a

GAO

United States Government Accountability Office

Report to the Chairman, Committee on 

the Budget, House of Representatives

May 2005 HEALTH 

INFORMATION 

TECHNOLOGY

HHS Is Taking Steps to 

Develop a National 

Strategy

GAO-05-628
What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

www.gao.gov/cgi-bin/getrpt?GAO-05-628.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact David A. 

Powner, (202) 512-9286, pownerd@gao.gov. 

Highlights of GAO-05-628, a report to the 

Chairman, Committee on the Budget, 

House of Representatives 

May 2005

HEALTH INFORMATION TECHNOLOGY

HHS Is Taking Steps to Develop a 

National Strategy 

The Secretary of HHS appointed the National Coordinator for Health IT in 

May 2004. In July 2004, the national coordinator released a framework for 

strategic action, which outlines four goals and 12 strategies to guide the 

development of a full strategic plan for national health IT adoption (see table 

below). The framework builds upon already-existing work in federal health 

IT and includes plans to identify and learn from agencies’ experiences. It 

also describes actions to be taken by both the public and private sectors to 

achieve interoperability in health IT across the nation. 

HHS plans to address the goals and strategies of the framework with a threephased approach over a number of years and is currently implementing 

phase I of the framework. However, HHS has not established milestones for 

the completion of phase I activities nor has it made detailed plans or set 

milestones for the completion of activities for phases II and III. 

Goals and Strategies of HHS’s Framework for Strategic Action 

Goals Strategiesa

Goal 1: Inform clinical practice with 

the use of electronic health records 

(EHR) 

1. Incentivize EHR adoption 

2. Reduce risk of EHR investment 

3. Promote EHR diffusion in rural and underserved 

areas 

Goal 2: Interconnect clinicians so that 

they can exchange health information 

using advanced and secure electronic 

communication 

1. Foster regional collaboration 

2. Develop a national health information network 

3. Coordinate federal health information systems

Goal 3: Personalize care with 

consumer-based health records and 

better information for consumers 

1. Encourage use of personal health records 

2. Enhance informed consumer choice 

3. Promote use of telehealth systems 

Goal 4: Improve public health through 

advanced biosurveillance methods and 

streamlined collection of data for 

quality measurement and research 

1. Unify public health surveillance architectures 

2. Streamline quality and health status monitoring 

3. Accelerate research and dissemination of evidence 

Source: HHS. a

 Phase I strategies are shown in bold type. 

GAO identified lessons learned from DOD and VA that could provide 

valuable insight to HHS as it works toward implementing a national health IT 

infrastructure. DOD and VA operate the largest health care delivery 

networks in the nation, and important lessons can be taken from their 

experiences in health IT. Additionally, other countries have begun initiatives 

to establish national health IT infrastructures. DOD, VA, Canada, Denmark, 

and New Zealand provided GAO with valuable lessons learned that can be 

applied to the United States’s efforts. Among other lessons learned, they 

reported the need to 

• obtain the endorsement of top leadership, 

• define and adopt standards, 

• address the needs of stakeholders, and 

• deploy IT solutions in small increments and build on successes. 

To prevent medical errors, reduce 

costs, improve quality, and produce 

greater value for health care 

expenditures, President Bush has 

called for the Department of Health 

and Human Services (HHS) to 

develop and implement a strategic 

plan to guide the nationwide 

implementation of health 

information technology (IT) in both 

the public and private health care 

sectors. The Departments of 

Defense (DOD) and Veterans 

Affairs (VA), along with other 

countries, have already taken steps 

to improve health care delivery and 

administration by implementing IT 

solutions. GAO was asked to 

provide an overview of HHS’s 

recent efforts to develop a national 

health IT strategy for realizing the 

President’s vision, and to identify 

lessons learned from DOD’s, VA’s, 

and other countries’ experiences in 

implementing health IT. 

What GAO Recommends

To accelerate the adoption of 

interoperable IT for health care, 

GAO recommends that the 

Secretary of Health and Human 

Services establish and follow 

detailed plans and set milestones 

for each phase of HHS’s framework 

for strategic action. 

In commenting on a draft of this 

report, DOD, HHS, and VA 

concurred with our results; HHS 

agreed with our recommendation. 

Technical comments were 

incorporated in this report as 

appropriate. 
Page i GAO-05-628 HHS National Health IT Strategy

Contents

Letter 1

Recommendation for Executive Action 4

Agency Comments 4

Appendixes

Appendix I: National Health Information Technology Strategy 6

Appendix II: Comments from the Department of Health and Human 

Services 84

Appendix III: Comments from the Department of Veterans Affairs 88

Abbreviations

AHRQ Agency for Health Research and Quality

CDC Centers for Disease Control and Prevention

CHI Consolidated Health Informatics

CMS Centers for Medicare and Medicaid Services

DOD Department of Defense

EHR electronic health records

FDA Food and Drug Administration

FHA Federal Health Architecture

HHS Department of Health and Human Services

HRSA Health Resources and Services Administration

IHS Indian Health Service

IT information technology

NCVHS National Committee on Vital and Health Statistics 

NHIN National Health Information Network

NIH National Institutes of Health

ONCHIT Office of the National Coordinator for Health IT

VA Department of Veterans Affairs

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately.
Page 1 GAO-05-628 HHS National Health IT Strategy

United States Government Accountability Office

Washington, D.C. 20548

A

May 27, 2005 Letr

The Honorable Jim Nussle

Chairman, Committee on the Budget

House of Representatives

Dear Mr. Chairman:

According to the Institute of Medicine, health care delivery in the United 

States has long-standing problems with medical errors and inefficiencies 

that increase health care costs. The U.S. health care delivery system is an 

information-intensive industry that is complex and highly fragmented with 

estimated spending of $1.7 trillion in 2003. In April 2004, President Bush 

announced a health information technology (IT) plan that calls for the 

development and implementation of a strategic plan to guide the 

nationwide implementation of health IT in both the public and private 

health care sectors to prevent medical errors, improve quality, and produce 

greater value for health care expenditures. 

Also in April 2004, the President issued an executive order that required the 

Secretary of Health and Human Services to appoint a national coordinator 

whose role is to provide leadership for the development and nationwide 

implementation of an interoperable health IT infrastructure to improve the 

quality and efficiency of health care. The National Coordinator for Health 

IT was appointed in May 2004; in July 2004, the coordinator released a 

framework for strategic action, the first step toward a national strategy. 

The framework builds upon already-existing work in federal health IT and 

includes plans to identify and learn from agencies’ experiences, including 

those of the Departments of Defense (DOD) and Veterans Affairs (VA), 

which operate the largest health care delivery networks in the nation and 

have experience with developing and implementing IT solutions 

throughout their systems. Additionally, other countries have begun to 

develop and implement strategies to improve health care delivery through 

the nationwide adoption of IT and can provide valuable lessons for the 

Department of Health and Human Services (HHS).

You asked us to (1) provide an overview of HHS’s efforts to develop and 

implement a national health IT strategy, (2) identify lessons learned from 

DOD’s and VA’s experiences with implementing electronic health records, 

and (3) identify lessons learned from other countries’ efforts to modernize 

health IT infrastructures. We conducted work at HHS, DOD, and VA—the 

federal agencies that play major roles in supporting and providing health 
Page 2 GAO-05-628 HHS National Health IT Strategy

care delivery in the United States and that are promoting the use of health 

IT. We reviewed and assessed HHS’s framework and plans for developing a 

national health IT strategy to understand the role of the new office for 

national coordination of health IT. We supplemented our assessment by 

discussing with officials throughout the department their involvement in 

national efforts to implement health IT and the integration of current health 

IT initiatives into the national strategy. We analyzed DOD and VA 

documentation and prior GAO reports discussing the two departments’ 

implementation of health IT (see app. I). We supplemented our analyses by 

discussing with DOD and VA officials the lessons that they learned from 

implementing health IT solutions in two of their major information 

systems. We selected examples of other countries’ efforts to modernize 

health IT infrastructures based upon literature reviews and discussions 

with health care IT experts. We discussed with Canada, Denmark, and New 

Zealand their initiatives to modernize national health IT infrastructures and 

identified lessons learned from their experiences that could be meaningful 

to the United States’s efforts. We conducted our work from October 2004 

through March 2005, in accordance with generally accepted government 

auditing standards.

On April 1, 2005, we provided your office with a briefing on the results of 

this review. The purpose of this letter is to provide the published briefing 

slides to you, which appear as appendix I. The information in these slides 

has been updated to include additional information requested by your 

office.

In summary, we found that HHS, through the Office of the National 

Coordinator for Health IT, is taking initial steps toward developing a 

national strategy for health IT and has released a framework that describes 

actions to be taken by the public and private sectors to develop and 

implement such a strategy. The framework defines goals and strategies that 

are to be implemented in three phases. Phase I focuses on the development 

of market institutions1

 to lower the risk of health IT procurement, phase II 

involves investment in clinical management tools and capabilities, and 

phase III supports the transition of the market to robust quality and 

performance accountability. 

1

According to HHS, market institutions include certification organizations, group 

purchasing entities, and low-cost implementation support organizations that do not 

currently exist but are necessary to support clinicians as they procure and use IT.
Page 3 GAO-05-628 HHS National Health IT Strategy

HHS is in the initial phase of implementing activities to achieve the goals of 

the framework and, as a result, has made progress toward coordinating 

federal health IT efforts and reaching out to private industry. For example, 

in November 2004, the department issued a request for information seeking 

public input and ideas for developing a national health information 

network; a task force of federal agencies is evaluating over 500 responses 

to this request. HHS is also working with the private sector to develop 

standards and certification procedures for health IT interoperability. 

However, HHS has not established milestones for the completion of phase 

I, nor has it defined plans for phases II and III. Without defined milestones, 

it remains unclear when the important activities of phase I will be 

completed to provide the building blocks needed to support the activities 

of the subsequent phases. 

We identified lessons learned from DOD and VA that could provide valuable 

insight to HHS as it works toward implementing a national health IT 

infrastructure. DOD and VA operate the largest health care delivery 

networks in the nation, and important lessons can be taken from their 

experiences in health IT. Among other things, they reported the need to

• obtain full endorsement of top leadership,

• define and adopt common standards and terminology,

• recognize and address the needs of the varied stakeholder communities, 

and

• deploy in small increments and build on success.

We also reported additional lessons learned from other countries’ 

experiences in modernizing health IT infrastructures. Canada, Denmark, 

and New Zealand have begun initiatives to establish national health IT 

infrastructures with government support and identified lessons learned 

from their experiences, such as

• focus on creating standards first,

• establish a central organization to lead health IT efforts, and

• implement solutions incrementally.
Page 4 GAO-05-628 HHS National Health IT Strategy

Recommendation for 

Executive Action

As a result of our work, we recommend that the Secretary of Health and 

Human Services establish detailed plans and milestones for each phase of 

the framework for strategic action and take steps to ensure that those plans 

are followed and milestones are met.

Agency Comments We received written comments on a draft of this report from the Acting 

Inspector General at HHS and the Deputy Secretary of VA. We received oral 

comments from the Chief Enterprise Architect for Military Health System 

at DOD. DOD, HHS, and VA concurred with our results and provided 

technical comments, which we have incorporated in this report as 

appropriate. HHS agreed with our recommendation and described 

additional actions that the Secretary is taking to achieve specific goals of 

the framework and to benefit from lessons learned from DOD and VA. HHS 

also provided additional information about the steps that the department is 

taking to lead the nation in health IT efforts. This information is provided in 

HHS’s written comments, which are reproduced in appendix II. VA’s written 

comments are reproduced in appendix III.

We are sending copies of this report to the Chairmen and Ranking Minority 

Members of other Senate and House committees and subcommittees 

having authorization and oversight responsibilities for health care IT. We 

are also sending copies to the Secretary of Health and Human Services and 

to the other agencies that participated in our review. We will also make 

copies available to others upon request. In addition, the report will be 

available at no charge on the GAO Web site at http://www.gao.gov.
Page 5 GAO-05-628 HHS National Health IT Strategy

Should you or your office have any questions about matters discussed in 

this report, please contact Dave Powner at (202) 512-9286 or by e-mail at 

pownerd@gao.gov. Contact points for our Offices of Congressional 

Relations and Public Affairs may be found on the last page of this report. 

Major contributors to this report also included Tonia D. Brown, Pamlutricia 

Greenleaf, M. Saad Khan, Valerie C. Melvin, M. Yvonne Sanchez, Teresa F. 

Tucker, and Jessica D. Waselkow.

Sincerely yours,

David A. Powner

Director, Information Technology

Management Issues

Linda D. Koontz

Director, Information Management Issues
Page 6 GAO-05-628 HHS National Health IT Strategy

Appendix I

National Health Information Technology Apendxies

Strategy ApendxiI

1

National Health Information 

Technology Strategy

Briefing for Majority Staff 

Committee on the Budget

House of Representatives

April 1, 2005

Updated
Appendix I

National Health Information Technology 

Strategy

Page 7 GAO-05-628 HHS National Health IT Strategy

2

Table of Contents

Page

• Introduction 3

• Objectives, Scope, and Methodology 4

• Results in Brief 8

• Background 10

• National Health Information Technology Strategy 27

• Lessons Learned from the Departments of 

Defense and Veterans Affairs 52

• Lessons Learned from Other Countries 57 

• Conclusions 67

• Recommendation 69

• Agency Comments 70

• Appendixes 71
Appendix I

National Health Information Technology 

Strategy

Page 8 GAO-05-628 HHS National Health IT Strategy

3

Introduction

• The United States health care delivery system is an information-intensive 

industry that is complex, inefficient, and highly fragmented, with estimated 

spending of $1.7 trillion in 2003.

• Calling for transformational change in the health care industry, the Institute 

of Medicine pointed out that health care delivery in the United States has 

longstanding problems with medical errors and inefficiencies that increase 

the cost of health care.1

• The President’s health care information technology (IT) plan calls for the 

development and implementation of a strategic plan to guide the 

nationwide implementation of interoperable health information technology 

in both the public and private health care sectors that will prevent medical 

errors, reduce costs, improve quality, and produce greater value for health 

care expenditures. 

.

1 Institute of Medicine, To Err Is Human: Building a Safer Health System (Washington, DC: November 1999) and Crossing the Quality 

Chasm: A New Health System for the 21st Century (Washington, D.C.: March 2001).
Appendix I

National Health Information Technology 

Strategy

Page 9 GAO-05-628 HHS National Health IT Strategy

4

Objectives, Scope and Methodology

Objectives and Scope

Objectives

• To provide an overview of the Department of Health and Human Services’ 

(HHS) efforts to develop and implement a national health information 

technology strategy

• To identify lessons learned from the Departments of Defense’s (DOD) and 

Veterans Affairs’ (VA) implementation of electronic health records (EHRs)

• To identify lessons learned from other countries’ efforts to modernize 

health IT infrastructures
Appendix I

National Health Information Technology 

Strategy

Page 10 GAO-05-628 HHS National Health IT Strategy

5

Objectives, Scope and Methodology

Objectives and Scope

Scope

• Conducted work at HHS components that play major roles in supporting 

health care IT, including the Agency for Healthcare Research and Quality, 

Centers for Medicare and Medicaid Services, Food and Drug 

Administration, Health Resources and Services Administration, Indian 

Health Service, National Institutes for Health, and Office of the National 

Coordinator for Health IT in Washington, D.C., and the Centers for 

Disease Control and Prevention in Atlanta, GA

• Conducted work at DOD’s Office of Health Affairs in Falls Church, VA and 

VA’s Veterans Health Administration in Washington, D.C.

• Selected and reviewed examples of health care IT infrastructure initiatives

from Canada, Denmark, New Zealand, and the United Kingdom.
Appendix I

National Health Information Technology 

Strategy

Page 11 GAO-05-628 HHS National Health IT Strategy

6

Objectives, Scope and Methodology

Methodology

• Reviewed HHS’s framework and implementation plans for developing a 

national health IT strategy and held discussions with agency officials about 

their involvement in national efforts to implement health IT and the 

integration of current health IT initiatives into the national strategy

• Analyzed agency documentation and GAO reports discussing DOD’s and 

VA’s implementation of EHRs as part of the Composite Health Care 

System II and the Veterans Health Information System and Technology 

Architecture

• Supplemented analyses with interviews of DOD and VA officials 

regarding the agencies’ practices, processes, and outcomes in 

implementing EHRs, and identified related lessons learned that could 

be useful in the implementation of a national health care system

• Consulted with a private health care consultant currently studying 

EHRs to assess the validity of the identified lessons and their 

applicability in federal and private health care settings
Appendix I

National Health Information Technology 

Strategy

Page 12 GAO-05-628 HHS National Health IT Strategy

7

Objectives, Scope and Methodology

Methodology

• Conducted literature reviews of other countries’ efforts to implement health 

IT and held discussions with officials in Canada, Denmark, and New 

Zealand to gain information about experiences related to costs, benefits, 

time frames, and challenges

• We held discussions with health care IT experts and reviewed 

literature to identify countries that are modernizing health IT 

infrastructures and were willing to discuss their initiatives and lessons 

learned with us.

• We obtained information about the United Kingdom’s health IT 

modernization project by reviewing publicly available documentation. 

• We conducted our work from October 2004 through March 2005 in 

accordance with generally accepted government auditing standards. 

• We collected systems descriptions and cost information from agency 

officials and did not independently verify data provided to us.

• We requested comments from HHS, DOD, and VA on a draft of these 

briefing slides.
Appendix I

National Health Information Technology 

Strategy

Page 13 GAO-05-628 HHS National Health IT Strategy

8

Results in Brief

• In July 2004, HHS delivered a framework for strategic actions as a first step 

toward a strategy to implement a nationwide health IT infrastructure that 

involves both the public and private sectors’ participation.

• The framework builds upon ongoing work in federal health IT and 

includes plans to identify and learn from agencies’ experiences.

• The framework defines goals and strategies which are to be 

implemented in three-phases.

• HHS is in the initial phase of implementing the framework’s strategies but 

has not defined milestones for completion of this phase or later phases.

• In November 2004, HHS issued a request for information seeking public 

input and ideas for developing a national health information network; a task 

force of federal agencies is evaluating over 500 responses.
Appendix I

National Health Information Technology 

Strategy

Page 14 GAO-05-628 HHS National Health IT Strategy

9

Results in Brief

• DOD and VA operate the largest health care delivery networks in the 

nation, and their experiences in implementing EHRs offer important 

lessons learned that could be applied to a national health records system. 

These lessons include:

• Obtain full endorsement of top leadership

• Define and adopt common standards and terminology

• Recognize and address needs of the varied stakeholder communities

• Deploy in small increments and build on success

• Other countries have begun initiatives to establish national health IT 

infrastructures with government support and also provided valuable 

lessons learned that can be applied to the U.S.’s efforts, such as:

• Focus on creating standards first

• Establish a central organization to lead health IT efforts

• Implement incrementally

• As a result of our review, we recommend that HHS establish plans and 

milestones for fully implementing its framework for strategic action.
Appendix I

National Health Information Technology 

Strategy

Page 15 GAO-05-628 HHS National Health IT Strategy

10

Background

IT in the Health Care Industry

• The President’s Information Technology Advisory Committee2 observed

that, unlike most industries in which IT has improved efficiency, quality, and 

productivity, health care still operates using primarily paper-based records, 

phone calls, faxes, and mail.

• Unlike the nationalized health systems of many countries, the U.S. 

health care system is composed of private, independent hospitals, 

ambulatory care and long-term care facilities, and private individual 

and group provider practices.

• The free market system does not inherently generate practical 

mechanisms for sharing information critical to patient care.

• According to HHS, health care is the largest sector of the economy that has 

not fully embraced information technology.

2 The President’s Information Technology Advisory Committee’s members are appointed by the President to provide independent expert advice on IT.
Appendix I

National Health Information Technology 

Strategy

Page 16 GAO-05-628 HHS National Health IT Strategy

11

Background

• Health IT is used to support health care quality and efficiency by providing 

tools to improve patient care and to reduce administration overhead. For 

example

• Electronic health records (EHRs)3 provide patients and their caregivers 

the necessary information required for optimal care while reducing 

costs and administrative overhead, such as that associated with 

patient registration, admission, discharge, and billing.

• Computer-assisted clinical decision support tools increase the ability of

health care providers to take advantage of current medical knowledge 

from online medical references as they make treatment decisions.

• Computerized provider order entry allows providers to electronically 

order tests, medicine, and procedures for patients, reducing errors 

associated with hand-written orders and prescriptions.

• Telehealth is used to provide health care to rural and remote areas 

through the use of communications technologies. .

IT in the Health Care Industry

3 There is a lack of consensus on what constitutes an EHR, and thus multiple definitions and names exist for EHRs, depending on the functions 

included. An EHR generally includes (1) a longitudinal collection of electronic health information about the health of an individual or the care 

provided, (2) immediate electronic access to patient- and population-level information by authorized users, (3) decision support to enhance the 

quality, safety, and efficiency of patient care, and (4) support of efficient processes for health care delivery.
Appendix I

National Health Information Technology 

Strategy

Page 17 GAO-05-628 HHS National Health IT Strategy

12

Background

IT Adoption Rates in Health Care

• We recently reported that current health IT adoption rates in the United 

States are varied and increasing the rates of IT adoption is critical to 

achieving significant benefits.4

• Respondents to a recent survey conducted by the Medical Group 

Management Association reported that only 31 percent of physician 

group practices use fully operational EHRs.

• The Healthcare Information and Management Systems Society 

reported that 19 percent of hospitals use fully operational EHRs.

• According to a study by the Commonwealth Fund, approximately 13 

percent of solo physicians have adopted some form of EHR, while 57 

percent of large group practices (50 or more physicians) have adopted 

an EHR. 

• According to the Commonwealth Fund, gaps in adoption rates are further 

widened by barriers and challenges to implementing health IT that are 

greater for solo and small group practices.

4 GAO, Health and Human Services’ Estimate of Health Care Cost Savings Resulting from the Use of Information Technology, GAO-05-309R 

(Washington, D.C.: February 16, 2005).
Appendix I

National Health Information Technology 

Strategy

Page 18 GAO-05-628 HHS National Health IT Strategy

13

Background

Challenges to Implementing IT

• While there are proven benefits to implementing health IT, the Medicare 

Payment Advisory Commission5 identified other factors that present 

financial, technical, and cultural challenges. 

• Investment in IT can be costly and must compete with other 

investments, and depends on the organization’s ability to access 

capital.

• Integrating new IT with other systems can further increase costs and 

system maintenance requirements.

• Maintaining full operations when making system changes presents 

additional challenges.

• Implementation of IT often requires changes in work processes and 

culture.

• Physicians’ reluctance is a major hurdle to implementing IT, and 

overcoming it is key to successful projects.

5 The Medicare Payment Advisory Commission is an independent federal body established by the Balanced Budget Act of 1997 

(P.L. 105–33) to advise the U.S. Congress on issues affecting the Medicare program.
Appendix I

National Health Information Technology 

Strategy

Page 19 GAO-05-628 HHS National Health IT Strategy

14

Background

Recent Studies on Cost and Benefits of Health IT

• Studies by the Center for Information Technology Leadership identified 

savings from the widespread adoption of health IT.

• The Value of Healthcare Information Exchange and Interoperability

identified $78 billion in annual savings based on electronically sharing 

health care data between providers and stakeholders, which resulted 

in saving time and avoiding duplicate tests.

• The Value of Computerized Provider Order Entry in Ambulatory 

Settings estimated $44 billion in annual savings based on avoidance of 

unnecessary outpatient visits and hospital admissions, as well as more 

cost-effective medication, radiology, and lab ordering.

• The center and other health care experts acknowledge that these 

estimates are based on limited data and a number of assumptions and, 

therefore, are not necessarily complete and precise. 

• In October 2003, we reported significant financial benefits realized from the 

implementation of health IT, including cost savings at VA and expected 

savings at DOD (GAO-04-224; see appendix I).
Appendix I

National Health Information Technology 

Strategy

Page 20 GAO-05-628 HHS National Health IT Strategy

15

Background

Administration’s Health IT Agenda

• The President’s health care IT plan calls for the widespread adoption of 

interoperable EHRs within 10 years.

• In April 2004, the President issued Executive Order 133356 to “provide 

leadership for the development and nationwide implementation of an 

interoperable health information technology infrastructure to improve the 

quality and efficiency of health care.” Among other things, the order called 

for

• the appointment of a national coordinator for health IT who is to report 

to the Secretary of HHS regarding progress on the development and 

implementation of a strategic plan.

• The Secretary appointed a national coordinator in May 2004 whose 

responsibilities include coordination of programs and policies regarding 

health IT across the federal government, and outreach and consultation 

between the federal government and the private sector.

6 Executive Order 13335, Incentives for the Use of Health Information Technology and Establishing the Position of the National Health 

Information Technology Coordinator (Washington, D.C.: April 27, 2004).
Appendix I

National Health Information Technology 

Strategy

Page 21 GAO-05-628 HHS National Health IT Strategy

16

Background

HHS’s Role in Health IT

• As a regulator, purchaser, health care provider, and sponsor of research, 

HHS is taking steps to promote the use of IT in public and private health 

care settings.

• The Agency for Healthcare Research and Quality (AHRQ) aims to 

translate research findings into better patient care and provides funding 

for state and regional IT demonstration projects and a national 

resource center for grantees and organizations that are engaged in 

health IT activities.

• According to HHS officials, over half of AHRQ’s funding goes to 

rural and small communities.

• The Centers for Medicare and Medicaid Services (CMS) administers

the Medicare program and works in partnership with states to 

administer the Medicaid program and the States Children’s Health

Insurance Program; CMS has established pilots to promote the 

adoption and effective use of health IT in physicians’ offices and to 

improve beneficiary telephone customer service using web-based call 

centers.
Appendix I

National Health Information Technology 

Strategy

Page 22 GAO-05-628 HHS National Health IT Strategy

17

Background

HHS’s Role in Health IT

• Indian Health Service (IHS) provides health services to American

Indians and Alaskan Natives and reportedly uses a hospital information 

system that provides order entry, results reporting, encounter 

documentation, and other clinical functions.

• The Health Resources and Services Administration (HRSA) aims to 

expand access to high-quality health care and provide grants for 

community-based activities in informatics, EHRs, and telehealth.

• HRSA awarded 65 grants and over $30 million for telehealth in 

2004.

• The National Institutes of Health (NIH) works to apply scientific 

knowledge to extend healthy life and provide research grants for

computer technologies to facilitate access, storage, and use of 

biomedical information, for training of informatics researchers and 

developers, and access to informatics resources.
Appendix I

National Health Information Technology 

Strategy

Page 23 GAO-05-628 HHS National Health IT Strategy

18

Background

Role of the 

National Committee on Vital and Health Statistics

• The National Committee on Vital and Health Statistics (NCVHS) was 

established in 1949 as a public advisory committee that is statutorily 

authorized to advise the Secretary of HHS on health data, statistics, and 

national health information policy, including the implementation of health IT 

standards.

• The committee is responsible for developing recommendations to HHS 

for standards to enable e-prescribing and delivered its first set of 

recommendations to the department in September 2004 with additional 

recommendations to be provided in March 2005.

• The committee is also responsible for making recommendations to the 

Secretary of HHS for transaction and code set standards.
Appendix I

National Health Information Technology 

Strategy

Page 24 GAO-05-628 HHS National Health IT Strategy

19

Background

Role of the 

National Committee on Vital and Health Statistics

• In November 2001, NCVHS called for federal leadership to accelerate and 

coordinate progress on a national health information infrastructure.7

• NCVHS intends to continue to address issues related to health IT and 

a national health information infrastructure and provide comments and 

recommendations to the Secretary as appropriate.

• NCVHS reviews results of HHS agencies’ standards-setting initiatives, 

along with government and nongovernmental requirements and issues, 

and makes recommendations to the department secretary regarding the 

adoption of health IT standards, as appropriate.

7 NCVHS, Information for Health: A Strategy for Building the National Health Information Infrastructure (Washington, D.C.: November 2001).
Appendix I

National Health Information Technology 

Strategy

Page 25 GAO-05-628 HHS National Health IT Strategy

20

Background

DOD’s Role in Health IT

• As previously reported,8 DOD has pursued the goal of providing IT support 

to its hospitals and clinics since 1968.

• From 1976 to 1984, DOD spent about $222 million to acquire, 

implement, and operate various health care computer systems.

• The Composite Health Care System (CHCS), deployed in 1993, is the 

primary DOD medical information system now used in all military health 

system facilities worldwide, supporting patient registration and inpatient 

activity documentation, and providing laboratory, radiology, pharmacy, 

drug interaction, and other functions.

8GAO, Information Technology: Greater Use of Best Practices Can Reduce Risks in Acquiring Defense Health Care System, 

GAO-02-345 (Washington, D.C.: September 26, 2002).
Appendix I

National Health Information Technology 

Strategy

Page 26 GAO-05-628 HHS National Health IT Strategy

21

Background

DOD’s Role in Health IT

• DOD initiated CHCS II in 1997 as an advanced medical information

system to assist clinicians in making improved health care decisions 

and to lower costs.

• As part of CHCS II, DOD is implementing a centralized Clinical 

Data Repository of life-long health records for military health 

system beneficiaries that provide documentation such as patient 

histories, physician notes, and population health reporting.

• CHCS II represents DOD’s EHR and will eventually replace the 

existing CHCS.

• According to HHS, DOD has a lengthy history working in remote and 

medically underserved areas and has experience in using IT, such as 

telehealth, to deliver care in isolated conditions which can be compared 

with the conditions in some rural environments.

8GAO, Information Technology: Greater Use of Best Practices Can Reduce Risks in Acquiring Defense Health Care System, 

GAO-02-345 (Washington, D.C.: September 26, 2002).
Appendix I

National Health Information Technology 

Strategy

Page 27 GAO-05-628 HHS National Health IT Strategy

22

Background

VA’s Role in Health IT

• VA is the country’s largest health care provider and, according to RAND,9

has been making significant strides in implementing technologies and 

systems to improve care, including an EHR that allows instant 

communication among providers across the country and reminds providers 

of patients’ clinical needs. 

• As we previously reported10, VA has had an automated information system 

in its medical facilities since 1985. In 1996, this system evolved into the 

Veterans’ Health Information Systems and Technology Architecture (VistA), 

an integrated outpatient and inpatient system that includes its EHR—the 

Computerized Patient Record System.

• VA’s EHR technologies are available for public use and are being modified 

for transfer to rural and medically underserved settings.

9 RAND, Improving Quality of Care: How the VA Outpaces Other Systems in Delivering Patient Care (Santa Monica, CA: 2005).

10 GAO, Information Technology: Benefits Realized for Selected Health Care Functions, GAO-04-224 (Washington, D.C.: October 31, 2003)
Appendix I

National Health Information Technology 

Strategy

Page 28 GAO-05-628 HHS National Health IT Strategy

23

Background

Private Industry’s Role in Health IT

According to the National Coordinator for Health IT:

• While the federal government plays an important role in health IT adoption, 

the effective use of health IT lies predominantly with the private sector. 

• The federal government can provide a vision and strategic direction for a 

national interoperable health care system but will rely on the private sector 

to provide a competitive technology industry, privately operated support 

services, and shared investments in health IT adoption. 

• The private sector must develop the market institutions to deliver the 

products and services that can transform the paper-based health care 

system into an electronic, consumer-centered, and quality-based system.
Appendix I

National Health Information Technology 

Strategy

Page 29 GAO-05-628 HHS National Health IT Strategy

24

Background

Relevant Legislation

Federal legislation requires specific activities related to the implementation of 

health IT by both the public and private sectors.

• The Health Insurance Portability and Accountability Act (HIPAA) of 199611

requires HHS to establish national standards for certain financial and 

administrative electronic health care transactions and national identifiers 

for providers, health plans, and employers.

• The Public Health Security and Bioterrorism Preparedness and Response 

Act of 200212 requires that the Secretary, in cooperation with health care 

providers and state and local public health officials, establish standards for 

interoperability of health alert and public health surveillance networks 

between federal, state, and local public health officials, and public and 

private health labs, hospitals and other facilities.

11 Public Law 104-191 (August 21, 1996).

12 Public Law 107-188 (June 12, 2002).
Appendix I

National Health Information Technology 

Strategy

Page 30 GAO-05-628 HHS National Health IT Strategy

25

Background

Relevant Legislation

• Among other things, the Medicare Prescription Drug Improvement and 

Modernization Act of 200313 includes provisions for an electronic 

prescription drug program and requires CMS to develop standards for 

electronic prescribing.

• It also requires the establishment of a Commission on Systemic 

Interoperability to provide a road map for interoperability standards.

• The act authorizes the Secretary of HHS to conduct a 3-year pay-forperformance demonstration program under which physicians are to 

adopt and use health IT to promote continuity of care, stabilize medical 

conditions, prevent or minimize acute exacerbations of chronic 

conditions, and reduce adverse health outcomes to meet beneficiaries’ 

needs.

13 Public Law 108-173 (December 8, 2003).
Appendix I

National Health Information Technology 

Strategy

Page 31 GAO-05-628 HHS National Health IT Strategy

26

Background

Previous GAO Reports on Health IT

• GAO has historically reviewed and reported issues related to the federal 

government’s efforts to implement health IT, including the need for an 

implementation strategy, costs and benefits of health IT, barriers to 

implementation, and DOD’s and VA’s efforts to implement EHRs and 

exchange data.

• Appendix I includes descriptions of GAO reports issued since 2000.
Appendix I

National Health Information Technology 

Strategy

Page 32 GAO-05-628 HHS National Health IT Strategy

27

National Health IT Strategy 

Office of the National Coordinator for Health IT

• The mission of the Office of the National Coordinator for Health IT is to 

develop and implement a strategic plan to guide the nationwide 

implementation of interoperable health care IT in both the public and 

private sectors.

• According to the national coordinator, the office is a transitional 

organization with no permanent positions under the HHS Assistant

Secretary for Budget, Technology and Finance.

• The first step in preparing a strategic plan was the release of a framework 

for strategic action, and in accordance with Executive Order 13335, HHS 

released The Decade of Health Information Technology: Delivering 

Consumer-centric and Information-rich Health Care (July 2004), which

describes a framework for strategic action.

• The office intends to release a complete strategic plan during this 

coming year to build upon the framework and provide detailed plans for 

implementing the President’s vision.
Appendix I

National Health Information Technology 

Strategy

Page 33 GAO-05-628 HHS National Health IT Strategy

28

National Health IT Strategy 

Framework for Strategic Action 

• The framework for strategic action outlines an approach toward the 

nationwide implementation of interoperable health IT in both the public and 

the private sectors.

• It calls for a sustained set of actions which will be taken over many 

years by the public and private health sectors.

• The framework outlines four major goals and 12 strategies for 

implementing a strategy for national health IT.

• The framework states a commitment to the development of interoperability 

standards, a key component of progress in interoperable health IT, and 

describes efforts to adopt standards for use by all federal health agencies.

• The framework also supports the role of the private sector and recognizes 

that the adoption and effective use of health IT require a joint effort 

between federal, state, and local governments and the private sector.

• As we testified in July 2004, as the national coordinator moves forward with 

this framework, it will be essential to have continued leadership, clear 

direction, measurable goals, and mechanisms to monitor progress.14

14 GAO, Health Care: National Strategy Needed to Accelerate the Implementation of Information Technology, GAO-04-947T 

(Washington, D.C.: July 14, 2004).
Appendix I

National Health Information Technology 

Strategy

Page 34 GAO-05-628 HHS National Health IT Strategy

29

National Health IT Strategy

Framework for Strategic Action 

• HHS’s approach for implementing the framework’s strategic actions 

aggregates its goals and strategies into three phases.

• Phase I focuses on the development of market institutions to stabilize 

the market, create a better environment for investment and 

accountability, and lower the risk of health IT procurement.

• Phase II involves investment in clinical management tools and 

capabilities such as EHRs, personal health records, telehealth, health 

information exchange, and other mechanisms for high-performance 

care delivery.

• Phase III supports the transition of the market to robust quality and 

performance accountability, where clinicians have the tools and 

capabilities to manage patients and populations and to deliver 

consistently high-quality care in an efficient manner.
Appendix I

National Health Information Technology 

Strategy

Page 35 GAO-05-628 HHS National Health IT Strategy

30

National Health IT Strategy

Framework for Strategic Action 

• HHS is currently implementing phase I and, according to the national 

coordinator, its initial efforts are focused on the building blocks of EHR 

adoption, interoperability, and streamlined federal health information 

systems.

• These building blocks are necessary to enable both the private and 

public sectors to implement interoperable health information systems 

and to provide a foundation for efforts in later phases, such as

personal health records and biosurveillance.

• However, HHS has not established milestones for the completion of phase 

I, nor has it defined or made plans for phases II and III.
Appendix I

National Health Information Technology 

Strategy

Page 36 GAO-05-628 HHS National Health IT Strategy

31

National Health IT Strategy

Framework for Strategic Action 

• According to officials with the Office of the National Coordinator for Health 

IT, the office is in the process of establishing milestones for the completion 

of phase I but has not made plans for phases II and III because HHS has 

not formalized the organization or funding for future activities.

• Without defined milestones it remains unclear when the important activities 

of phase I will be completed and when the building blocks to support 

activities of the subsequent phases will be available.

• The following slides describe the framework’s 4 goals and 12 strategies 

and key HHS IT initiatives that support the phase I goals.
Appendix I

National Health Information Technology 

Strategy

Page 37 GAO-05-628 HHS National Health IT Strategy

32

National Health IT Strategy

Framework for Strategic Action

Goals Strategiesa

1. Unify public health surveillance architectures

2. Streamline quality and health status monitoring

3. Accelerate research and dissemination of evidence

Goal 4: Improve public health through 

advanced biosurveillance methods and 

streamlined collection of data for quality 

measurement and research

1. Encourage use of personal health records

2. Enhance informed consumer choice

3. Promote use of telehealth systems

Goal 3: Personalize care with consumer-based 

health records and better information for 

consumers

1. Foster regional collaborations

2. Develop a national health information network

3. Coordinate federal health information systems

Goal 2: Interconnect clinicians so that they can 

exchange health information using advanced 

and secure electronic communication

1. Incentivize EHR adoption

2. Reduce risk of EHR investment

3. Promote EHR diffusion in rural and underserved areas

Goal 1: Inform clinical practice with the use of 

EHRs

Source: GAO analysis of HHS information.

a Phase I strategies are shown in bold type.
Appendix I

National Health Information Technology 

Strategy

Page 38 GAO-05-628 HHS National Health IT Strategy

33

National Health IT Strategy

Phase I: Standards for EHRs

• HHS is working with the private sector to develop standards for EHR 

functionality, interoperability, and security in order to reduce the risk of 

EHR implementation failure, a goal 1 strategy.

• In July 2004, three leading health care industry associations—the 

Health Information and Management Systems Society, American 

Health Information Management Association, and National Alliance for 

Health IT—established a private sector task force to develop 

certification requirements for ambulatory EHRs.

• The Certification Commission for Health IT is made up of private

sector and not-for-profit members with federal employees serving 

as experts on the commission’s work groups. 

• The committee plans to define a basic certification process for 

EHRs in ambulatory settings by summer 2005.
Appendix I

National Health Information Technology 

Strategy

Page 39 GAO-05-628 HHS National Health IT Strategy

34

National Health IT Strategy

Phase I: HHS Support for Regional Collaborations

• Currently, there are two HHS programs to support regional collaborations

through grants and contracts.

• In October 2004, AHRQ announced $139 million in multi-year grants 

and contracts to promote the use of health IT, including five-year 

contracts to five states to help them develop statewide networks.

• HRSA’s Office for the Advancement of Telehealth provides seed 

money and support to multi-stakeholder collaboratives within 

communities to implement regional health information organizations. 

It provided $2.3 million in 2004.

• These programs support the goal 2 strategy to foster regional 

collaborations.

• The Office of the National Coordinator for Health IT plans to host an 

interoperability meeting with stakeholders this year to address requirements 

for regional organizations and the national health information network.
Appendix I

National Health Information Technology 

Strategy

Page 40 GAO-05-628 HHS National Health IT Strategy

35

National Health IT Strategy 

Phase I: National Health Information Network

• In November 2004, HHS issued a request for information (RFI) for ideas to 

develop a national health information network (NHIN)15—a goal 2 strategy.

• The network is intended to provide technologies for the secure 

movement of information used in the delivery of health care in the U.S 

integrated with public health surveillance and response, and shared 

within the public domain. 

• If implemented properly, the network should help achieve 

interoperability of health IT used in the mainstream delivery of health 

care in America, particularly pertaining to the information contained in 

or used by EHRs.

• A key component of a NHIN is the development of interoperability

standards and policies for diffusion into practice.

• The RFI addresses the goal to interconnect clinicians by seeking public 

comment and input regarding how widespread interoperability of health IT 

and health information exchange can be achieved. 15 The national health information network is now referred to as the nationwide health information network.
Appendix I

National Health Information Technology 

Strategy

Page 41 GAO-05-628 HHS National Health IT Strategy

36

National Health IT Strategy

Phase I: National Health Information Network

• The results of the RFI are intended to provide information for policy 

discussions inside and outside the government about possible methods by 

which widespread interoperability and health information exchange could 

be deployed and operated on a sustainable basis.

• HHS intends to explore the role of the federal government in facilitating 

deployment of a national health information network, how it could be 

coordinated with efforts to define a federal health architecture, and 

how it could be supported and coordinated by regional health 

information organizations.16

• The RFI also requests input regarding privacy and security 

considerations, including compliance with HIPAA rules and the role of 

the private sector in the construction and implementation of a NHIN.

• According to the national coordinator, HHS received over 500 responses 

and has convened a governmentwide task force made up of over 100 

people from 17 agencies to review the responses and produce a summary.

16 Regional health information organizations are multi-stakeholder collaboratives within communities that support health information exchange 

efforts.
Appendix I

National Health Information Technology 

Strategy

Page 42 GAO-05-628 HHS National Health IT Strategy

37

National Health IT Strategy 

Phase I: Federal Health Information Systems

• The office of the national coordinator is responsible for the Federal Health 

Architecture (FHA) program which is to define a framework and 

methodology for establishing the target architecture and standards for 

interoperability and communication throughout the federal health

community, supporting a goal 2 strategy to coordinate federal health 

information systems

• FHA was initiated in 2003 in HHS’s office of the chief information officer 

and was incorporated into the national coordinator’s office in 2004.

• FHA is intended to provide a structure for bringing HHS’s divisions and 

other federal departments together through its partners’ council,17 initially

targeting standards for enabling interoperability. 

• The FHA program is supported by four advisory work groups. 

• Appendix II includes descriptions of the FHA work groups and their 

responsibilities, followed by a table describing membership.

17 The FHA partners’ council includes almost 400 members from 15 agencies
Appendix I

National Health Information Technology 

Strategy

Page 43 GAO-05-628 HHS National Health IT Strategy

38

National Health IT Strategy 

Phase I: Federal Health Information Systems

• The FHA partners are responsible for improving coordination and 

collaboration on federal health IT solutions and investments and improving 

efficiency, standardization, reliability, and availability of health 

comprehensive information solutions.

• According to the national coordinator, there is a strong need for the 

federal government’s health information systems to be able to 

exchange data so that these systems become more efficient and costeffective.

• HHS plans to produce in September 2005 the first release of an 

information architecture for the federal health enterprise to enable 

collaboration and data sharing across the government and with various 

organizations, such as states and private entities.

• The first release will contain foundational elements to support the 

development and evolution of the full architecture which will occur 

over several years.
Appendix I

National Health Information Technology 

Strategy

Page 44 GAO-05-628 HHS National Health IT Strategy

39

National Health IT Strategy 

Phase I: Federal Health Information Systems

• The FHA’s Consolidated Health Informatics (CHI) initiative is focused on 

the adoption of health information interoperability standards, identification 

of gaps and additional work areas in domains without standards 

recommendations, and coordination with developers of health information 

interoperability standards to promote accessibility and distribution of 

adopted standards to support the FHA. 

• Consolidated Health Informatics was initiated in December 2001 as an 

OMB e-government project to establish federal health information 

standards to enable federal agencies to build interoperable health data 

systems.

• The project was incorporated into FHA in September 2004.
Appendix I

National Health Information Technology 

Strategy

Page 45 GAO-05-628 HHS National Health IT Strategy

40

National Health IT Strategy 

Phase I: Personal Health Records

• In January 2005, NCVHS held hearings on personal health records—a goal 

3 strategy to personalize care—and identified issues, some specifically 

related to the federal government.

• Issues discussed include privacy and information control, security of 

health information, legal issues, cost, and interoperability.

• Federal issues include the relationship of roles in and uses of personal 

health records to the larger health objectives of the federal 

government, such as (1) what costs agencies will face, (2) how the 

federal government should promote interoperability, and (3) whether 

there needs to be a standardized approach to a personal health record 

across all of the federal activities.

• The hearings also discussed broader issues such as ownership and control

of personal health information and policy issues such as access rights and 

authorization of usage.
Appendix I

National Health Information Technology 

Strategy

Page 46 GAO-05-628 HHS National Health IT Strategy

41

National Health IT Strategy 

Framework Support: Standards and Interoperability

• According to the national coordinator, the development of technically sound 

and robustly specified interoperability standards and policies is a key 

component of progress toward the implementation of a national strategy 

that provides interoperable health IT systems

• The development, approval, and adoption of standards for health IT is an 

ongoing, long-term process that supports multiple goals of the framework 

and includes federally mandated standards requirements (e.g., HIPAA) and 

a voluntary consensus process within a market-based health care industry.

• The use of some standards, such as those defined by HIPAA and MMA, is 

mandated by the federal government while others are defined by standards 

development organizations such as the American Association of Medical 

Instrumentation and the National Council for Prescription Drug Programs.

• The following graphic provides an overview of the highly complex

standards-setting process for health care data exchange in the United 

States.
Appendix I

National Health Information Technology 

Strategy

Page 47 GAO-05-628 HHS National Health IT Strategy

42

National Health IT Strategy

Framework Support: Standards and Interoperability

CONGRESS/GOVERNMENT 

AGENCIES

Legislation and Regulations

VOLUNTEERS

From professional societies, technical groups, firms, trade 

associations, consumer groups, and government agencies

U.S. MARKET PLACE

NIST

Interagency Committee on 

Standards Policy

AMERICAN NATIONAL 

STANDARDS INSTITUTE

Trade Associations and Medical 

Societies

Standards Development 

Organizations (SDO)

Includes: AAMI, ACS, X12N, HL7, 

IEEE,NCPDP, ASTM, DICOM, etc.

STANDARDS DEVELOPERS

VENDORS

USERS

Consumer or

Regulatory 

Authorities

International Organization 

for Standardization

NIST

Office of Standards 

Services

Manufacturers

Independent Laboratories

Product Certifiers

Quality System Registrars

De facto Standards

(company and industry)

Accreditation

and Recognition

Conformity

Assessment and 

Certification

Voluntary or 

Mandatory Standards

Mandatory

Standards

(government unique

or required by law)

Submit standards

for approval

Accredits the SDOs;

Requests new standards;

Oversees standard

development process

(1) FEDERALLY MANDATED STANDARDS (2) VOLUNTARY CONSENSUS PROCESS (3) MARKET DOMINANCE

Note: AAMI = American Association of Medical Instrumentation; ASC = Accredited Standards Committee; ASTM = American Society for Testing and Materials

DICOM = Digital Imaging and Communication in Medicine; HL7 = Health Level Seven; IEEE = Institute for Electrical and Electronics Engineers

NCPDP = National Council for Prescription Drug Programs; NIST = National Institute of Standards and Technology, (part of the Commerce Dept)

Source: Institute of Medicine, Patient Safety: Achieving a New Standard for Care (Washington, D.C..: 2004).

Federal role is highlighted

Overview of the Process to Set Standards for the Exchange of Health Care Data in the U.S.
Appendix I

National Health Information Technology 

Strategy

Page 48 GAO-05-628 HHS National Health IT Strategy

43

National Health IT Strategy 

Framework Support: Standards and Interoperability

• HHS identifies and researches standards that are defined by standards 

development organizations and determines which approved standards are 

appropriate for use in federal agencies’ health IT systems.

• According to an HHS official, the department has limited authority to 

mandate standards outside of the federal government, but, through the 

Consolidated Health Informatics initiative, is encouraging the 

implementation of standards within the federal government to provide a 

catalyst for the private sector to follow.

• Federal agencies agreed to endorse 20 domains of health data 

standards for information exchange as a model for the private sector, 

yielding 11 sets of standards to be used in federal IT architectures. 

• HHS is committed to supporting collaboration between the public and 

private sectors to develop, adopt, and certify standards.
Appendix I

National Health Information Technology 

Strategy

Page 49 GAO-05-628 HHS National Health IT Strategy

44

National Health IT Strategy 

Framework Support: Standards and Interoperability

• HHS divisions, such as AHRQ, CMS, NIH, CDC, and FDA, have been and 

continue to be responsible for selecting and adopting standards and are now 

included in the CHI initiative, supporting multiple goals of the framework.

• AHRQ and CMS are working on initiatives that support goal 1 of the 

framework.

• AHRQ is working to identify and establish clinical standards and research 

to help accelerate the adoption of interoperable health IT systems, 

including 

• industry clinical messaging and terminology standards,

• national standard nomenclature for drugs and biological products, and

• standards related to clinical terminology.

• CMS is responsible for identifying and adopting standards for 

e-prescribing and for implementing the administrative simplification 

provisions of HIPAA, including electronic transactions and code sets, 

security, and identifiers.
Appendix I

National Health Information Technology 

Strategy

Page 50 GAO-05-628 HHS National Health IT Strategy

45

National Health IT Strategy 

Framework Support: Standards and Interoperability

• NIH’s work on standards supports the framework’s goal 2.

• NIH’s National Library of Medicine (NLM) is working on the 

implementation of standard clinical vocabularies, including support for 

and development of selected standard clinical vocabularies to enable 

ongoing maintenance and free use within the United States’ health 

communities, both private and public.

• In 2003, NLM obtained a perpetual license for the Systematized 

Nomenclature of Medicine (SNOMED)18 standard and ongoing 

updates, making SNOMED available to U.S. users. 

• Other efforts at NLM include the uniform distribution and mapping 

of HIPAA code sets, standard vocabularies, and Health Level 719

code sets.

18 SNOMED is a nomenclature classification for indexing medical vocabulary, including signs, symptoms, diagnoses, and procedures. It 

was adopted as a CHI standard in May 2004.

19 HL7 is a standards development organization that creates message format standards for electronic exchange of health information.
Appendix I

National Health Information Technology 

Strategy

Page 51 GAO-05-628 HHS National Health IT Strategy

46

National Health IT Strategy 

Framework Support: Standards and Interoperability

• The Centers for Disease Control and Prevention (CDC), FDA, and NIH are 

working on standards-setting initiatives that support the framework’s goal 4.

• CDC, through its Public Health Information Network (PHIN) initiative, is 

working on the development of shared data models, data standards, 

and controlled vocabularies for electronic laboratory reporting and 

public health information exchange that are compatible with federal 

standards activities such as CHI. 

• FDA and NIH, together with the Clinical Data Interchange Standards 

Consortium, a group of over 40 pharmaceutical companies and clinical 

research organizations, have developed a standard for representing 

observations made in clinical trials, the Study Data Tabulation Model.

• In May 2003, we recommended to HHS that ongoing standards-setting 

organizations coordinate their efforts to define and implement health IT 

standards (GAO-03-139; see appendix I).
Appendix I

National Health Information Technology 

Strategy

Page 52 GAO-05-628 HHS National Health IT Strategy

47

National Health IT Strategy 

Framework’s Goals and Supporting HHS IT Initiatives

• In addition to those already described, other ongoing HHS IT initiatives 

support the framework’s goals.

• The following table lists key HHS IT initiatives for health IT by division and 

identifies the goals that they support. 

• Descriptions of each of the initiatives are included in appendix III.
Appendix I

National Health Information Technology 

Strategy

Page 53 GAO-05-628 HHS National Health IT Strategy

48

National Health IT Strategy 

Framework’s Goals and Supporting HHS IT Initiatives 

x Resource and Patient Management System IHS

x x Doctors’ Office Quality – IT

CMS

x Medicare Care Management Performance Demonstration

x Virtual Call Center

x VistA – Office EHR

x FDA Bar Coding for Prescription Products

x x Structured Product Labeling Program

x Public Health Information Network CDC

x x x x State and Regional Health IT Demonstrations

x x x x Health IT Resource Center

AHRQ

x Transforming Healthcare Quality Through IT

Goal 4

Improve Population 

Health

Goal 3

Personalize 

Care

Goal 2

Interconnect 

Clinicians

Goal 1

Inform Clinical 

Practice

Division Initiative

Source: GAO analysis of HHS information.
Appendix I

National Health Information Technology 

Strategy

Page 54 GAO-05-628 HHS National Health IT Strategy

49

National Health IT Strategy 

Framework’s Goals and Supporting HHS IT Initiatives 

x x Advancement of Telehealth Grants

x x x x National Health Information Network 

x x x Federal Health Architecture

x x x Consolidated Health Informatics

ONCHIT

x x Cancer Biomedical Informatics Grid 

NIH

x Grants for Research, Training, and Access to Informatics 

Resources

x x National Electronic Clinical Trials and Research Network

x Development and Implementation of Controlled Clinical 

Vocabularies

x x x x Shared Integrated Management Information Systems 

/Information and Communication Technology 

x x x x Health Communities Access Program

HRSA

x x Sentinel Centers Network

x x Patient Electronic Care System

x x Integrated Services Development Initiative

Goal 4

Improve Population 

Health

Goal 3

Personalize Care

Goal 2

Interconnect 

Clinicians

Goal 1

Inform Clinical 

Practice

Division Initiative

Source: GAO analysis of HHS information.
Appendix I

National Health Information Technology 

Strategy

Page 55 GAO-05-628 HHS National Health IT Strategy

50

National Health IT Strategy 

Framework Support: Private Sector Participation

• Certain private sector activities provide support for goals 1 and 2 of the 

framework.

• The private sector task force, the Certification Commission for Health 

IT, is working to develop certification procedures for EHRs, supporting 

goal 1.

• The Commission on Systemic Interoperability, which includes 

nationally recognized experts in the area of health IT, is charged by 

the Medicare Modernization Act to develop a comprehensive strategy 

for the adoption and implementation of health care IT interoperability 

standards, which supports goal 2.
Appendix I

National Health Information Technology 

Strategy

Page 56 GAO-05-628 HHS National Health IT Strategy

51

National Health IT Strategy 

Framework Support: Private Sector Participation

• HHS has supported and continues to support opportunities for private 

sector participation in establishing health care IT through grants and 

funding for demonstration projects through its divisions.

• HHS participates with the medical and public health communities,

academia, and health IT vendors through conferences and symposia.

• The national coordinator speaks at industry conferences that are

focused on identifying government incentives to encourage health IT 

adoption in private industry.

• HHS’s Secretarial Summit on Health IT held in July 2004 provided 

nongovernmental participants opportunities to make recommendations 

regarding incentives for health IT, population health, clinical research, 

and health IT governance.

• According to HHS, close collaboration between public and private sectors 

can develop new methods for improving care without creating unnecessary 

regulation and minimizing reporting burdens on private industry.
Appendix I

National Health Information Technology 

Strategy

Page 57 GAO-05-628 HHS National Health IT Strategy

52

Lessons Learned from VA and DOD

• DOD and VA experiences in implementing EHRs offer important lessons 

learned that could be used in developing and implementing a national 

health care effort. As providers and payers of health care services, DOD 

and VA’s lessons include

• Obtain full endorsement of top leadership

• Senior administrators and clinical leaders should share and 

communicate a common sense of urgency regarding the need for 

change.

• Senior leadership’s full endorsement, including support for funding, 

is critical to successfully implementing an electronic health record, 

promoting end-user support, and securing a usable product. 
Appendix I

National Health Information Technology 

Strategy

Page 58 GAO-05-628 HHS National Health IT Strategy

53

Lessons Learned from VA and DOD

• Implement an enterprise-wide communication plan

• EHR implementation entails organizational change and acceptance 

across the enterprise and at all organizational levels.

• System acceptance and support depend upon regular, effective 

communication, from executive leadership levels down through end

users.

• Keeping stakeholders informed of objectives, progress, problems 

encountered and resolved, lessons learned, and benefits is critical to 

setting realistic expectations and facilitating stakeholder buy-in.
Appendix I

National Health Information Technology 

Strategy

Page 59 GAO-05-628 HHS National Health IT Strategy

54

Lessons Learned from VA and DOD

• Recognize and address needs of the varied stakeholder communities

• A management/governance structure that represents the entire 

stakeholder community should be established, and reflect clearly

defined roles, responsibilities, and decision-making authority 

among the different levels of leadership.

• Users (i.e., clinicians, payers, and others) should have an early and 

integral role in defining a strategy to meet their needs, establish 

accountability for the initiative, and sustain long-term project 

success.

• Users should be actively involved in all project phases, including 

requirements definition, system design, development, testing, and 

implementation.
Appendix I

National Health Information Technology 

Strategy

Page 60 GAO-05-628 HHS National Health IT Strategy

55

Lessons Learned from VA and DOD

• Define and adopt common standards, terminology, and performance 

measures

• Early definition and adoption of common standards, terminology, 

and performance measures (communication, data, and security) 

and agreement on related implementation guidelines are essential

to achieving data quality and consistency, system interoperability, 

and information protection.

• Deploy in small increments and build on success 

• Follow an incremental system development approach to 

accommodate evolving business processes, requirements, and 

technology changes; limit initial deployment to a few test sites to 

allow time for the process to mature, and assimilate lessons 

learned before full deployment.
Appendix I

National Health Information Technology 

Strategy

Page 61 GAO-05-628 HHS National Health IT Strategy

56

Lessons Learned from VA and DOD

• Customize training and support to sustain system implementation

• Establish training programs that are tailored to meet the needs of 

the varied users’ groups. On-site clinical champions and subjectmatter experts should be identified and empowered to promote and

demonstrate the new system to other personnel and provide 

ongoing technical assistance. 
Appendix I

National Health Information Technology 

Strategy

Page 62 GAO-05-628 HHS National Health IT Strategy

57

Lessons Learned from Other Countries

Canada, Denmark, and New Zealand

• While the U.S. has just begun to develop a national strategy for health IT 

adoption, Canada and Denmark have developed national strategies and 

begun to take steps toward implementation, and New Zealand plans to 

finalize its strategy in June 2005.

• Canada finalized its strategy in 2004 and is a year into implementation.

• Denmark finalized its strategy in February 2003 and is 2 years into a 

4-year implementation plan.

• New Zealand has prioritized six initiatives to be implemented in the 

next 3 to 5 years.

• These countries are farther along in their strategy development and 

implementation than the U.S. and are able to share lessons learned from 

their experiences.
Appendix I

National Health Information Technology 

Strategy

Page 63 GAO-05-628 HHS National Health IT Strategy

58

Lessons Learned from Other Countries

Overview of Canada’s Health Care System

• The Canadian health care system supports publicly financed health for 

over 31 million people.

• The federal government is responsible for direct health service delivery to 

veterans, native Canadians living on reserves, military personnel, inmates 

of federal penitentiaries, and the Royal Canadian Mounted Police, as well 

as health protection, disease prevention, and health promotion services.

• The administration and delivery of health care services is the responsibility 

of each province or territory, guided by the provisions of the Canada Health 

Act. The provinces and territories fund these services with assistance from 

the federal government in the form of fiscal transfers. 

• Canada Health InfoWay is working with the provinces and territories to 

advance the IT building blocks needed for the health care system. 

• Canada Health InfoWay is a corporation whose board of directors is 

made up of representatives from all of the provinces and territories, as 

well as elected representatives. 
Appendix I

National Health Information Technology 

Strategy

Page 64 GAO-05-628 HHS National Health IT Strategy

59

Lessons Learned from Other Countries

Lessons Learned from Canada

Lessons Learned

• Focus on creating standards first.

• Recognize that creating a health IT infrastructure takes years, and benefits 

may not be realized in the short term.

• Identify a central visible point to provide political advocacy and highlight the 

achievements of health IT as work progresses to help maintain support for 

long-term projects. 

• Identify and provide appropriate incentives based on provincial and 

territorial elements to motivate physicians to use IT.

• Proactively resolve issues related to privacy protection. 

• Anticipate and mitigate border-crossing issues with implementing 

telehealth, such as issues with licensing arrangements and cross-border 

reimbursements.
Appendix I

National Health Information Technology 

Strategy

Page 65 GAO-05-628 HHS National Health IT Strategy

60

Lessons Learned from Other Countries

Overview of Denmark’s Health Care System

• The Danish health care system serves a population of 5.3 million people 

and is 85% tax-financed. 

• At the national level, the Ministry of Health is responsible for legislation and 

preparing overall guidelines for the health care sector, and the National 

Board of Health is responsible for supervising health personnel.

• The regional level consists of 14 counties and the Copenhagen Hospital 

Corporation. The counties own and run hospitals and prenatal care centers 

and finance general and specialist practitioners, pharmacies and

physiotherapists through the National Health Security System.

• The responsibility for the municipal level includes nursing homes, home 

nursing, health visitors, and school health services. 
Appendix I

National Health Information Technology 

Strategy

Page 66 GAO-05-628 HHS National Health IT Strategy

61

Lessons Learned from Other Countries

Overview of Denmark’s Health Care System

• Denmark’s National Strategy for IT in Health Care 2003 - 2007 was 

finalized in February 2003. 

• It states that the most important reasons for increasing the use of IT in 

health care are related to the improvement of quality, efficiency, and 

effectiveness of health care delivery. 

• Three major initiatives of the National Strategy are

• coordinated development, testing, and implementation of EHRs,

• a national database to organize health care terms and concepts, 

and

• concept classifications to facilitate communications across sectors 

and professions in health care.
Appendix I

National Health Information Technology 

Strategy

Page 67 GAO-05-628 HHS National Health IT Strategy

62

Lessons Learned from Other Countries

Lessons Learned from Denmark

Lessons Learned

• Implementation of health IT across the entire country will take a long time.

• Involve health care service providers throughout the entire implementation 

process.

• A very strong central organization must lead the entire health IT 

implementation from start to finish.

• Integrate federal efforts with hospitals before undertaking a larger national 

plan. 

• Anticipate and resolve funding, IT process reengineering, consensusbuilding, and other issues during the planning phase to avoid negative 

impacts on progress. 

• Realize that the investment in health care IT is costly, and short-term gains 

are hard to identify. 

• Promote successes as soon as possible to encourage acceptance by

stakeholders. 
Appendix I

National Health Information Technology 

Strategy

Page 68 GAO-05-628 HHS National Health IT Strategy

63

Lessons Learned from Other Countries

Overview of New Zealand’s Health Care System

• The New Zealand health care system serves a population of 4 million 

people. 

• At the national level, the Ministry of Health provides policy advice on 

improving health outcomes and monitors the performance of the district 

health boards.

• The regional level consists of 21 district health boards. Each district health 

board has up to 11 members, seven of which are elected by the community 

and up to four of which are appointed by the Minister of Health.

• District health boards are responsible for planning, funding and

ensuring the provision of health and disability services to a 

geographically defined population.
Appendix I

National Health Information Technology 

Strategy

Page 69 GAO-05-628 HHS National Health IT Strategy

64

Lessons Learned from Other Countries

Overview of New Zealand’s Health Care System

• New Zealand is currently redeveloping its health information strategy, 

which is expected to be complete by June 2005.

• The draft strategy identifies 12 action zones for implementation planning 

over the next 3 to 5 years; six were selected as initial priorities:

• Enable secure connections and access to health information

• Ensure national systems anchors (such as the National Health Index) 

are in place

• Create and publish accessible key event summaries 

• Expand the level of electronic communication across primary and 

secondary care

• Extend the collection of health information

• Safe Access to National Information within the context of the Health 

Information Privacy Code is essential for the support of population 

health 
Appendix I

National Health Information Technology 

Strategy

Page 70 GAO-05-628 HHS National Health IT Strategy

65

Lessons Learned from Other Countries

Lessons Learned from New Zealand

Lessons Learned

• The distributed government model that governs New Zealand’s health care 

system works best.

• High level EHR components that can be shared and accessed encourage 

greater coordination of health services.

• Provide adequate funding for and prioritize the initiatives

• Educate stakeholders about the value of developing health IT to encourage 

stakeholder buy-in.
Appendix I

National Health Information Technology 

Strategy

Page 71 GAO-05-628 HHS National Health IT Strategy

66

Lessons Learned from Other Countries

Overview of the United Kingdom’s Health Care System

• The United Kingdom’s Department of Health is responsible for setting 

health and social care policy in England; health services are largely taxfinanced in the United Kingdom and account for 14 per cent of general 

government spending.

• In summer 2002, the government set up the National Programme for IT 

(NPfIT) which defines four main projects to be introduced in stages across 

different regions:

• Electronic Patient Records

• Electronic Appointment Booking

• Electronic Transmission of Prescriptions

• Communications Network

• NPfIT plans to have electronic booking substantially in place and to have 

50% of prescriptions transmitted electronically by the end of 2005.

• We could not identify lessons learned from the United Kingdom’s efforts 

based upon publicly available information.
Appendix I

National Health Information Technology 

Strategy

Page 72 GAO-05-628 HHS National Health IT Strategy

67

Conclusions

• Since establishing the Office of the National Coordinator for Health IT, HHS 

has made progress toward coordinating federal health IT efforts and 

reaching out to private industry.

• However, coordination of standards development and adoption activities 

throughout the health care industry, including federal efforts to accelerate 

the process, remains a challenge.

• HHS has not made long-term plans or established milestones for the 

implementation of a national strategy to accelerate the adoption of IT 

across the health care industry.
Appendix I

National Health Information Technology 

Strategy

Page 73 GAO-05-628 HHS National Health IT Strategy

68

Conclusions

• DOD’s and VA’s experiences in implementing EHR systems offer important 

lessons learned that may be applied to HHS’s efforts to help increase the 

likelihood that interoperable EHRs could be available in the next ten years.

• The United States could benefit from other countries’ experiences and 

lessons learned from their efforts toward modernizing their health IT 

infrastructures.

• The National Coordinator for Health IT recognizes DOD’s and VA’s efforts 

and works closely with them to share lessons learned from their 

experiences with implementing health IT. 

• The national coordinator has recently initiated discussions with other 

countries to also learn from their experiences in modernizing health 

information infrastructures.
Appendix I

National Health Information Technology 

Strategy

Page 74 GAO-05-628 HHS National Health IT Strategy

69

Recommendation

To accelerate the adoption of interoperable IT for health care, we recommend 

that the Secretary of HHS

• establish detailed plans and milestones for each phase of the 

framework for strategic action, and

• take steps to ensure that plans are followed and milestones are met.
Appendix I

National Health Information Technology 

Strategy

Page 75 GAO-05-628 HHS National Health IT Strategy

70

Agency Comments

We requested comments from HHS, DOD, and VA on a draft of these briefing 

slides.

• HHS did not provide comments.

• DOD’s Chief Enterprise Architect for Military Health System provided 

written technical comments, which we incorporated as appropriate.

• VA’s Acting Deputy Chief Information Officer for Health provided oral 

comments and agreed with the information presented.
Appendix I

National Health Information Technology 

Strategy

Page 76 GAO-05-628 HHS National Health IT Strategy

71

Appendix I

Recent GAO Reports on Health IT

• Health and Human Services’ Estimate of Health Care Cost Savings Resulting from the Use 

of Information Technology (GAO-05-309R; February 17, 2005): We reported that IT can 

improve the efficiency and quality of medical care and result in costs savings and that, although 

estimated nationwide savings are primarily based on studies with methodological limitations and 

are contingent on much higher IT adoption rates than are currently estimated, the potential for 

substantial savings is promising.

• Health Care: HHS’s Efforts to Promote Health Information Technology and Legal Barriers 

to its Adoption (GAO-04-991R; August 13, 2004): We identified major HHS IT initiatives and 

associated funding, and reported that attempts by the federal government to address legal issues 

that present barriers to the widespread use of IT have not been sufficient.

• Health Care: National Strategy Needed to Accelerate the Implementation of Information 

Technology, (GAO-04-947T; July 14, 2004): We reported that it will be essential to have 

continued leadership, clear direction, measurable goals, and mechanisms to monitor progress of 

the implementation of a national strategy for health IT.

• Computer-Based Patient Records: VA and DOD Efforts to Exchange Health Data Could 

Benefit from Improved Planning and Project Management, (GAO-04-687; June 7, 2004):

To help ensure progress in achieving the two-way exchange of health information, we 

recommended that VA and DOD develop an architecture for an electronic interface between their 

health systems and establish a project management structure to guide the initiative.
Appendix I

National Health Information Technology 

Strategy

Page 77 GAO-05-628 HHS National Health IT Strategy

72

Appendix I 

Recent GAO Reports on Health IT

• Computer-Based Patient Records: Improved Planning and Project Management Are Critical 

to Achieving Two-Way VA-DOD Health Data Exchange, (GAO-04-811T; May 19, 2004): 

We testified that DOD and VA were continuing with activities to support the sharing of health data; 

nonetheless, achieving the two-way electronic exchange of patient health information remained 

far from being realized.

• Computer-Based Patient Records: Sound Planning and Project Management Are Needed 

to Achieve A Two-Way Exchange of VA and DOD Health Data (GAO-04-402T; March 17, 

2004): We testified that DOD and VA had made little progress since November 2003 in 

determining an approach for achieving two-way exchange of patient data and reported that DOD 

and VA have taken measures towards implementing prior recommendations for enhancing 

management and accountability.

• Computer- Based Patient Records: Short-Term Progress Made But Much Work Remains to 

Achieve A Two-Way Data Exchange Between VA and DOD Health Systems (GAO-04-271T; 

November 19, 2003): We testified that DOD and VA faced challenges in exchanging 

standardized data and that a common health information infrastructure and architecture was 

needed to achieve data exchange capability.
Appendix I

National Health Information Technology 

Strategy

Page 78 GAO-05-628 HHS National Health IT Strategy

73

Appendix I 

Recent GAO Reports on Health IT

• Information Technology: Benefits Realized for Selected Health Care Functions ( GAO-04-

224, October 31, 2003): We reported significant improvements in health care delivery and

financial benefits realized from the nation’s health care community’s implementation of health IT, 

including cost savings resulting from VA’s and DOD’s implementation of health IT.

• Bioterrorism: Information Technology Strategy Could Strengthen Federal Agencies’ 

Abilities to Respond to Public Health Emergencies (GAO-03-139; May 30, 2003):

We recommended that HHS coordinate with DHS, DOD, and VA to establish a national IT 

strategy, and that ongoing standards-setting organizations coordinate their efforts to define and 

implement health IT standards.

• Computer Based Patient Records: Better Planning and Oversight by VA, DOD, and IHS 

Would Enhance Health Data Sharing (GAO-01-459; April 30, 2001): We recommended that 

DOD, VA, and IHS create comprehensive and coordinated plans to ensure that the agencies can 

share patient health data, including performance measures and use of existing IT capabilities.
Appendix I

National Health Information Technology 

Strategy

Page 79 GAO-05-628 HHS National Health IT Strategy

74

Appendix II

Responsibilities of FHA Work Groups

• Food safety: recommend a target, business architecture to serve as the 

framework for developing and implementing systems which support the 

food safety business government-wide

• Interoperability: recommend target technical standards for interoperability 

across the health line of business. 

• EHR: recommend a target, health care services electronic health record 

business architecture, a component of the health lines of business, to serve 

as framework within the federal sector for developing and implementing an 

electronic health record. 

• Public health surveillance: recommend a target architecture related to 

the health line of business to serve as the framework within the federal 

sector for developing and implementing public health surveillance systems. 
Appendix I

National Health Information Technology 

Strategy

Page 80 GAO-05-628 HHS National Health IT Strategy

75

Appendix II 

FHA Work Groups’ Members and Leaders

Federal Membership Electronic Health Record Food Safety Interoperability Public Health Surveillance

FHA Work Groups

HHS Divisions

NIH z

USAID

USPS

USDA

VA

State

SSA

OMB

Commerce/NIST

NASA

Justice

EPA

DOE

DOD

DHS

Other Federal Agencies

ONCHIT

IHS

HRSA

FDA

CMS

CDC

AHRQ

z



z

z

z

z



z

z

z

z



z

z

z

z

z

z

z



z

z

z

z

z

z

z

z

z

z

z

z



z

z

z

z

z

z

z

z



z

z

z

z

z

z

z

z

z

z

z



z

Source: HHS Co-lead agencies are indicated by 
Appendix I

National Health Information Technology 

Strategy

Page 81 GAO-05-628 HHS National Health IT Strategy

76

Appendix III

Descriptions of Key HHS IT Initiatives

Bar Coding for Prescription Products An initiative to standardize bar code labels. $0

FDA

$4,000,000

Supports health IT initiatives such as electronic prescribing and decision support by 

providing standards for medication terminology and information found in approved FDA 

drug labels or package inserts in a computer-readable format.

Structured Product Labeling Program

$4,000,000 A project to modify and repackage VistA (the VA’s EHR software) for the physician office 

setting.

VistA-Office EHR

$20,750,000 A project to improve beneficiary telephone customer service through the implementation 

of various web-based initiatives for efficient and effective handling of all types of inquiries. 

Virtual Call Center pilots

$4,965,664 A contract solicitation to establish and implement state and regional demonstrations of 

interoperable health information systems.

State and Regional Health IT 

Demonstrations

A 3-year, pay-for-performance pilot with physicians to promote the adoption and effective 

use of HIT to improve the quality of patient care for chronically ill Medicare patients. 

A special study to develop an approach to promoting adoption and use of information 

technologies in the physician office and reporting of information to Quality Improvement 

Organizations (QIOs).

An initiative between CDC and its public and private partners to advance software 

components and data, and technical specifications that are compatible with federal 

standards activities such as CHI, NCVHS, and eGov. 

A state-of-the-art service center for grantees and organizations that are engaged in 

health IT diffusion activities (research, diffusion, or adoption).

A series of three grant programs released in FY04 that include 1) demonstrating the 

value of HIT, 2) planning grants for future HIT implementations, and 3) providing HIT 

implementation grants for partnerships of three or more entities.

Description

$354,531

not determined

$10,000,000

$3,533,885

$25,630,246

FY 05 

Funding

Doctors' Office Quality - Information 

Technology

CMS

Medicare Care Management 

Performance Demonstration

Public Health Information Network 

CDC

Transforming Healthcare Quality 

through IT

AHRQ Health Information Technology 

Resource Center

Divisions IT initiative

Source: HHS divisions.
Appendix I

National Health Information Technology 

Strategy

Page 82 GAO-05-628 HHS National Health IT Strategy

77

Appendix III

Descriptions of Key HHS IT Initiatives

Grants for support of community-based activities in informatics, electronic health not determined

records, and telemedicine, including telepharmacy.

Office for the Advancement of 

Telehealth grants

The hospital information system utilized by 49 hospitals, 221 health centers, 120 $36,166,000

health stations, and 170 Alaska village clinics. It includes IHS-EHR which provides 

order entry, results reporting, encounter documentation, and other clinical functionality 

to IHS, tribal, and urban Indian health care providers. 

Resource and Patient Management 

IHS System

$697,000 (SIMIS)

$4,988,000 (ICT)

Provides hardware, software, and support services for integration of practices 

management systems among federally supported health centers, and integration of 

electronic health records with practice management systems at consolidated health 

centers.

Shared Integrated Management 

Information Systems / Information 

and Communication Technology

Invests in the information systems of participant health centers and networks to $870,000

provide timely, patient-level data to inform policy decisions and quality improvement 

activities across all health centers.

Sentinel Centers Network 

Enables health centers to electronically track clinical information on patients, that $652,000

would otherwise only be captured in the patient’s medical chart..

Patient Electronic Care System

A clinical network providing support to physicians who are on their way to an $5,555,000

electronic health record by encouraging people to work together.

Integrated Services Development 

Initiative

$76,500,000 

(not all for health 

IT)

A community-based program to develop or strengthen health care safety net delivery 

systems through providing an infrastructure that will coordinate health care for the 

uninsured. Development of information systems is fundamental to supporting 

coordination of efforts that increase access to care.

Healthy Communities Access 

Program

HRSA

Description

FY 05

Funding

Divisions IT initiative

Source: HHS divisions.
Appendix I

National Health Information Technology 

Strategy

Page 83 GAO-05-628 HHS National Health IT Strategy

78

Appendix III

Descriptions of Key HHS IT Initiatives

included in 

FHA

A project that establishes federal health information interoperability standards as the 

basis for electronic health data transfer in all activities and projects and among all 

agencies and departments.

Consolidated Health Informatics

ONCHIT

A project that defines an overarching framework and methodology that allows initiatives $5,500,000

throughout several federal agencies to proceed coherently, establishing the target and 

standards for interoperability and communication that will unify the federal health 

community.

Federal Health Architecture

A network of health IT intended to provide low-cost and secure movement of not determined

information used in the delivery of health care in the U.S.; be HIPAA-compliant, 

integrated with public health surveillance and response, and shared within the public 

domain; adhere to standards for interoperability to support rapid adoption of 

interoperable EHRs; and be coordinated and interoperable with the FHA. ONCHIT’s

review of RFI responses will help further define the NHIN.

National Health Information Network

A project that includes uniform distribution and mapping of HIPAA code sets, CHI $5,600,000

standard vocabularies, HL7 code sets, and other important vocabularies.

Development and Implementation of 

Controlled Clinical Vocabularies

A network which will link research sites and create a “national network of networks” in $16,769,000

coordination with the national health information network, by which research information 

and findings will be shared and scientific collaborations facilitates. 

National Electronic Clinical Trials and 

Research Network

A virtual cancer research network of interconnected data, individuals, and organizations $30,000,000

that will create a common, widely distributed infrastructure that facilitates th e sharing of 

data and applications, enhancing research productivity and efficiency of research. The 

infrastructure is based on CHI standards and is composed of HHS-established 

controlled vocabularies, standard data elements, and domain models.

Cancer Biomedical Informatics Grid

NIH

Grant programs that provide incentives for health information exchange, such as 

technology support, training, and access to digital libraries. 

Description

Grants for research, training, and $40,000,000

access to informatics

FY 05

Funding Divisions IT Initiative

Source: HHS divisions.
Page 84 GAO-05-628 HHS National Health IT Strategy

Appendix II

Comments from the Department of Health and Apendxies

Human Services ApendxiI
Appendix II

Comments from the Department of Health 

and Human Services

Page 85 GAO-05-628 HHS National Health IT Strategy

M
Appendix II

Comments from the Department of Health 

and Human Services

Page 86 GAO-05-628 HHS National Health IT Strategy
Appendix II

Comments from the Department of Health 

and Human Services

Page 87 GAO-05-628 HHS National Health IT Strategy
Page 88 GAO-05-628 HHS National Health IT Strategy

Appendix III

Comments from the Department of Veterans 

Affairs ApendxiI

(310475)
GAO’s Mission The Government Accountability Office, the audit, evaluation and 

investigative arm of Congress, exists to support Congress in meeting its 

constitutional responsibilities and to help improve the performance and 

accountability of the federal government for the American people. GAO 

examines the use of public funds; evaluates federal programs and policies; 

and provides analyses, recommendations, and other assistance to help 

Congress make informed oversight, policy, and funding decisions. GAO’s 

commitment to good government is reflected in its core values of 

accountability, integrity, and reliability.

Obtaining Copies of 

GAO Reports and 

Testimony

The fastest and easiest way to obtain copies of GAO documents at no cost 

is through GAO’s Web site (www.gao.gov). Each weekday, GAO posts 

newly released reports, testimony, and correspondence on its Web site. To 

have GAO e-mail you a list of newly posted products every afternoon, go to 

www.gao.gov and select “Subscribe to Updates.”

Order by Mail or Phone The first copy of each printed report is free. Additional copies are $2 each. 

A check or money order should be made out to the Superintendent of 

Documents. GAO also accepts VISA and Mastercard. Orders for 100 or 

more copies mailed to a single address are discounted 25 percent. Orders 

should be sent to:

U.S. Government Accountability Office

441 G Street NW, Room LM

Washington, D.C. 20548

To order by Phone: Voice: (202) 512-6000 

TDD: (202) 512-2537 

Fax: (202) 512-6061

To Report Fraud, 

Waste, and Abuse in 

Federal Programs

Contact:

Web site: www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470

Congressional 

Relations

Gloria Jarmon, Managing Director, JarmonG@gao.gov (202) 512-4400

U.S. Government Accountability Office, 441 G Street NW, Room 7125 

Washington, D.C. 20548

Public Affairs Paul Anderson, Managing Director, AndersonP1@gao.gov (202) 512-4800

U.S. Government Accountability Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548