We have reported that some hospitals are  expanding their IT systems to support improvements in quality of  care. 1). In the  health IT field, standards may govern areas ranging from technical  issues, such as file types and interchange systems, to content issues,  such as medical terminology. Federal Health IT Efforts Highlight Importance of Establishing Standards, Developing Comprehensive Plans, and Ensuring Privacy

Widespread adoption of health IT has the potential to improve the  efficiency and quality of health care. Among these are mechanisms to establish  clearly defined health IT standards that are agreed upon by all  important stakeholders, comprehensive planning grounded in  results-oriented milestones and measures, and an approach to  privacy protection that encourages acceptance and adoption of  electronic health records. Mechanisms and Structures for Harmonizing and Implementing Health IT Standards Are Essential to Enable Interoperability

The need for health care standards has been broadly recognized for  a number of years. Among other lessons, they reported the need to define and adopt  common standards and terminology to achieve data quality and  consistency, system interoperability, and information protection. The interconnected work of these organizations to identify and  promote the implementation of standards is important to the overall  effort to advance the use of interoperable health IT. Comprehensive Planning with Milestones and Performance Measures Is Essential to Achieving Health IT Goals

Using interoperable health IT to help improve the efficiency and  quality of health care is a complex goal that involves a range of  stakeholders and numerous activities taking place over an expanse  of time; in view of this complexity, it is important to develop  comprehensive plans that are grounded in results-oriented  milestones and performance measures. Without comprehensive  plans, it is difficult to coordinate the many activities under way and  integrate their outcomes. Addressing and mitigating this risk is essential to  encourage public acceptance of the increased use of health IT and  electronic medical records. ●  Examples of principles that health IT programs and applications  need to address include the uses and disclosures principle, which  provides limits to the circumstances in which an individual’s  protected heath information may be used or disclosed, and the  access principle, which establishes individuals’ rights to review and  obtain a copy of their protected health information in certain  circumstances. ●  Key challenges include understanding and resolving legal and policy  issues (for example, those related to variations in states’ privacy  laws), ensuring that only the minimum amount of information  necessary is disclosed to only those entities authorized to receive  the information, ensuring individuals’ rights to request access and  amendments to their own health information, and implementing  adequate security measures for protecting health information. Specifically, within  its approach, the department had not defined a process to ensure  that the key privacy principles and challenges we had identified  were fully and adequately addressed. Moreover, the department may miss an opportunity to  establish the high degree of public confidence and trust needed to  help ensure the success of a nationwide health information network. Lacking an overall approach for protecting the privacy of personal  electronic health information, there is reduced assurance that  privacy protection measures will be consistently built into health IT  programs and applications. Without such assurance, public  acceptance of health IT may be at risk. In closing, Mr. Chairman, many important steps have been taken,  but more is needed before we can make a successful transition to a  nationwide health IT capability and take full advantage of potential  improvements in care and efficiency that this could enable. This is a work of the U.S. government and is not subject to copyright protection in the  United States.
Why GAO Did This Study

As GAO and others have reported, the use of information technology (IT) has enormous potential to help improve the quality of health care and is important for improving the performance of the U.S. health care system. Given its role in providing health care, the federal government has been urged to take a leadership role to improve the quality and effectiveness of health care, and it has been working to promote the nationwide use of health IT for a number of years. However, achieving widespread adoption and implementation of health IT has proven challenging, and the best way to accomplish this transition remains subject to much debate. At the committee's request, this testimony discusses important issues identified by GAO's work that have broad relevance to the successful implementation of health IT to improve the quality of health care. To develop this testimony, GAO relied largely on its previous work on federal health IT activities.

What GAO Found

Health IT has the potential to help improve the efficiency and quality of health care, but achieving the transition to a nationwide health IT capability is an inherently complex endeavor. A successful transition will require, among other things, addressing the following issues: (1) Establishing a foundation of clearly defined health IT standards that are agreed upon by all important stakeholders. Developing, coordinating, and agreeing on standards are crucial for allowing health IT systems to work together and to provide the right people access to the information they need: for example, technology standards must be agreed on (such as file types and interchange systems), and a host of content issues must also be addressed (one example is the need for consistent medical terminology). Although important steps have been taken, additional effort is needed to define, adopt, and implement such standards to promote data quality and consistency, system interoperability (that is, the ability of automated systems to share and use information), and information protection. (2) Defining comprehensive plans that are grounded in results-oriented milestones and measures. Using interoperable health IT to improve the quality and efficiency of health care is a complex goal that involves a range of stakeholders, various technologies, and numerous activities taking place over an expanse of time, and it is important that these activities be guided by comprehensive plans that include milestones and performance measures. Without such plans, it will be difficult to ensure that the many activities are coordinated, their results monitored, and their outcomes most effectively integrated. (3) Implementing an approach to protection of personal privacy that encourages public acceptance of health IT. A robust approach to privacy protection is essential to establish the high degree of public confidence and trust needed to encourage widespread adoption of health IT and particularly electronic medical records. Health IT programs and applications need to address key privacy principles (for example, the access principle, which establishes the right of individuals to review certain personal health information). At the same time, they need to overcome key challenges (for example, those related to variations in states' privacy laws). Unless these principles and challenges are fully and adequately addressed, there is reduced assurance that privacy protection measures will be consistently built into health IT programs and applications, and public acceptance of health IT may be put at risk.