Health Information Technology:

HHS Is Taking Steps to Develop a National Strategy

GAO-05-628: Published: May 27, 2005. Publicly Released: May 27, 2005.

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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.

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. 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 three-phased 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. 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.

Status Legend:

More Info
  • Review Pending-GAO has not yet assessed implementation status.
  • Open-Actions to satisfy the intent of the recommendation have not been taken or are being planned, or actions that partially satisfy the intent of the recommendation have been taken.
  • Closed-implemented-Actions that satisfy the intent of the recommendation have been taken.
  • Closed-not implemented-While the intent of the recommendation has not been satisfied, time or circumstances have rendered the recommendation invalid.
    • Review Pending
    • Open
    • Closed - implemented
    • Closed - not implemented

    Recommendation for Executive Action

    Recommendation: As a result of our work, the Secretary of Health and Human Services should 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 Affected: Department of Health and Human Services

    Status: Closed - Implemented

    Comments: In June 2008, the Department of Health and Human Services' Office of the National Coordinator for Health IT published a federal health IT strategic plan that included strategic goals for advancing and coordinating federal health IT efforts. These goals are consistent with those identified in the department's 2004 framework for strategic action. The plan also outlined measures and milestones for completing key strategies related to each of the goals. Further, in February 2009, we requested and received documentation from HHS that described in greater detail how the department intended to implement its strategic plan. This documentation included a detailed schedule and near-term milestones for all of the projects the Office of the National Coordinator had underway to implement the strategies outlined in the plan. Also included was information on a database and tool that the office built to track the projects back to the plan's strategies and goals, as well as longer term milestones for completing operational plans beyond 2009. The development of the strategic plan and the tool to track ongoing projects to the strategies, goals, and milestones of the strategic plan, should provide HHS with key mechanisms needed to support successful implementation of its health IT strategy, and enable ONC to ensure the plans are followed. By taking these actions, HHS will be better positioned to lead the nation's efforts in developing and implementing a nationwide infrastructure for exchanging health information amongst health care providers.

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