient falls, decubitus ulcers, complications of blood product transfusions). 

° Prevention capabilities—Develop and evaluate point-of-care decision support to prevent 

errors of omission or commission. 

° Data mining techniques—Identify and develop data mining techniques to enhance learning 

from regional and national patient safety databases. Apply natural language processing 

techniques to facilitate the extraction of patient safety–related concepts from text 

documents and incident reports. 

• Dissemination—Deploy knowledge and tools to clinicians and patients. 

Recommendation 7. AHRQ should develop an event taxonomy and common report format for 

submission of data to the national patient safety database. Specifically: 

• The event taxonomy should address near misses and adverse events, cover errors of both 

omission and commission, allow for the designation of primary and secondary event types for 

cases in which more than one factor precipitated the adverse event, and be incorporated into 

SNOMED CT.

• The standardized report format should include the following: 

° A standardized minimum set of data elements. 

° Data necessar a necessary to calculate a risk assessment inde y to calculate a risk assessment index for determining prospectively the ely the 

probability of an event and its severity.

° A free-text narrative of the event. 

° Data necessar a necessar a necessar a necessar a necessar a necessar a necessary to support use of the Eindho y to support use of the Eindho y to support use of the Eindho y to support use of the Eindho y to support use of the Eindho y to support use of the Eindho y to support use of the Eindhoven Classifi en Classifi en Classifi en Classifi en Classifi en Classifi en Classification Model—Medical cation Model—Medical cation Model—Medical cation Model—Medical cation Model—Medical cation Model—Medical Version f ersion f ersion f ersion f ersion f ersion for 

classifying root causes, including e classifying root causes, including e classifying root causes, including expansions f xpansions f xpansions f xpansions f xpansions for (1) reco or (1) reco or (1) reco or (1) reco or (1) recovery factors associated with near actors associated with near actors associated with near actors associated with nearmiss events, (2) cor ents, (2) cor ents, (2) cor ents, (2) cor ents, (2) corrective actions t e actions t e actions t e actions t e actions taken to reco en to reco en to reco en to reco en to recover from adv er from adv er from adv er from adv er from adverse events, and (3) patient ents, and (3) patient ents, and (3) patient ents, and (3) patient 

outcome/functional status as a result of those corrective actions. 

Appendix C: Appendix C: Past Recommendations
228 

A free-te

8

° A free-text section for lessons learned as a result of the event.

° Clinical documentation of the patient context.

• The taxonomy and report format should be used by the federal reporting system integration 

project in the areas for basic domain, event type, risk assessment, and causal analysis but should 

provide for more extensive support for patient safety research and analysis (Department of 

Health and Human Services, 2002c). 

From Letter to HHS Secretary Tommy G.Thompson from John R. Lumpkin, Chairman, 

National Committee on Vital and Health Statistics: First Set of Recommendations 

on E-Prescribing Standards (2004) 

RECOMMENDED ACTIONS:

Recommended Action 1.1: HHS should ensure that e-prescribing standards are not only 

appropriate for Medicare Part D but also for all types of prescribers, dispensers, and public and 

private sector payers. 

Recommended Action 1.2: HHS should ensure that e-prescribing standards are compatible with 

those adopted as HIPAA and CHI standards, and with those recommended in November 2003 by 

NCVHS for clinical data terminologies. 

Recommended Action 2.1: HHS should work with the industry in its rulemaking process to determine 

how best to afford flexibility in keeping standards in pace with the industry, including standards for 

HIPAA and e-prescribing. For example, HHS might consider recognizing new versions of standards, 

without a separate regulation, if they are backward compatible. 

Recommended Action 3.1: HHS should recognize as a foundation standard the most current version 

of NCDPDP SCRIPT for new prescriptions, prescription renewals, cancellations, and changes between 

prescribers and dispensers. The National Council for Prescription Drug Programs (NCPDP) SCRIPT 

Standard would include its present code sets and various mailbox and acknowledgement functions, as 

applicable. 

Recommended Action 3.2: HHS should include the fill status notification function of the NCPDP 

SCRIPT Standard in the 2006 pilot tests. These pilot tests should assess the business value and clinical 

utility of the fill status notification function, as well as evaluate privacy issues and possible mitigation 

strategies. 

Recommended Action 4.1: HHS should financially support the acceleration of coordination activities 

between Health Level 7 (HL7) and NCPDP for electronic medication ordering and prescribing. HHS 

should also support ongoing maintenance of the HL7 and NCPDP SCRIPT coordination. 

Recommended Action 4.2: HHS should recognize the exchange of new prescriptions, renewals, 

cancellations, changes, and fill status notification within the same enterprise [[delete bracketed number?]][10] as outside the scope of MMA e-prescribing standard specifications. 

Recommended Action 4.3: HHS should require that any prescriber that uses an HL7 message within 

an enterprise convert it to NCPDP SCRIPT if the message is being transmitted to a dispenser outside 

of the enterprise. HHS also should require that any retail pharmacy within an enterprise be able to 

receive prescription transmittals via NCPDP SCRIPT from outside the enterprise. 

Recommended Action 5.1: HHS should actively participate in and support the rapid development of 

an NCPDP standard for formulary and benefit information file transfer, using the RxHub protocol as 

a basis. 

Ending the Document Game 
Appendix C: Past Recommendations 

his translation will require the participation of intermediary drug knowledge 

stem that represents 

hanges. RxNorm is being included in 

, strength, and dosage inf

06 pilot tests the RxNorm terminology in the 

andard and/or readiness f

229

Recommended Action 5.2: NCVHS will closely monitor the progress of NCPDP’s developing a standard for a formulary and benefit information file transfer protocol, and provide advice to the Secretary 

in time for adoption as a foundation standard and/or readiness for the 2006 pilot tests. 

Recommended Action 6.1: HHS should recognize the ASC X12N 270/271 Health Care Eligibility Inquiry and Response Standard Version 004010X092A1 as a foundation standard for conducting eligibility 

inquiries from prescribers to payers/PBMs. 

Recommended Action 6.2: HHS should support NCPDP’s efforts to create a guidance document to 

map the pharmacy information on the Medicare Part D Pharmacy ID Card to the appropriate fields on 

the ASC X12N 270/271 in further support of its use in e-prescribing. 

Recommended Action 6.3: HHS should work with ASC X12 to determine if there are any requirements under MMA with respect to how situational data elements are used in the ASC X12N 270/271, 

especially concerning the quality of information needed for real-time drug benefits. Use of these 

situational data elements could be addressed in trading partner agreements. Specifications of use 

of situational data elements, as well as proper usage of the functional acknowledgments, should be 

included in the 2006 pilot tests. 

Recommended Action 6.4: HHS should ensure that the functionality of the ASC X12N 270/271, as 

adopted under HIPAA, keeps pace with requirements for e-prescribing and that new versions to the 

Standard be pilot tested. 

Recommended Action 7.1: HHS should support ASC X12 in their efforts to incorporate functionality 

for real-time prior authorization messages for drugs in the ASC X12N 278 Health Care Services Review 

Standard Version 004010X094A1for use between the prescriber and payer/PBM. 

Recommended Action 7.2: HHS should support standards development organizations and other 

industry participants in developing prior authorization work flow scenarios to contribute to the design 

of the 2006 pilot tests. 

Recommended Action 7.3: HHS should evaluate the economic and quality of care impacts of automating prior authorization communications between dispensers and prescribers and between payers 

and prescribers in its 2006 pilot tests. 

Recommended Action 7.4: HHS should ensure that the functionality of the ASC X12N 278, as 

adopted under HIPAA, keeps pace with requirements for e-prescribing and that new versions to the 

Standard be pilot tested. 

Recommended Action 8.1: HHS should actively participate in and support rapid development of 

an NCPDP standard for a medication history message for communication from a payer/PBM to a 

prescriber, using the RxHub protocol as a basis. 

Recommended Action 8.2: NCVHS will closely monitor the progress of NCPDP’s developing a standard medication history message for communication from a payer/PBM to a prescriber, and provide 

advice to the Secret advice to the Secretary in time f y in time f y in time for adoption as a f or adoption as a f or adoption as a foundation st oundation st oundation standard and/or readiness f andard and/or readiness for the 20 or the 20 or the 2006 

pilot tests. 

Recommended Action 9.1: HHS should include in the 2006 pilot tests the RxNorm terminology in the 06 pilot tests the RxNorm terminology in the 

NCPDP SCRIPT St NCPDP SCRIPT Standard f andard for new prescriptions, rene w prescriptions, renewals, and c als, and changes. RxNorm is being included in 

the 2006 pilot tests to determine ho 06 pilot tests to determine how well the RxNorm clinical dr ell the RxNorm clinical drug, strength, and dosage information ormation 

can be translated from the prescriber can be translated from the prescriber’s system into an NDC at the dispenser stem into an NDC at the dispenser stem into an NDC at the dispenser’s system that represents stem that represents 

the prescriber the prescriber the prescriber the prescriber the prescriber’s intent. s intent. s intent. s intent. s intent. s intent. s intent. s intent. s intent. s intent. This translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediar his translation will require the participation of intermediary drug knowledge 

base vendors until the RxNorm is fully mapped. 

Appendix C: Appendix C: Past Recommendations
230 

ug Code (NDC) with RxNorm (e.g

0

Recommended Action 9.2: HHS should accelerate the promulgation of the Food & Drug 

Administration dministration’s (FDA) Drug Listing r ug Listing rule and hence the abilit ule and hence the ability to support the cor y to support the correlation of National relation of National 

Drug Code (NDC) with RxNorm (e.g., for passing daily updates of the SPL to NLM for inclusion in the or inclusion in the 

DailyMed). Timely rulemaking is critical to sustain the daily use of RxNorm beyond the 2006 pilot tests. 

Recommended Action 9.3: HHS should ensure that, if the Medicare Part D Model Guidelines and 

NDF-RT differ, an accurate mapping exists so they both can be used successfully. 

Recommended Action 10.1: HHS should support NCPDP, HL7, and others (especially including 

the prescriber community) in addressing SIG components in their standards. This should include preserving the ability to incorporate free text whenever necessary (e.g., for complex dosing instructions, 

and to address special cultural sensitivities, language, and literacy requirements). 

Recommended Action 10.2: HHS should include in the 2006 pilot tests the structured and codified 

SIGs as developed through standards development organization efforts. 

Recommended Action 11.1: HHS should ensure that the NPI, when it becomes available, is incorporated as the primary identifier for dispensers in the NCPDP SCRIPT and other e-prescribing standards. 

Recommended Action 11.2: HHS should accelerate the enumeration of all dispensers to support 

transition to the NPI for e-prescribing. 

Recommended Action 11.3: HHS should permit the industry to use the NCPDP Provider Identifier 

Number in the event that the NPS cannot enumerate dispensers in time for Medicare Part D 

implementation. 

Recommended Action 11.4: HHS should evaluate how mass enumeration of dispensers for the NPI 

can occur using the NCPDP Provider Identifier Number database. 

Recommended Action 11.5: HHS, when requiring the NPI as the primary identifier for dispensers, 

should protect the ability to maintain linkages to the NCPDP Provider Identifier Number database for 

current claims processing purposes. 

Recommended Action 12.1: HHS should ensure that the NPI, when it becomes available, is incorporated as the primary identifier for prescribers in the NCPDP SCRIPT and other e-prescribing standards. 

It should be noted that the NPI must be at the individual prescriber level, because a prescription 

cannot be written at a group level. 

Recommended Action 12.2: HHS should accelerate the enumeration of all prescribers to support 

transition to the NPI for e-prescribing. 

Recommended Action 12.3: HHS should permit the industry to use the NCPDP HCIdea in the event 

that the NPS cannot enumerate prescribers in time for Medicare Part D implementation. 

Recommended Action 12.4: HHS should work with the industry to identify issues and possible 

solutions that deal with all elements of the prescriber location and include those solutions in the 2006 

pilot tests. 

Recommended Action 12.5: HHS should evaluate how mass enumeration of prescribers for the NPI 

can occur using the NCPDP HCIdea database. 

Recommended Action 12.6: HHS, when requiring the NPI as the primary identifier for prescribers, 

should protect the ability to maintain linkages to the NCPDP HCIdea database for e-prescribing routing 

functions. 

Recommended Action 13:1: HHS should support the efforts of standards development organizations 

to incorporate in the foundation standards as many as possible of the additional functions required for 

MMA, as identified in these recommendations. 

Ending the Document Game 
Appendix C: Past Recommendations 

ss DEA needs for adequate securit

ances, without seriously impairing the growth of e-prescribing in 

ork together to reconcile 

y be needed f

Appendix 

y to use their prof

or securing electronic prescriptions. 

231

Recommended Action 13.2: HHS should include foundation standards with as many as possible of 

the additional functions required for MMA in the 2006 pilot tests. 

Recommended Action 13.3: HHS should immediately begin to work with the vendors to ensure readiness for the pilot tests on January 1, 2006. 

Recommended Action 13.4: HHS should identify and widely publicize specific goals, objectives, 

timelines, and metrics to guide the design and assessment and increase industry awareness of the 

2006 pilot tests. HHS should include metrics that address economic, quality of care, patient safety, 

and patient and prescriber satisfaction factors. 

Recommended Action 13.5: After the pilot tests, HHS should develop and widely disseminate information concerning any economic and quality of care benefits of e-prescribing, provide comprehensive 

education on implementation strategies, describe how e-prescribing can be implemented consistent 

with the privacy protections under HIPAA, and address other elements that contribute to successful 

and widespread prescriber adoption and patient acceptance. 

Recommended Action 14.1: HHS should financially support standards coordination activities to 

ensure a seamless e-prescribing process across provider domains (e.g., physician office, hospital, long 

term care), dispensers, and payers/PBMs. 

Recommended Action 14.2: HHS should encourage standards development organizations to adopt 

a change management process that permits versions to maintain interoperability. 

Recommended Action 15.1: HHS should ensure that regulations define the parameters of safe harbor, ensure preservation of provider/patient choice, and require that e-prescribing messages received 

through e-prescribing applications be free from commercial bias. 

Recommended Action 16.1: HHS should support standards development organizations in their 

development of conformance tests for the e-prescribing standards and their implementation guides. 

Recommended Action 16.2: HHS should require that e-prescribing system vendors validate the conformance of their e-prescribing messages. 

Recommended Action 16.3: The HHS Office of the National Coordinator for Health Information 

Technology should investigate how e-prescribing applications might best be certified. 

From: Letter to HHS Secretary Mike Leavitt from Simon P. Cohn, Chairman,

National Committee on Vital and Health Statistics: Second Set of Recommendations 

on E-Prescribing Standards (2005)

Recommended Action 1.1: HHS, Drug Enforcement Administration (DEA), and state boards of 

pharmacy should recognize the current e-prescribing network practices that are in compliance with 

HIPAA security and authentication requirements as a basis for securing electronic prescriptions. or securing electronic prescriptions. 

These securit hese securit hese securit hese securit hese security practices are discussed in the bac y practices are discussed in the bac y practices are discussed in the bac y practices are discussed in the bac y practices are discussed in the bac y practices are discussed in the background and illustrated in ground and illustrated in ground and illustrated in ground and illustrated in ground and illustrated in ground and illustrated in Appendix Appendix Appendix Appendix Appendix A. In addition, In addition, In addition, In addition, In addition, In addition, 

these practices are applied in conjunction with the dispensers’ responsibility to use their professional essional 

judgment in determining the v judgment in determining the validity of prescriptions. y of prescriptions. y of prescriptions. Different requirements ma erent requirements ma erent requirements may be needed f y be needed for 

transmission of electronic prescriptions that do not go through such networks. 

Recommended Action 1.2: HHS and Department of Justice (DOJ) should work together to reconcile ork together to reconcile 

different agency mission requirements in a manner that will addre erent agency mission requirements in a manner that will addre erent agency mission requirements in a manner that will address DEA needs f ss DEA needs f ss DEA needs for adequate securit or adequate securit or adequate security 

of prescriptions for all controlled subst or all controlled substances, without seriously impairing the gro ances, without seriously impairing the growth of e-prescribing in wth of e-prescribing in wth of e-prescribing in 

support of patient safety as mandated by MMA. 

Appendix C: Appendix C: Past Recommendations
232 

ure, and PKI f

2

Recommended Action 2.1: HHS should evaluate emerging technologies such as biometrics, digital 

signature, and PKI for higher assurance authentication, message integrity, and non-repudiation in a , and non-repudiation in a 

researc research agenda f h agenda for e-prescribing and all other aspects of health inf or e-prescribing and all other aspects of health information tec ormation technology hnology.

Recommendations Relative to Progress on NCVHS Recommendations from the 

September 2, 2004 Letter:

Recommended Action 3.1: NCVHS will continue to monitor the progress of the development of the 

NCPDP Formulary and Benefit Coverage Message Standard and will report any further recommendations to HHS based upon this progress. 

Recommended Action 4.1: NCVHS will continue to monitor the progress of the development of the 

NCPDP Medication History Message Standards and will report any further recommendations to HHS 

based upon this progress. 

Recommended Action 5.1: HHS should include the fill status notification function of the NCPDP 

SCRIPT Standard in the 2006 pilot tests, consistent with NCVHS recommendations of 

September 2, 2004. 

Recommended Action 6.1: HHS should include evaluation of structured and codified SIGs in the 2006 

pilot tests, consistent with NCVHS recommendations of September 2, 2004. 

Recommended Action 7.1: HHS should include evaluation of RxNorm in the e-prescribing pilots. 

The pilots should evaluate the use of RxNorm codes as the primary identifiers of orderable drugs in 

prescription messages. This would assess how well the RxNorm codes capture the intent of the 

prescriber and whether a dispenser can accurately fill the prescription based on the Rxnorm code. 

RxNorm should also be evaluated for use where a proprietary code is used for the orderable drug and 

the RxNorm code is included in the message to provide interoperability with other proprietary coding 

systems from drug knowledge bases. 

Recommended Action 7.2: HHS should take immediate steps to accelerate the promulgation and 

implementation of FDA’s Drug Listing Rule in order to make the inclusion of RxNorm in the 2006 pilot 

tests as comprehensive as possible. Delayed promulgation may jeopardize the success of the 2006 

pilot tests. This is also necessary to achieve the patient safety objectives of MMA. 

Recommended Action 8.1: HHS should support the standards development organizations (NCPDP, 

HL7, and ASC X12) in their efforts to incorporate functionality for real-time prior authorization messages 

for medications in the ASC X12N 278 Health Care Services Review Standard and ASC X12N 275 

Claims Attachment Standard. 

Recommended Action 8.2: HHS should include the evaluation of the interaction of standards related 

to the flow of prior authorization in the 2006 e-prescribing pilot tests. 

Recommended Action 9.1: HHS should recognize the exchange of prescription messages within the 

same enterprise as outside the scope of MMA e-prescribing standard specifications. 

Recommended Action 9.2: HHS should require that any prescriber that uses an HL7 message within 

an enterprise convert it to NCPDP SCRIPT if the message is being transmitted to a dispenser outside 

of the enterprise. HHS also should require that any retail pharmacy within an enterprise be able to 

receive prescription transmittals via NCPDP SCRIPT from outside the enterprise. 

Recommended Action 9.3: HHS should financially support the acceleration of coordination activities 

between HL7 and NCPDP for electronic medication ordering and prescribing. HHS should also support ongoing maintenance of the HL7 and NCPDP SCRIPT coordination. 

Ending the Document Game 
.

Appendix C: Past Recommendations 

, 

ormation and communications tec

n

hnology 

o c

essionals and consumers, including access to 

ance with on-line applications, suc

233

Recommended Action 10.1: HHS should identify and evaluate any privacy issues (within the context 

of the HIPAA Privacy Rule and health records laws) that arise during the 2006 pilot tests of e-prescribing. 

Special attention should be placed on issues regarding individuals’ rights to request restrictions on 

access to their prescription records. 

Recommended Action 10.2: HHS should use experience gained from the e-prescribing pilot tests to 

develop appropriate actions for handling privacy issues. 

From QualityThrough Collaboration:The Future of Rural Health (2005) 

RECOMMENDATIONS

1. Congress should provide appropriate direction and financial resources to assist rural providers in 

converting to electronic health records over the next 5 years. Working collaboratively with the 

Office of the National Coordinator for Health Information Technology: 

• The Indian Health Service should develop a strategy for transitioning all of its provider sites 

(including those operated by tribal governments under the Self-Determination Act) from 

paper to electronic health records. 

• The Health Resources and Services Administration should develop a strategy for 

transitioning community health centers, rural health clinics, critical access hospitals, 

and other rural providers from paper to electronic health records. 

• The Centers for Medicare and Medicaid Services and the state governments should 

consider providing financial rewards to providers participating in Medicare or Medicaid 

programs that invest in electronic health records. These two large public insurance programs should work together to re-examine their benefit and payment programs to ensure 

appropriate coverage of telehealth and other health services delivered electronically. 

2. The Agency for Healthcare Research and Quality’s Health Information Technology Program 

should be expanded. Adequate resources should be provided to allow the agency to sponsor 

developmental programs for information and communications technology in five rural areas. 

Communities should be selected from across the range of rural environments, including frontier 

areas. The 5-year developmental programs should commence in fiscal year 2006 and result in 

the establishment of state-of-the-art information and communications technology infrastructure 

that is accessible to all providers and all consumers in those communities. 

3. The National Library of Medicine, in collaboration with the Office of the National Coordinator 

for Health Information Technology and the Agency for Healthcare Research and Quality, should 

establish regional information and communications technology/telehealth resource centers that 

are interconnected with the National Network of Libraries of Medicine. These resource centers 

should provide a full spectrum of services, including the following: 

•Information resources f ormation resources for health prof or health professionals and consumers, including access to essionals and consumers, including access to 

on-line information sources and technical assistance with on-line applications, such as 

distance monitoring. 

• Lifelong educational programs for health care professionals. 

• Anon-callresourcecentertoassistcommunitiesinresolvingtechnical, organizational,clinical, 

financial, and legal questions related to inf nancial, and legal questions related to information and communications tec ormation and communications technology hnology. 

Appendix C: Appendix C: Past Recommendations
234 

Summary of Nation

4

Summary of Nationwide Health Inf wide Health Information Netw mation Network (NHIN) Request f k (NHIN) Request for Information 

(RFI) Responses (2005) 

RECOMMENDATIONS

Drawn from the respondents’ unique perspectives, the comments offered a wide range of thoughtful 

suggestions. Among the many opinions expressed, the following concepts emerged from the majority 

of RFI respondents: 

• A NHIN should be a decentralized architecture built using the Internet linked by uniform 

communications and a software framework of open standards and policies.

• A NHIN should reflect the interests of all stakeholders and be a joint public/private effort. 

• A governance entity composed of public and private stakeholders should oversee the 

determination of standards and policies.

• A NHIN should be patient-centric with sufficient safeguards to protect the privacy of personal 

health information. 

• Incentives will be needed to accelerate deployment and adoption of a NHIN. 

• Existing technologies, federal leadership, prototype regional exchange efforts, and certification 

of EHRs will be the critical enablers of a NHIN. 

• Key challenges will be the need for additional and better-refined standards; addressing privacy 

concerns; paying for the development and operation of, and access to the NHIN; accurately 

matching patients; and addressing discordant inter- and intra-state laws regarding health 

information exchange. 

Health Information Technology (HIT) Leadership Panel Final Report (2005) 

RECOMMENDATIONS

The HIT Leadership Panel identified three key imperatives for HIT: 

1. Widespread adoption of interoperable HIT should be a top priority for the U.S. health 

care system.

2. The federal government should use its leverage as the nation’s largest health care payer and 

provider to drive adoption of HIT.

3. Private sector purchasers and health care organizations can and should collaborate alongside the 

federal government to drive adoption of HIT. 

Rather than attempting to implement HIT all at once through a “big bang,” implementation should 

occur through a well-planned sequence of steps and incentives to promote widespread HIT adoption. 

Both carrots (i.e., incentives) and, when necessary, sticks (i.e., mandates, other requirements) should 

be used to promote the widespread adoption of HIT. 

Ending the Document Game 
Appendix C: 

235

The HIT Leadership Panel also suggested that mechanisms be created to incentivize or otherwise 

assist providers to install HIT and reengineer health care processes to take full advantage of its 

potential benefits. 

The national HIT vision must be communicated clearly and directly to enlist consumer support for 

the widespread adoption of HIT, including the necessary investment to achieve this vision. This vision 

should convey how the American consumer has the most to gain from adoption of HIT, including more 

safe and effective health care in a more efficient, personalized, and secure system. 

The federal government and other HIT proponents must specifically address the protections to privacy 

and confidentiality afforded by the Health Insurance Portability and Accountability Act (HIPAA) and 

continue to promote and enforce related standards and safeguards accordingly. 

The federal government should monitor progress and impact of widespread HIT adoption to ensure 

that no population group is left out or disadvantaged by this transition in HIT. 

Appendix C: Appendix C: Past Recommendations
236 

Ending the Document Game 
Appendix D: 

237

Appendix D

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Appendix D: Appendix D: Bibliography
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Ending the Document Game 
243

Appendix E

Index 

Appendix E: Appendix E: Index
244 

INDEX

A

Access issues

broadband access, 93

connectivity and individual access to information, 98

consumers, 45, 47, 50

interoperability and, 5, 6, 32

lab results, 78

paper-based system and, 22

personal data access, 61–62

specific communities and, 63–66

Administrative issues

connectivity and, 82–84

costs to physicians, 82

Adoption

connectivity and, 86–95

focus of, 1

incentives for, 2

public awareness campaign for, 3, 4

recommendations, 2–4

regulatory reform and, 2

reporting gaps in, 2–3

statistics, 87

timeline, 94

workforce needs and impacts, 3, 4

Adult caregivers

interoperability benefits, 13, 31

long-distance caregivers, 52

paper-based system and, 21

Affordable Health Care Act, 109

Agency for Healthcare Research and Quality

contact information, 115–117 

AHIC. See American Health Information Community 

AHRQ. See Agency for Healthcare Research and Quality 

Alaskan Natives 

healthcare issues, 65

American Health Information Community, 5, 89

contact information, 115

American Indians

healthcare issues, 65

Ameritrade

data theft, 59

Annals of Family Medicine 

medical errors article, 67

Anti-kickback law

provisions, 24

safe harbors and, 25

sanctions for violations, 24–25

B

Barmakian, Joseph, 59

Bioterrorism

interoperability and, 9, 30

paper-based system and, 9, 23

Brailer, Dr. David, 14

Bush, Pres. George

broadband access, 93

C

caBIGTM. See Cancer Biomedical Informatics GridTM

Canada

interoperability, 29

Cancer Biomedical Informatics GridTM

contact information, 118–119

CardSystems Solutions Inc.

data theft, 59

CareGroup, 41, 83

Center for Information Technology Leadership

e-prescribing, 70

medical errors, 67

Centers for Medicare and Medicaid Services

adoption guidance, 2

contact information, 117–118

ChoicePoint

data theft, 59, 60

Chronic conditions

community health centers and, 63–64

connectivity benefits, 80–81, 85

interoperability and, 32–33

monitoring, 54

paper-based system and, 23

Chronic Disease Management Program, 125

CMS. See Centers for Medicare and Medicaid Services

Collins, Sen. Susan M., 112–113

Commission on Systemic Interoperability

authorization for, 40

Commonwealth Fund

continuity of care survey, 53

Ending the Document Game 
y

e information,

 to a high-quality system of healthcar

 51

245

Community health centers 

chronic diseases and, 63–64, 124

Compliance monitoring, 54

Computerized Patient Record System, 127

Confidentiality. See also Privacy; Security

connectivity and, 1

consumers and, 56–62

doctor-patient relationship and, 62

paper-based system and, 12, 21–22

patient consent, 96–97

The Connecting the Operations of National Networks 

of Emergency Communications 

Technologies for First Responders Act of 2005, 111

Connectivity. See also Interoperability

administrative efficiencies, 82–84

adoption and implementation, 86–95

barriers to, 23–24

benefits, 77–86, 99

broadband access and, 93

cell phone technology parallel, 45

challenges of implementation, 94

chronic conditions and, 80–81

consumers and, 7, 23

costs and benefits, 24, 95

criminal sanctions for privacy violations, 7, 9

data elements, 91

doctor-to-doctor communication, 78

e-prescribing and, 81

emergency rooms and, 79

example, 74–76

existing efforts, 101–127

federal privacy standard, 7

financial barriers, 88

focus of, 1

geographic location and, 78

gradually phasing in, 86

individual access to information, 98

information sharing and, 12, 20–21

lab result access, 78

lack of standards and, 24

legacy systems and, 93–94

nationwide health information network, 7

patient authentication standard, 7, 8

patient communication and, 84–85

pay-for-performance and, 95

privacy and confidentiality and, 12 

product certification, 89–90 

public health and security, 85–86 

quality of care and, 78–81 

recommendations, 7–9 

security, 97–98 

standards, 90–91 

treatment setting and, 78

United States compared with other 

countries, 26–28 

Consumers 

access issues, 45, 47, 48, 50

care improvement, 51–52 

community health centers, 63–64 

compliance monitoring, 54

confidentiality, privacy, and security issues, 56–62 

continuity of care and, 53

convenience of interoperability, 50–52 

data theft and, 59–61 

filling out forms and, 51

financial advantages of interoperability, 70

fraud and abuse reduction, 70

healthy lifestyle and, 47

high-touch and low-touch attention, 50–51 

interoperability and electronic medical 

record comparison, 48

interoperability benefits, 49

medical errors, 53, 67–71 

medical test duplication and, 70

military service members, 66

online support example, 52

Peggy Frank’s testimony, 44–45 

personal data access and, 61–62 

personalized care, 55

poor and indigent people, 63

redundancy of retelling medical histor etelling medical history, 51

relative risk of healthcare, 68

rural area residents, 64–66 

seven “rights” to a high-quality system of healthcare, 47

seven ways to kno ys to know if your healthcar our healthcare provider uses an vider uses an 

interoperable system of healthcar le system of healthcare information, 48

Continuity of care, 13, 53

Cox, Rep. Christopher, 112

Appendix E: Appendix E: Index
246 

D

Data backups

interoperability and, 12

paper-based system and, 22

Data elements, 91

Data theft, 59–61

Denmark

interoperability, 29

Department of Commerce

workforce needs identification, 3

Department of Defense

contact information, 120

Department of Homeland Security

nationwide health information network and, 7

Department of Labor

workforce needs identification, 3

Department of Labor, Health and Human Services, and 

Education and Related Agencies Appropriation Act, 2006,

107–108

Department ofVeterans Affairs

electronic patient records, 66

interoperability success story, 41

Digitization. See Connectivity 

Doctor-patient relationship

confidentiality and, 62

electronic networks and, 84–85

DoD. See Department of Defense

Dodd, Sen. Christopher J., 103–104

Domestic Preparedness Act of 2005, 114

Drug records. See also Prescriptions

access issues, 5, 6

DSW Shoe Warehouse

data theft, 59, 60

E

E-prescribing

benefits of, 14, 54–55

connectivity benefit, 81

financial advantages, 70

timeline, 14, 39

United States compared with other countries, 28

Emergency rooms

connectivity and, 79

example, 80

Emergency workers

connectivity and, 86

Enzi, Sen. Michael B., 105–106

F

Family Caregiver Alliance

long-distance caregivers, 52

Faster and Smarter Funding for First Responders Act 

of 2005, 112

Feinstein, Sen. Dianne, 113

Florida

Medicaid fraud and abuse, 70

Frank, Peggy, 44–45

Fraud and abuse

data theft, 59–61

reducing, 70

G

Gonzalez, Rep. Charles A., 106

H

Health Community Access Programs, 124

Health Information Technology Act of 2005, 104

Health Insurance Portability and Accountability Act

data standards and, 5

patient authentication and identification, 8

patient consent and, 96–97

privacy standards, 8

Health Resources and Services Administration

contact information, 124–125

time healthcare professionals spend filling out charts, 51

HEALTHeFORCESTM 

contact information, 121–122

HEALTHeSTATESTM, 121

HealtheVetVistA, 127

HIPAA. See Health Insurance Portability and 

Accountability Act

HIV/AIDS Program, 124

Homeland Security FORWARD Funding Act of 2005, 113

Homeland Security Grant Enhancement Act of 2005, 112–113

HRSA. See Health Resources and Services Administration

Ending the Document Game 
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247

“IDs—Not That Easy,” 8

IHS. See Indian Health Services

Improve Interoperable Communications for First Responders 

Act of 2005, 111

Indian Health Services

contact information, 122–123 

Information Technology for Health Care Quality Act, 103–104 

Institute of Medicine 

medical error deaths estimate, 11

rural healthcare and, 66

Interoperability. See also Connectivity

access and, 32–33 

adults caring for aging parents and, 13

benefits, 12–14, 49, 76–78, 95

byproducts, 82

confidentiality and, 32

consumers and, 48, 49, 70

continuity of care and, 13, 53

convenience and, 31, 50–52 

current need for, 40–42 

data backups and, 12

data standards, 5

existing technologies and, 41

focus of, 1, 30

four levels of, 86

incremental changes and, 30–31 

legal considerations, 24–26 

patient record access, 5, 6

physician practice example, 34–39 

product certification, 4

recommendations, 4–6 

standard product identifiers and vocabulary, 5, 34, 92

success stories, 41

typed prescriptions and, 13

United States compared with other countries, 28–29 

IoM. See Institute of Medicine 

J

Jeffords, Sen. James M., 102–103

Johnson, Nancy, 108

K

Kennedy, Sen. Edward, 109

L

Leavitt, Mike, 5, 14, 89

Legacy systems, 93–94

Legal considerations

federal anti-kickback law, 24–25 

Stark Law, 25–26 

Lexis-Nexis 

data theft, 59, 60

Lieberman, Sen. Joseph I., 111

Living Will Registry, 59

Lowey, Rep. Nita M., 111

M

Markle Foundation 

financial costs of medical errors, 69

McCarthy, Rep. Carolyn, 114

McLeod Regional Hospital, S.C., 41

Medical errors

consumers and, 53, 67–71

financial costs, 69

Institute of Medicine estimate, 11, 40

paper-based system and, 11–12

Medicare and Medicaid

anti-kickback law and, 24–25

fraud and abuse and, 70

Stark Law and, 25–26

Medicare Modernization Act, 40

Migrant workers, 41, 63

Military service members

HEALTHeFORCESTM program, 121–122 

medical information transmission and, 66

Morrow, Dr. James, 41, 85

Murphy, Rep.Tim, 106–107

Appendix E: Appendix E: Index
248 

N

National Academies’ Computer Science and 

Telecommunication Board 

report on patient identification, 8

National All Schedules Prescription Electronic Reporting Act 

of 2005, 109–110

National Committee forVital and Health Statistics, 5, 125–126

National Health Information Incentive Act of 2005, 106

NCVHS. See National Committee forVital and Health Statistics

New England Health EDI Network, 41, 83

New Zealand

interoperability, 29

O

Obstetrics

average number of visits for expectant mothers, 55

interoperability benefits, 13

Office for the Advancement of Telehealth, 124

Office of the Inspector General

adoption guidance, 2

Office of the National Coordinator for Health Information 

Technology, 40, 103

P

Panza, Dr. Julio, 88–89 

Paper-based system

access to information and, 22, 47

confidentiality and, 12, 21–22

inconvenience of, 20–21

lack of connectivity and, 20

medical errors and, 11–12, 40

problems, 18–29

public acceptance of, 19–20

quality of care and, 22–23

solution to the problem, 13–33

transition from, 89

Patient authentication

creating a unique number, 98

standard for, 7, 8

Patient consent, 96–97 

Patient records 

access issues, 5, 6

Patient Safety and Quality Improvement Act of 2005, 102–103

Polo Ralph Lauren

data theft, 59, 60

Poor and indigent people 

healthcare issues, 41, 63

Pregnancy. See Obstetrics

Prescriptions. See also E-prescribing

doctors’ handwriting and, 22–23, 54

drug interaction reduction, 70–71

typed prescriptions, 13

Privacy. See also Confidentiality; Security

consumers and, 56–62

criminal sanctions for violations, 7, 9, 97–98

federal standard for, 7

paper-based system and, 12

patient consent and, 96–97

states and, 8

Product certification, 4, 89–90 

Product recalls

interoperability and, 33

paper-based system and, 23

Public awareness campaign, 3, 4

Public health

connectivity and, 85–86

The Public Safety Interoperability Implementation Act, 114

Q

Quality of care

connectivity and, 78–81

interoperability and, 32–33

paper-based system and, 22–23

seven “rights” to a high-quality system of healthcare, 47

United States compared with other countries, 27

R

Recommendations 

adoption, 2–4 

connectivity, 7–9 

interoperability, 4–6 

Regula, Rep. Ralph, 107–108

Research America

medical errors survey, 68

Rural areas

chronic condition management, 81

healthcare issues, 64–66, 125

interoperability and, 13

Rural Health Program, 125

Ending the Document Game 
249

S

Safe harbors, 25

Security. See also Confidentiality; Privacy

authorization devices, 97

consumers and, 56–62

data thefts, 59–61

Sessions, Sen. Jeff, 109–110 

Sonoma County, Calif. 

migrant worker healthcare, 41, 63

Stabenow, Sen. Debbie, 104

Standard product identifiers and vocabulary, 5, 34, 92

Stanford University

study of doctors’ access to information, 79

Stark Law, 25–26

Stupak, Rep. Bart, 114

Sweden

interoperability, 29

T

Technology

Americans’ attitude towards, 23, 56–58

consumer trust and, 58

existing technology, 41, 47, 88–89

Time-Warner

data theft, 59

21st Century Health Information Act of 2005, 106–107

U

United Kingdom

interoperability, 28

United States

healthcare compared with other countries, 26–28

V

Vaccination records, 21, 66

Veterans Health Administration

contact information, 127

VHA. SeeVeterans Health Administration

von Eschenbach,Andy

seven “rights” to a high-quality system of healthcare, 47

W

Westin, Dr.Alan, 61

Whitfield, Rep. Ed, 110

The Wired for Healthcare Quality Act, 105–106

Wishard Memorial Hospital, Indianapolis, Ind., 41, 80

Workforce needs, 3, 4

Z

Zahn, Dr. Evan, 41, 74–76 

Appendix E: Appendix E: Index
250

Ending the Document Game