comprehensive plan to design information networks comprising the following elements:

  • Communications technologies such as high-speed telecommunications networks, computer-based systems, and wireless systems

  • Data standards such as common standards for medical terminology, encoding and transmitting data, and formatting electronic documents

  • Application programs for EHRs, telemedicine, and patient self-management

  • Certain systems that relate to the underlying electronic architecture, databases for collecting and storing data, and medical knowledge sources

  • Values and laws to ensure appropriate regulatory oversight, consumer protection, and government support for vulnerable populations

Building the NHII is an enormous undertaking that will likely take a decade or more to complete, but the process is well under way. A detailed discussion of the many ongoing efforts related to the establishment of the NHII can be found elsewhere (IOM, 2003d; Javitt, 2004). Following is a brief summary of recent developments in four key areas: federal leadership, patient privacy laws, data standards for connectivity, and finance.

Federal Leadership

In May 2004, the White House announced a new national initiative aimed at establishing the NHII and implementing EHRs over the next 10 years (WH, 2004c). One key component of this initiative was the establishment of the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services (DHHS) to facilitate higher levels of interagency strategic development and coordination. The National Coordinator serves as the chief architect and strategic planner for coordinating federal, state, and private-sector activities directed at establishment of the NHII. The National Coordinator was tasked with providing a comprehensive NHII implementation plan to the Secretary of DHHS by July 21, 2004, followed by delivery to the President (WH, 2004c).

Patient Privacy Laws

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) set standards for administrative and financial transactions and the

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