Achieving the goal set forth in Recommendation 1 can be accomplished in the United States only by building a national health information infrastructure (NHII). As defined by the National Committee on Vital and Health Statistics and discussed in Chapter 2 of this report, the NHII consists of a set of values, practices and relationships, laws and regulations, health data standards, technologies, and systems and applications that support all facets of individual health, health care delivery, and public health (National Committee on Vital and Health Statistics, 2001).

Building the NHII requires actions on the part of health care providers, as well as public- and private-sector leadership at the national level. Of primary importance, it is necessary for health care providers to invest in electronic health record (EHR) systems that can capture patient and other clinical data and interact with decision support applications that improve safety and quality of care. In August 2003, this committee released a letter report entitled Key Capabilities of an Electronic Health Record System (Institute of Medicine, 2003) (see Appendix E) which provides guidance on the functional capabilities such systems should possess. Actions by individual health care providers, however, will not be enough to create a safe health care delivery environment. Patients receive services from many different health care providers. A nationwide infrastructure is required to support the exchange of patient information and to facilitate communication among the members of the patient’s care team and between clinicians and the patient.

At the national level, the federal government, working collaboratively with the private sector, will need to provide financial resources and establish national standards for the NHII. Other IOM committees have recommended that the federal government provide both capital resources for the development of key aspects of the NHII and financial incentives to health care providers to invest in EHRs (Institute of Medicine, 2001, 2002a, b). It is essential that the federal government act on these recommendations.

Also critically important to the development of the NHII is the need for the federal government to enhance its leadership role in the establishment of national data standards. In fact, the federal government has already taken the initiative to assume this leadership role in some key areas. The Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191) led to the establishment of standards to protect the privacy and confidentiality of personally identifiable data, and the Department of Health and Human Services recently endorsed the use of certain messaging standards to

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