United States Government Accountability Office

GAO Testimony

Before the Subcommittee on Federal 

Workforce and Agency Organization, 

Committee on Government Reform, 

House of Representatives 

HEALTH INFORMATION 

TECHNOLOGY 

For Release on Delivery 

Expected at 3:15 p.m. EST

March 15, 2006

HHS is Continuing Efforts 

to Define a National 

Strategy 

Statement of David A. Powner 

Director, Information Technology Management Issues 

GAO-06-346T 
Abbreviations 

CHCS Composite Health Care System 

CMS Centers for Medicare and Medicaid Services 

Community American Health Information Community 

DOD Department of Defense 

EHR electronic health record 

HHS Department of Health and Human Services 

IT information technology 

NIST National Institute for Standards and Technology 

ONC Office of the National Coordinator for Health

Information Technology 

OPM Office of Personnel Management 

VA Department of Veterans Affairs 

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What GAO Found

United States Government Accountability Office

Why GAO Did This Study

Highlights

Accountability Integrity Reliability

March 15, 2006

HEALTH INFORMATION TECHNOLOGY

HHS is Continuing Efforts to Define a 

Highlights of GAO-06-346T, a report to National Strategy 

Subcommittee on Federal Workforce and 

Agency Organization, Committee on 

Government Reform, House of 

Representatives 

As GAO and others have reported,

the use of information technology 

(IT) has enormous potential to 

improve the quality of health care

and is critical to improving the

performance of the U.S. health care

system. Given the federal

government’s influence in the 

health care industry, it has been 

urged over the years to take a 

leadership role in driving change to 

improve the quality and 

effectiveness of medical care,

including the adoption of IT. In

April 2004, President Bush called 

for widespread adoption of interoperable electronic health records

within 10 years; established the 

position of the National 

Coordinator for Health IT, who was

appointed in May 2004 and released

a framework for strategic action

two months later. In May 2005, 

GAO recommended that HHS 

establish detailed plans and

milestones for each phase of the 

framework and take steps to 

ensure that those plans are

followed and milestones are met. 

HHS agreed with our 

recommendation. 

GAO (1) assessed the progress 

being made by the Department of

Health and Human Services (HHS)

since 2005 to develop a national 

health IT strategy and (2) provided

an overview of selected federal

agencies’ health IT initiatives 

related to the national health IT

strategy. 

HHS has continued efforts to develop a national health IT strategy. For 

example, HHS—through the Office of the National Coordinator for Health 

IT—has established the organizational structure of the office and awarded 

$42 million in contracts intended to advance the use of health IT. These 

contracts address a range of issues important to encouraging the adoption of 

IT such as reviewing standards activities for gaps and duplication (see 

table). In addition, HHS has established the American Health Information 

Community to obtain public and private sector input on how to make health 

records digital and achieve interoperability for health information exchange. 

HHS intends to use the results of the contracts and the Community 

proceedings to define future direction. Key HHS divisions also continue 

funding and supporting the development of health IT initiatives that support 

the goals of the framework. According to the National Coordinator, he 

intends to release a strategic plan with detailed plans and milestones later 

this year. 

Health IT Contracts Awarded by HHS’s Office of the National Coordinator 

Contract 

Date 

Awarded Duration Cost Description

Standards

Harmonization 

Process

September 

2005 

1 year $3.2 million To develop and test a process for 

identifying, assessing, endorsing, and 

maintaining a set of standards required for 

interoperable health information exchange.

Compliance 

Certification 

Process

September 

2005 

1 year $2.7 million To develop and evaluate a compliance 

certification process for health IT, including 

the infrastructure components through 

which these systems interoperate. 

Privacy and

Security

September 

2005 

11⁄2 years $11.5 

million 

To assess and develop plans to address 

variations in organization-level business 

policies and state laws that affect privacy 

and security practices, which may pose 

challenges to health information exchange.

National Health 

Information 

Network 

Prototypes 

November 

2005 

1 year $18.6 

million; 

4 contracts 

To develop and evaluate prototypes for a 

nationwide health information network 

architecture for widespread health 

information exchange. 

Several federal agencies collaborating with HHS—namely, the Departments 

of Veterans Affairs, Defense, and Commerce, and the Office of Personnel 

Management— also have responsibility for their own health IT initiatives 

related to the national health IT strategy. These agencies participate in the 

American Health Information Community. Veterans Affairs and Defense play 

critical roles in the advancement of electronic health records, which they 

have developed and are implementing in their facilities. The Office of 

Personnel Management is attempting to use its position as one of the largest 

purchaser of employee health care benefits by encouraging its carriers to use

applications such as enabling a physician to transmit a prescription 

electronically to a patient’s pharmacy of choice. The National Institute for 

Standards and Technology is also providing technical expertise in the 

standards development and harmonization process and established a Web 

site to assist in standards development efforts.

www.gao.gov/cgi-bin/getrpt?GAO-06-346T.

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 or

pownerd@gao.gov. 
Mr. Chairman and Members of the Committee: 

I am pleased to be here today to comment on federal efforts to 

advance the use of information technology (IT) for health care 

delivery and public health. As we and others have reported, the use 

of IT has enormous potential to improve the quality of health care 

and is critical to improving the performance of the U.S. health care 

system. The federal government has been working to promote the 

use of IT in public and private health care settings. With the growing 

momentum behind a national health IT strategy, leveraging federal 

efforts is an important component of this strategy. Several federal 

agencies are collaborating with the Department of Health and 

Human Services (HHS)—namely, the Departments of Veterans 

Affairs, Defense, and Commerce, and the Office of Personnel 

Management—as it works toward developing a national strategy to 

advance the use of health IT. 

At your request, today we will (1) discuss our assessment of the 

progress being made since 2005 by HHS’s Office of the National 

Coordinator for Health IT and other key divisions toward the 

development of a national IT strategy and (2) provide an overview of 

selected federal agencies’ initiatives related to the national health IT 

strategy. In preparing this statement, we reviewed agency 

documents that describe the current status of HHS’s and other 

federal agencies’ activities related to a health IT strategy and 

supplemented our analysis with interviews of agency officials. We 

also summarized our prior reports. Our work was performed in 

accordance with generally accepted auditing standards. 

Results in Brief 

HHS—through the Office of the National Coordinator for Health 

IT—has continued efforts to define a national health IT strategy. 

HHS has established the organizational structure of the Office of the 

National Coordinator and awarded about $42 million in contracts 

intended to advance the adoption of health IT. These contracts 

address a range of issues important in advancing the use of IT, such 

as reviewing standards activities for gaps and duplication and 

reviewing privacy and security laws across federal and state 

Page 1 GAO-06-346T
governments. In addition, the Secretary of HHS has established an 

advisory body called the American Health Information Community 

to obtain public and private sector input. The Community, 

composed of representatives from federal agencies and the private 

sector, began meeting in October 2005 to advise HHS on how to 

make health records digital and achieve interoperability for health 

information exchange. HHS plans to use the results of the contracts 

and the Community proceedings to define future direction. HHS also 

has other important health IT programs and initiatives, such as the 

demonstration grants awarded by the Agency for Healthcare 

Research and Quality and the Centers for Disease Control and 

Prevention’s Public Health Information Network. These initiatives 

are intended to address a variety of issues to accelerate and 

encourage the adoption of health IT across the health care industry 

and support the goals of the framework for strategic action. 

According to the National Coordinator, he intends to release a 

strategic plan later this year that will guide the nationwide 

implementation of interoperable health IT by establishing 

milestones and performance metrics. 

Several federal agencies collaborating with HHS—namely, the 

Departments of Veterans Affairs, Defense, and Commerce, and the 

Office of Personnel Management—also have responsibility for their 

own initiatives related to the national health IT strategy. Many of 

these agencies, as well as a representative from the Department of 

the Treasury, participate in the American Health Information 

Community, HHS’s newly formed Health IT Policy Council, and the 

Federal Health Architecture.1

 Veterans Affairs and Defense, as 

major federal health care providers, play critical roles in the 

advancement of electronic health records (EHR). Veterans Affairs 

has developed and implemented an EHR system; Defense is still in 

the process of implementing one in their facilities. The Office of 

Personnel Management is planning to use its position as one of the 

 1

HHS’s Federal Health Architecture program is intended to define a framework and

methodology for establishing a target architecture and standards for interoperability and 

communication. An architecture describes an entity in both logical terms (e.g., interrelated 

functions, information needs and flows, work locations, systems, and applications) and 

technical terms (e.g., hardware, software, data, communications, and security). 

Page 2 GAO-06-346T
largest purchasers of employee health care benefits to encourage its 

carriers to use applications such as electronic prescribing.2

 When 

the agency issued its 2005 annual call letter to carriers last April, it 

requested that plans describe their health IT initiatives, including 

any currently in place for doctors and pharmacies to use electronic 

prescribing. The National Institute for Standards and Technology is 

also providing technical expertise, largely in the standards 

development and harmonization process, and has established a Web 

site containing information on health care standards, organizations, 

and resources to assist in standards development, implementation, 

and use by developers and other stakeholders. 

Background 

Studies published by the Institute of Medicine and others have 

indicated that fragmented, disorganized, and inaccessible clinical 

information adversely affects the quality of health care and 

compromises patient safety. In addition, long-standing problems 

with medical errors and inefficiencies increase costs for health care 

delivery in the United States. With health care spending in 2004 

reaching almost $1.9 trillion, or 16 percent of the gross domestic 

product, concerns about the costs of health care continue. As we 

reported last year, many policymakers, industry experts, and 

medical practitioners contend that the U.S. health care system is in

crisis.3

Health IT—the technology used to collect, store, retrieve, and 

transfer clinical, administrative, and financial health information 

electronically—is seen as a promising solution to improve patient 

safety and reduce inefficiencies. Hence, it has great potential to 

improve the quality of care, bolster preparedness of our public 

health infrastructure, and save money on administrative costs. As 

 2

Electronic prescribing enables a physician to transmit a prescription electronically to a 

patient’s pharmacy of choice. It decreases prescription errors caused by hard-to-read 

handwriting and automates the process of checking for drug interactions and allergies.

3

GAO, 21st Century Challenges: Reexamining the Base of the Federal Government, GAO05-325SP (Washington, DC: February 2005). 

Page 3 GAO-06-346T
we reported in 2003, technologies such as electronic health records4

and bar coding of certain human drug and biological product labels 

have been shown to save money and reduce medical errors.5

 For 

example, a 1,951-bed teaching hospital reported that it realized 

about $8.6 million in annual savings by replacing paper medical 

charts with electronic medical records for outpatients. This hospital 

also reported saving more than $2.8 million annually by replacing its 

manual process for handling medical records with electronic access 

to laboratory results and reports. Health care organizations also 

reported that IT contributed other benefits, such as shorter hospital 

stays, faster communication of test results, improved management 

of chronic diseases, and improved accuracy in capturing charges 

associated with diagnostic and procedure codes. 

However, according to HHS, only a small number of U.S. health care 

providers have fully adopted health IT as there are significant 

financial, technical, cultural, and legal barriers to its adoption. These 

include a lack of access to capital, a lack of data standards, and 

resistance from health care providers. 

Federal Government’s Role in Health Care 

According to the Institute of Medicine, the federal government has a 

central role in shaping nearly all aspects of the health care sector as 

a regulator, purchaser, health care provider, and sponsor of 

research, education, and training. Seven major federal health care 

programs, such as Medicare and Medicaid, provide health care 

services to approximately 115 million Americans. Table 1 

summarizes the number of citizens who receive health care services 

from the federal government and the cost of these services. 

 4

There is a lack of consensus on what constitutes an electronic health record (EHR), and 

thus multiple definitions and names exist for EHRs, depending on the functions included.

An EHR generally includes (1) a longitudinal collection of electronic health information

about the health of an individual or the care provided, (2) immediate electronic access to 

patient- and population-level information by authorized users, (3) decision support to

enhance the quality, safety, and efficiency of patient care, and (4) support of efficient 

processes for health care delivery. 

5

GAO, Information Technology: Benefits Realized for Selected Health Care Functions, 

GAO-04-224 (Washington, D.C.: Oct. 31, 2003). 

Page 4 GAO-06-346T
Table 1: Beneficiaries and Expenditures in Major Federal Health Care Programs for 

Fiscal Year 2004 

Federal 

Agency Program Beneficiaries Expenditures

HHS Medicare 42 million elderly and 

disabled beneficiaries 

$309 billion 

HHS Medicaid 43.7 million low-income 

persons 

$276.8 billion (joint 

federal and state) 

HHS State Children’s Health 

Insurance Program 

5.8 million childrena $6.6 billion (joint 

federal and state) 

HHS Indian Health Service 1.8 million Native Americans 

and Alaska Natives 

$3.7 billion 

VA Veterans Health

Administration

5 million veterans $29.1 billion 

DOD Tricare Program 9.2 million active-duty 

military personnel and their 

families, and military retirees 

$24.4 billion 

OPM Federal Employees

Health Benefit Program 

8 million federal employees, 

retirees and dependents 

$27 billion 

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

a

 Based on FY 2003 data 

Given the federal government’s influence in the health care industry, 

it has been urged to take a leadership role in driving change to 

improve the quality and effectiveness of medical care in the United 

States, including the adoption of IT. In April 2004, President Bush 

called for widespread adoption of interoperable electronic health 

records within 10 years and issued an executive order6

 that 

established the position of the National Coordinator for Health 

Information Technology, who was appointed in May 2004. The 

National Coordinator is to develop and implement a strategic plan to 

guide the nationwide implementation of interoperable health IT in 

both the public and private sectors. Two months later, HHS released 

The Decade of Health Information Technology: Delivering 

Consumer-centric and Information-rich Health Care—Framework 

for Strategic Action. 

 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). 

Page 5 GAO-06-346T
The framework describes actions to be taken by the public and 

private sectors to develop and implement a strategy that is built on 

already-existing work in health IT. The framework defines goals and 

strategies that are to be implemented in three phases.7

 HHS is in the 

initial phase of implementing activities of the framework by 

coordinating federal health IT efforts across the government and 

reaching out to private industry. The framework also introduced the 

concept of regional health information organizations, which are 

considered an essential element in the establishment of a national 

health information network. Regional health information 

organizations—entities that enable the exchange and use of health 

information—are expected to facilitate information exchange across 

different jurisdictions and hospital systems. 

Other federal agencies also play an important role in fostering the 

adoption of health IT. The Department of Veterans Affairs—one of 

the country’s largest health care providers—has had an automated 

information system in its medical facilities since 1985. The agency’s

Veterans’ Health Information Systems and Technology Architecture 

is an integrated outpatient and inpatient system that includes its 

electronic health record—the Computerized Patient Record System. 

The Department of Defense has provided IT support to its hospitals 

and clinics since 1968. The Composite Health Care System (CHCS), 

deployed in 1993, is the primary medical information system now 

used in all military health system facilities worldwide. In 1997, the 

department initiated CHCS II and is in the process of implementing 

the system in their facilities. Now known as the Armed Forces 

Health Longitudinal Technology Application, it will eventually 

replace CHCS. The Office of Personnel Management (OPM) has 

responsibility for the Federal Employees Health Benefit Program, 

which is one of the largest employer-based health insurance 

programs in the country. The government pays on average about 72 

percent of the cost of the coverage and enrollees pay the remainder 

based on a formula set by law. 

 7

These goals address the development of market institutions to lower the risk of health IT

procurement (phase I), investment in clinical management tools and capabilities (phase II), 

and support for the transition of the market to robust quality and performance 

accountability (phase III). 

Page 6 GAO-06-346T
National Strategy and Greater Interoperability Still Needed 

In the summer of 2004, we testified on the benefits that effective 

implementation of IT can bring to the health care industry and the 

need for HHS to provide continued leadership, clear direction, and 

mechanisms to monitor progress in order to bring about measurable 

improvements.8

 Last year, we reported that HHS, through the Office 

of the National Coordinator for Health IT, and in conjunction with 

other federal agencies, had taken a number of actions toward 

accelerating the use of IT to transform the health care industry, 

including the issuance of a framework for strategic action as a first 

step toward defining a national strategy. To accelerate the adoption 

of interoperable information systems, we recommended that HHS 

establish detailed plans and milestones for each phase of the 

framework and take steps to ensure that those plans are followed 

and milestones are met.9

 The department agreed with our 

recommendation. 

We have also reported on major public health IT initiatives and 

challenges that still need to be overcome to strengthen the IT that 

supports the public health infrastructure.10 Federal agencies face 

many challenges in improving the public health infrastructure. 

These challenges include (1) integrating current initiatives into a 

national health IT strategy and federal architecture to reduce the 

risk of duplicative efforts, (2) developing and adopting consistent 

standards to encourage interoperability, (3) coordinating initiatives

with states and local agencies to improve the public health 

infrastructure, and (4) overcoming federal IT management 

weaknesses to improve progress on IT initiatives. Until these 

agencies address all these challenges, movement toward building a 

 8

GAO, Health Care: National Strategy Needed to Accelerate the Implementation of 

Information Technology, GAO-04-947T (Washington, D.C.: July 14, 2004). 

9

GAO, Health Information Technology: HHS Is Taking Steps to Develop a National

Strategy, GAO-05-628 (Washington, D.C.: May 27, 2005). 

10GAO, Bioterrorism: Information Technology Strategy Could Strengthen Federal 

Agencies’ Abilities to Respond to Public Health Emergencies, GAO-03-139 (Washington, 

D.C.: May 30, 2003); GAO, Information Technology: Federal Agencies Face Challenges in

Implementing Initiatives to Improve Public Health Infrastructure, GAO-05-308 

(Washington, D.C.: June 10, 2005). 

Page 7 GAO-06-346T
stronger public health infrastructure will be limited, as will the 

ability to share essential information concerning public health 

emergencies and bioterrorism. We recommended that HHS 

coordinate with state and local public health agencies, align federal 

public health initiatives with the national health IT strategy and 

federal health architecture, and continue federal actions to 

encourage the development and adoption of data standards. 

Last September, we testified before the full committee about the 

importance of defining and implementing data and communication

standards to speed the adoption of interoperable IT in the health 

care industry.11 Hurricane Katrina highlighted the need for 

interoperable electronic health records as thousands of people were 

separated from their health care providers and paper medical 

records were lost. As we noted, standards are critical to enabling 

this interoperability. Although federal leadership has been 

established to accelerate the use of IT in health care, we testified 

that several actions12 are still needed to position HHS to further 

define and implement relevant standards. Otherwise, the health care 

industry will continue to be plagued with incompatible systems that 

are incapable of exchanging key data that are critical to delivering 

care and responding to public health emergencies. 

For the past seven years, the Departments of Defense (DOD) and 

Veterans Affairs (VA) have been working to achieve the capability of

sharing medical information. However, they have been severely 

challenged in their pursuit of the longer-term objective—providing a 

virtual medical record in which data are computable.13 As we have 

noted, the departments had achieved some success in sharing data 

through the one-way transfer of health information from DOD to VA 

 11GAO, Health Care: Continued Leadership Needed to Define and Implement Information

Technology Standards, GAO-05-1054T (Washington, D.C.: Sept. 29, 2005). 

12 These actions included the lack of mechanisms for better agency coordination of the

various standards efforts, incomplete milestones associated with these efforts, and no 

mechanism to monitor the implementation of standards across the health care industry. 

13Rather than data being provided as text for viewing only, data would be in a format that

the health information application can act on: for example, providing alerts to clinicians of 

such things as drug allergies and plotting graphs of changes in vital signs such as blood

pressure. 

Page 8 GAO-06-346T
health care facilities. 14 According to the departments, the use of 

such computable medical data contributes significantly to the 

usefulness of electronic medical records. In the past year, VA and 

DOD have begun to implement applications that exchange limited 

electronic medical information between the departments’ existing 

health information systems. The agencies have implemented three 

recommendations that we made in June 2004, such as developing an 

architecture for the electronic interface and establishing a lead 

entity for the project, but they have not developed a clearly defined 

project management plan and they have experienced delays in 

exchanging computable patient health data. 

HHS Continuing Efforts to Define a National Health Information 

Technology Strategy 

HHS—through the Office of the National Coordinator (ONC) for 

Health IT—has continued efforts to define a national strategy, 

building on the framework already established. HHS has established 

the organizational structure of the Office of the National 

Coordinator. It has also awarded about $42 million in contracts to 

address a range of issues important in developing a robust IT 

infrastructure, such as reviewing IT standards activities for gaps and 

duplication and reviewing privacy and security laws across federal 

and state governments. In order to obtain public and private sector 

input, the Secretary of HHS has established an advisory body called 

the American Health Information Community (Community). The 

Community began meeting in October 2005 to advise the Secretary 

concerning efforts to develop standards and achieve interoperability

of health IT. HHS has other important programs and initiatives such 

 14GAO, Computer-Based Patient Records: VA and DOD Made Progress, but Much Work 

Remains to Fully Share Medical Information, GAO-05-1051T (Washington, D.C.:

September 28, 2005); GAO, Computer-Based Patient Records: Improved Planning and

Project Management Are Critical to Achieving Two-Way VA–DOD Health Data Exchange, 

GAO-04-811T (Washington, D.C.: May 19, 2004); and Computer-Based Patient Records:

Short-Term Progress Made, but Much Work Remains to Achieve a Two-Way Data

Exchange Between VA and DOD Health Systems, GAO-04-271T (Washington, D.C.: Nov.

19, 2003). 

Page 9 GAO-06-346T
as the demonstration grants awarded by the Agency for Healthcare 

Research and Quality and the Centers for Disease Control and 

Prevention’s Public Health Information Network. 

The National Coordinator is Continuing Efforts to Develop a National Health 

Information Technology Strategy 

HHS’s Office of the National Coordinator for Health IT (ONC) has 

continued to move forward with its mission to guide the nationwide 

implementation of interoperable health IT in the public and private 

health care sectors. Building on the framework for strategic action, 

last summer the National Coordinator announced the organizational 

structure of his office and recently announced the appointment of 

his management team. ONC is organized as follows: 

● Immediate Office of the National Coordinator—provides 

executive direction to the office and is responsible for carrying 

out the office’s mission and functions. 

● Office of Health IT Adoption—works with all other ONC offices 

to identify health IT strategies, implement plans, and monitor 

outcomes toward meeting the President’s goals. 

● Office of Interoperability and Standards—provides leadership in 

developing and implementing nationwide interoperable health IT 

infrastructure and standards to support the secure and seamless 

exchange of health information. 

● Office of Programs and Coordination—ensures the integration of 

all efforts across the ONC and supports the dissemination and 

adoption of the federal government’s policy on health IT. 

● Office of Policy and Research—conducts studies in support of 

ongoing health IT and coordinates efforts that inform policy 

decisions related to health IT. 

Since our May 2005 report, HHS has also awarded a series of 

contracts that address the development of the infrastructure needed 

to support a national health information network. These contracts, 

outlined in table 2, total about $42 million. 

Page 10 GAO-06-346T
Table 2: Health IT Contracts Awarded by HHS’s Office of the National Coordinator 

Contract 

Date 

Awarded Duration Cost Description

American Health 

Information Community 

Program Support 

September 

2005 

1 year $0.8 million To provide assistance to the National Coordinator in convening 

and managing the meetings and activities of the Community to 

ensure that the health IT plan is seamlessly coordinated. 

Standards Harmonization 

Process for Health IT

September 

2005 

1 year $3.2 million To develop and test a process for identifying, assessing, 

endorsing, and maintaining a set of standards required for 

interoperable health information exchange. 

Compliance Certification 

Process for Health IT

September 

2005 

1 year $2.7 million To develop and evaluate a compliance certification process for 

health IT, including the infrastructure components through which 

these systems interoperate. 

Privacy and Security aSeptember 

2005 

11⁄2 

years 

$11.5 million To assess and develop plans to address variations in

organization-level business policies and state laws that affect 

privacy and security practices, including those related to HIPAA, 

which may pose challenges to interoperable health information 

exchange. 

National Health 

Information Network 

Prototypes 

November 

2005 

1 year $18.6 million 

(4 contracts) 

To develop and evaluate prototypes for a nationwide health

information network architecture that maximize the use of existing 

resources such as the Internet to achieve widespread 

interoperability among software applications, particularly electronic 

health records. These contracts are also intended to spur technical

innovation for nationwide electronic sharing of health information 

in patient care and public health settings. 

Measuring the Adoption 

of Electronic Health 

Records 

September 

2005 

2 years $1.8 million To develop a methodology to better characterize and measure the 

state of electronic health records adoption and determine the 

effectiveness of policies aimed at accelerating adoption of 

electronic health records and interoperability.

Gulf Coast Electronic 

Digital Health Recovery 

September 

2005 

1 year $3.7 million To plan and promote the widespread use of electronic health 

records in the Gulf Coast regions affected by recent hurricanes. 

These agreements are expected to bring together local and

national resources, coordinate the planning for a digital health 

information recovery, and develop a prototype of health 

information sharing and electronic health record support that can 

be replicated throughout the region. 

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

a Jointly managed by the Agency for Healthcare Research and Quality and the Office of the National 

Coordinator. 

As part of HHS’s plans to include private sector involvement, the 

Secretary of HHS established the American Health Information 

Community, a public-private collaboration to advise HHS on how to 

make health records digital and achieve interoperability for health 

information exchange. The Community will also provide a forum for 

public and private interests to recommend specific actions that will 

accelerate the widespread application and adoption of electronic 

health records and other health IT applications. Chartered for two 

Page 11 GAO-06-346T
years, with the option to renew for no more than five years, HHS 

intends for the Community to be succeeded by a private sector 

health information initiative. (The first meeting of the Community 

was held in October 2005). To date, it has identified several potential 

breakthrough areas15 and established four priority areas—consumer 

empowerment, biosurveillance, electronic health records, and 

chronic care management. Workgroups are in the process of being 

established, each with a specific charge to be accomplished within 

one year (e.g., deploy a widely available pre-populated medication

history linked to the registration summary). Milestones have been 

established to present findings and recommendations to the 

Community on a quarterly basis. 

HHS intends to use the results of its contracts and the Community 

workgroups to define future direction. The National Coordinator’s 

office intends to release a strategic plan later this year now that his 

management team is in place. This plan is expected to guide the 

nationwide implementation of interoperable health IT by providing 

detailed plans and milestones, as we had recommended. 

Other HHS Divisions Contribute to the Department’s Efforts on the National Health 

Information Technology Strategy 

As we have previously reported, the role of the National Coordinator 

includes the coordination of programs and policies regarding health 

IT across HHS. Building on ongoing agency initiatives—health IT 

demonstration grants, the Federal Health Architecture, and the 

Public Health Information Network16—these activities address a 

variety of issues important to accelerating and encouraging the 

adoption of health IT across the health care industry. Key HHS 

divisions, such as the Centers for Medicare and Medicaid and the 

Agency for Healthcare Research and Quality, continue funding and 

supporting the development of health IT initiatives that support the 

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

three years. 

16The Public Health Information Network is a national initiative intended to integrate and 

coordinate existing systems by serving as a comprehensive architecture, information 

exchange network, and a set of services that will integrate existing capabilities and 

advance the ways in which IT can support public health. 

Page 12 GAO-06-346T
goals of the framework for strategic action. The National 

Coordinator also plans to form an HHS health IT committee for 

improving coordination within the agency. Examples of health IT 

initiatives associated with the framework, some that we have 

previously reported on, include: 

● The Centers for Medicare and Medicaid Services (CMS), in 

conjunction with VA, released a test version of VistA-Office EHR 

for evaluation by a limited number of physician’s practices. This 

system is targeted for use in clinics and small physician offices 

and will be subject to the same certification requirements as 

private sector products. CMS is continuing with the Doctor's 

Office Quality Information Technology initiative, a two-year 

demonstration designed to improve quality of care and patient 

safety services provided to Medicare beneficiaries by promoting 

the adoption of electronic health records in primary care 

physician offices. Quality measures developed by the program 

will be reported by participating practices to the Quality 

Improvement Organization Clinical Warehouse. The warehouse 

will review and validate electronically transmitted information 

regarding physician performance and identify opportunities for 

improvement. CMS also awarded $6 million for electronic 

prescribing pilot programs. 

● The Agency for Healthcare Research and Quality is continuing its 

support of demonstration and developmental projects to better 

understand the connection between improved care and health IT. 

It awarded more than $22.3 million in grant funds for the 

implementation of 16 health IT demonstration projects in 

October 2005. In addition, the agency created the National 

Resource Center for Health IT to provide technical assistance 

and share new knowledge and findings from the real-world 

experiences of its grantees. 

● The Health Resources and Services Administration formed the 

Office of Health IT in December 2005 to promote the adoption 

and effective use of IT for improving the delivery of care in the 

Page 13 GAO-06-346T
safety net community.17 It is also continuing its work with federal 

community health centers to implement ambulatory electronic 

health records, including the development of initial performance 

measures to demonstrate the cost benefits of health IT. In 

addition, the Health Resources and Services Administration has 

provided funds for telehealth and other health IT projects 

through its Office for the Advancement of Telehealth. 

● The National Institutes of Health is continuing its efforts to 

achieve interoperability as part of its standards development 

initiative (i.e., Systemized Nomenclature of Medicine-Clinical 

Terms) and development of a virtual infrastructure to allow 

research centers to pool data, such as the Cancer Biomedical 

Informatics Grid and the Rare Disease Clinical Research 

Network. It plans to host a joint meeting with the Agency for 

Healthcare Research and Quality in May 2006 to look at how a 

national health information network can support clinical studies 

and trials. 

● The Centers for Disease Control and Prevention is continuing 

work on the information systems that support the Public Health 

Information Network. For example, data collection for BioSense 

is being expanded to include emergency room data at selected 

cities and plans for the National Electronic Disease Surveillance 

System call for it to move to a Web-based data entry system. 

Other Federal Agencies Have Initiatives Related to the National 

Health Information Technology Strategy 

Several federal agencies collaborating with HHS —namely the 

Departments of Veterans Affairs, Defense, and Commerce, as well as 

the Office of Personnel Management— also have responsibility for 

their own health IT initiatives related to the national health IT 

strategy. Many of these agencies, as well as a representative from

the Department of the Treasury, participate in the American Health 

Information Community, HHS’s newly formed Health IT Policy 

 17The safety net community is made up of providers that by mandate or mission organize 

and deliver a significant level of health care and other health-related services to the

uninsured, Medicaid, and other vulnerable patients. 

Page 14 GAO-06-346T
Council, and the Federal Health Architecture. In 2004, the Office

the National Coordinator for Health IT was assigned responsibility 

for the Federal Health Architecture. According to the National 

Coordinator, he is planning to renew the Federal Health 

Architecture workgroups this spring in order to improve

coordination and collaboration on federal health IT. In ad

the Departments of Defense, Veterans Affairs, and Commerce, othe

federal agencies involved with the Federal Health Architecture 

include the Departments of Agriculture, Homeland Security, Jus

and the Environmental Protection Agency. 

of

dition to 

r

tice,

As major federal health care providers, the Departments of Defense 

on

d

areas

According to the Office of Personnel Management, it is planning to 

been

Federal

d

 

and Veterans Affairs play critical roles in the advancement of 

electronic health records. The experience of these agencies in

implementing electronic health records and in health informati

exchange across organizational boundaries offer important lessons

learned—both positive and negative—that could be applied as 

health care delivery organizations adopt electronic health recor

systems. According to HHS, the Department of Defense has a 

lengthy history working in remote and medically underserved

and has experience in using IT, such as telehealth, to deliver care in 

isolated areas that can be compared to the conditions in some rural 

environments. 

use its position as one of the largest purchasers of employee health

care benefits to contribute to the expansion and use of electronic 

health records, electronic prescribing, and other health IT-related 

provisions. The agency is represented on the American Health 

Information Community and, according to agency officials, has

holding informal discussions with staff from the Office of the 

National Coordinator. In July 2004, the Office of Personnel 

Management outlined various options for health plans in the

Employee Health Benefit program, such as adopting systems based 

on generally accepted and certified standards. When the agency 

issued its 2005 annual call letter18 to carriers last April, it requeste

18Call letters provide guidance for benefit and rate proposals from FEHB program plans for

the next contract term. 

Page 15 GAO-06-346T
that plans describe their health IT initiatives, including any currently

in place for doctors and pharmacies to use electronic prescribing. 

According to an agency official, it received responses from 

participating health plans and reviewed them to establish a b

with the intention of measuring progress on the use of health IT. 

aseline

The National Institute for Standards and Technology (NIST) is also

e.

t

m

ected to

 

collaborating with HHS, largely by supporting the Office of the 

National Coordinator and its contractors with technical expertis

Initially, its support had been focused on the standards developmen

and harmonization process. NIST supports a Website—the Health 

Care Standards Landscape—to address the need for a Web-based 

repository of information on health care standards, organizations,

and resources that can assist in standards development, 

coordination, implementation, adoption, and use by syste

developers and other stakeholders.19 In addition, NIST is exp

leverage its technical resources by assisting HHS with the national 

health information network architecture and the certification 

process for health IT. 

In summary, HHS’s efforts to transform the use of IT in the health 

r

t

 

care industry are continuing although much work remains. As we 

recommended last May, HHS still needs to establish detailed plans

and milestones as part of the national strategy and take steps to 

ensure that those plans are followed and milestones are met. The

National Coordinator plans to release a strategic plan later this yea

that establishes milestones. Given the billions of dollars the federal 

government spends annually towards health care and the potential 

of IT to save money and improve quality, it is important that 

coordination continue across the federal government and tha

federal resources are leveraged appropriately. 

 

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

Page 16 GAO-06-346T
Contacts and Acknowledgements 

If you should have any questions about this statement, please 

contact me at (202) 512-9286 or by e-mail at pownerd@gao.gov. 

Other individuals who made key contributions to this statement are 

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

310804 Page 17 GAO-06-346T
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