The health  care industry has recognized that IT can improve the quality of care,  promote patient safety, reduce costs of both care and administrative  functions, and expedite response to public health emergencies. The Centers for Disease Control and Prevention (CDC) has  previously acknowledged several IT limitations in the public health  infrastructure. Information Technology Can Provide Benefits for Delivery of Care

IT can provide significant benefits in providing clinical health care  and in the administrative functions associated with health care  delivery. Specific examples included:
A teaching hospital reported that it realized about $8.6 million in  annual savings by replacing paper medical charts with EMRs for  outpatients. It also reported saving over $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 told us that EMRs could also improve  the delivery of care because, among other reasons, more complete  medical documentation was available to support the provider’s  diagnosis. In addition, EMRs greatly facilitate the reporting of  public health information associated with the early detection of and  response to disease outbreaks. The lessons learned that were reported to us by health care  organizations that have successfully implemented IT may prove  useful for other organizations as they implement solutions—such as  recognizing the importance of reengineering business processes,  gaining users’ acceptance, providing adequate training, and making  systems available and secure. Many IT Initiatives Address the Public Health Infrastructure, Although Standards Implementation Challenges Remain

In May 2003, we reported that six federal agencies involved in  bioterrorism preparedness and response had a large number of  existing and planned information systems associated with  supporting a public health emergency. Specifically, these agencies  identified 72 information systems and supporting technologies. Of  the 72 systems, 34 are surveillance systems, 18 are supporting  technologies, 10 are communications systems, and 10 are detection  systems. In spite of these many initiatives, the key ones that are  intended to facilitate greater information sharing are still being  developed and implemented. For example, CDC is currently  implementing its Public Health Information Network, which  consists of a number of disease surveillance and communications  systems, including the Health Alert Network. This network is an  early warning and response system intended to provide federal,  state, and local agencies with better communications during public  health emergencies. Most recently, in May 2003, we again reported that the  identification and implementation of health care data,  communications, and security standards—which are necessary to  support the compatibility and interoperability of agencies’ various  IT systems—remains incomplete across the health care industry. To address the challenges of coordinating the many IT initiatives  and implementing a consistent set of standards, we recommended  that the Secretary of Health and Human Services (HHS), in  coordination with other key stakeholders, establish a national IT  strategy for public health preparedness and response, including  specific steps toward improving the nation’s ability to use IT in  support of the public health infrastructure. Specifically, we  recommended, among other things, that the Secretary set priorities for information systems, supporting technologies,  and other IT initiatives; define activities for ensuring that the various standards-setting  organizations coordinate their efforts and reach further  consensus on the definition and use of standards; establish milestones for defining and implementing all standards; create a mechanism—consistent with HIPAA requirements—to  monitor the implementation of standards throughout the health  care industry. In addition, in April of this year, the President issued an Executive  Order, which calls for the establishment of a National Health  Information Technology Coordinator and the issuance of a broader  strategic plan to guide the nationwide implementation of  interoperable health care information systems. As health IT  initiatives are pursued, it will be essential to have continued  leadership, clear direction, measurable goals, and mechanisms to  monitor progress. However, much more work remains to more fully  utilize IT for the delivery of care and to identify and respond to  public health emergencies.
Why GAO Did This Study

Health care is an information-intensive industry that remains highly fragmented and inefficient. Hence, the uses of information technology (IT)--in delivering clinical care, performing administrative functions, and supporting the public health infrastructure--have the potential to yield both cost savings and improvements in the care itself. In 2003, GAO reported on benefits to health care that could result from using IT--both cost savings and measurable improvements in the delivery and quality of care. GAO also reported on federal agencies' existing and planned information systems intended to support our nation's preparedness for and ability to respond to public health emergencies and the status of health care standards setting initiatives. Congress has asked GAO to summarize our work on reported benefits of the use of IT for health care delivery and on IT initiatives supporting public health preparedness and response.

What GAO Found

The use of IT can yield benefits in clinical care and associated administrative functions as well as in public health. Health care organizations reported that electronic medical records (EMR) improved the delivery of care because, among other reasons, more complete medical documentation was available to support the provider's diagnosis. In addition, EMRs could greatly facilitate the reporting of public health information associated with the early detection of and response to disease outbreaks. One hospital replaced outpatients' paper medical charts with EMRs, realizing about $8.6 million in annual savings. This hospital also established electronic access to laboratory results and reports, replacing its manual process for handling medical records and saving another $2.8 million a year. In addition, the lessons learned that were reported to us by health care organizations that have successfully implemented solutions could be used by other organizations to accelerate the adoption of health IT. These lessons recognize the importance of reengineering business processes, gaining users' acceptance of IT, providing adequate training, and making systems secure. Regarding public health, federal agencies identified 72 existing and planned information systems--34 surveillance systems, 18 supporting technologies, 10 communications systems, and 10 detection systems. For example, the Centers for Disease Control and Prevention is currently implementing its Public Health Information Network comprised of a number of disease surveillance and communications systems, including the Health Alert Network. This network is an early warning and response system that is intended to facilitate communication among federal, state, and local agencies during public health emergencies. GAO also reported that identification and implementation of health care data, communications, and security standards--which are necessary to support compatibility and interoperability of agencies' various IT systems--remained incomplete across the health care sector. To address the challenges of coordinating the many IT initiatives and implementing a consistent set of standards, GAO recommended last year that the Secretary of Health and Human Services develop a strategy for public health preparedness and response, to include setting priorities for IT initiatives and establishing mechanisms to monitor the implementation of standards throughout the health care industry. Since that time, progress has been made in identifying standards. The Office of Management and Budget's e-government initiative, the Consolidated Health Informatics initiative, has identified a number of standards to be applied to new federal development efforts and modifications of existing systems. This initiative is intended to promote the interoperability of information systems. However, implementing these standards across the federal government is still a work in progress. Until these standards are implemented, information-sharing challenges will remain. In April of this year, Executive Order 13335 established a National Health IT Coordinator and called for a strategic plan to guide the nationwide implementation of interoperable health IT. As this plan moves forward, it will be essential to have continued leadership, clear direction, measurable goals, and mechanisms to monitor progress.