Given the level of the federal government’s participation in  providing health care, it has been urged to take a leadership role in  driving change to improve the quality and effectiveness of medical  care in the United States, including an expanded adoption of IT. In April 2004, President Bush called for the widespread adoption of  interoperable electronic health records within 10 years and issued  an executive order that established the position of the National  Coordinator for Health Information Technology within HHS. The  National Coordinator’s responsibilities include the development and  implementation of a strategic plan to guide the nationwide  implementation of interoperable health IT in both the public and  private sectors. The first National Coordinator was appointed in  May 2004, and two months later HHS released The Decade of Health  Information Technology: Delivering Consumer-centric and  Information-rich Health Care—Framework for Strategic Action,  the first step toward the development of a national strategy. To further accelerate the adoption of interoperable  health information systems, we recommended that HHS establish  detailed plans and milestones for meeting the goals of its framework  for strategic action and take steps to ensure that those plans are  followed and milestones are met. The department agreed with our  recommendation. HHS Is Continuing Efforts to Advance the Nationwide Implementation of Health IT and Complete a National Strategy

HHS and its Office of the National Coordinator for Health IT have  made progress through the work of the American Health  Information Community and several contracts in five major areas:  (1) advancing the use of electronic health records, (2) establishing  standards to facilitate the exchange of patient data, (3) defining  requirements for the development of prototypes of the Nationwide  Health Information Network, (4) incorporating privacy and security  policy, practices, and standards into the national strategy, and (5)  integrating public health into nationwide health information  exchange. These activities and others are being used by the Office of the  National Coordinator for Health IT to continue its efforts to  complete a national strategy to guide the nationwide  implementation of interoperable health IT. Since the release of its  initial framework in 2004, the office has taken additional steps to  define a complete national strategy, building on its earlier work. However, while HHS has made progress in these areas, it still lacks  detailed plans, milestones, and performance measures for meeting  the President’s goals. Without it, HHS  risks not meeting the President’s goal for health IT.
Why GAO Did This Study

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 role in providing health care in the U.S., it has been urged to take a leadership role in driving change to improve the quality and effectiveness of health care, including the adoption of IT. In April 2004, President Bush called for widespread adoption of interoperable electronic health records within 10 years and issued an executive order that established the position of the National Coordinator for Health Information Technology. A National Coordinator within the Department of Health and Human Services (HHS) 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 its plans are followed and milestones are met. GAO was asked to identify progress made by HHS toward the development and implementation of a national health IT strategy. To do this, GAO reviewed prior reports and agency documents on the current status of relevant HHS activities.

What GAO Found

In late 2005, to help define the future direction of a national strategy, HHS awarded several health IT contracts and formed the American Health Information Community, a federal advisory committee made up of health care stakeholders from both the public and private sectors. Through the work of these contracts and the community, HHS and its Office of the National Coordinator for Health IT have made progress in five major areas associated with the President's goal of nationwide implementation of health IT. These activities and others are being used by the Office of the National Coordinator for Health IT to continue its efforts to complete a national strategy to guide the nationwide implementation of interoperable health IT. Since the release of its initial framework in 2004, the office has defined objectives and high-level strategies for accomplishing its goals. Although HHS agreed with GAO's prior recommendations and has made progress in these areas, it still lacks detailed plans, milestones, and performance measures for meeting the President's goals.