A STRATEGY FOR BUILDING THE NATIONAL HEALTH INFORMATION INFRASTRUCTURE

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INFORMATION FOR HEALTH
A STRATEGY FOR BUILDING
THE NATIONAL HEALTH INFORMATION
INFRASTRUCTURE
Report and Recommendations
From the National Committee on Vital and Health Statistics
Washington, D.C.
November 15, 2001

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CONTENTS
Members of the National Committee on Vital and Health Statistics . . . . . . . . . . . . . . . . . . .
iii
Transmittal Letter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
v
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
vii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
viii
Staffing and Support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ix
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1
Information for Health: A Strategy for Building the National Health
Information Infrastructure (NHII) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7
Background and Overview of the Report. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
2. The NHII Vision in Brief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
Definition and Key Elements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
11
Three Dimensions: Personal Health, Healthcare Provider, and
Population Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
3. Technical and Functional Building Blocks of the NHII . . . . . . . . . . . . . . . . . . . . . .
17
4. Contributing Activities and Prototype Programs . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
Crosscutting Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
The Healthcare Provider Dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
23
The Population Health Dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
The Personal Health Dimension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
26
The Canadian Example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
28
The Leap to the NHII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29
5. Leadership as the Cornerstone of Implementation . . . . . . . . . . . . . . . . . . . . . . . . .
30
Gaps and Barriers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
30
Disparate Responsibilities Create a Fragmented Environment. . . . . . . . . . . . . .
31
Operationalizing the Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
Three Major Stages To Realize the NHII . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
36
Recommendations for the National Health Information Infrastructure From the
National Committee on Vital and Health Statistics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
39
Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
48
Appendix: Toward a National Health Information Infrastructure: Interim Report
prepared by the National Committee on Vital and Health Statistics Workgroup on the
National Health Information Infrastructure, June 2000. . . . . . . . . . . . . . . . . . . . . . . . . . . .
A-1
i

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MEMBERS OF THE NATIONAL COMMITTEE ON VITAL AND HEALTH
STATISTICS
CHAIR
John R. Lumpkin, M.D., M.P.H.
Director
Illinois Department of Public Health
Springfield, Illinois
MEMBERSHIP
Jeffrey S. Blair, M.B.A.
Richard K. Harding, M.D.
Vice President
Professor of Clinical Psychiatry and
Medical Records Institute
Pediatrics
Albuquerque, New Mexico
Vice Chairman, Clinical Services
Neuropsychiatry & Behavioral Science
Simon P. Cohn, M.D., M.P.H., FACP
University of South Carolina
National Director for Health Information
Columbia, South Carolina
Policy
Kaiser Permanente Medical Care Program
Eugene J. Lengerich, V.M.D.
Oakland, California
Penn State University
Hershey, Pennsylvania
Kathryn L. Coltin, M.P.H.
Director
Vickie M. Mays, Ph.D.
External Quality and Data Initiatives
Department of Psychology
Harvard Pilgrim Health Care
University of California, Los Angeles
Wellesley, Massachusetts
Los Angeles, California
John W. Danaher, M.D.
Clement Joseph McDonald, M.D.
Litchfield, Connecticut
Distinguished Professor of Medicine
Indiana University School of Medicine
Daniel J. Friedman, Ph.D.
Director
Assistant Commissioner
Regenstrief Institute
Bureau of Health Statistics, Research and
Indianapolis, Indiana
Evaluation
Massachusetts Department of Public Health
Paul Newacheck, Dr.P.H.
Boston, Massachusetts
Professor of Health Policy and Pediatrics
Institute of Health Policy Studies
School of Medicine
University of California at San Francisco
San Francisco, California
iii

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Mark A. Rothstein, J.D.
Barbara Starfield, M.D., M.P.H.
Herbert F. Boehl Chair of Law and Medicine
Distinguished University Professor and
Director, Institute for Bioethics, Health
Professor of Health Policy and Pediatrics
Policy and Law
School of Hygiene/Public Health
University of Louisville School of Medicine
The Johns Hopkins University
Louisville, Kentucky
Baltimore, Maryland
Edward H. Shortliffe, Ph.D., M.D.
Kepa Zubeldia, M.D.
Department of Medical Informatics
President
Columbia University
Claredi
New York, New York
Kaysville, Utah
iv

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December 19, 2001
The Honorable Tommy G. Thompson
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Dear Secretary Thompson:
On behalf of the National Committee on Vital and Health Statistics (NCVHS), I am pleased to submit the
report of the NCVHS Workgroup on the National Health Information Infrastructure (NHII), which was
approved by the full Committee at its November 15, 2001, meeting. Information for Health: A Strategy
for Building the National Health Information Infrastructure builds on the Workgroup’s Interim
Report of June 2000 and is the culmination of an 18-month review that included hearings and
consultations with healthcare providers, public health professionals, consumer representatives, and
healthcare information technology representatives.
Recent events make this report both timely and urgent. They have dramatically underscored the
importance of an effective, comprehensive health information infrastructure that links all health
decisionmakers, including the public. Based on public hearings about the NHII, the Committee has
determined that Federal leadership, under the U.S. Department of Health and Human Services (HHS), is
the most important missing ingredient that could accelerate and coordinate progress on the NHII. Its
recommendations therefore include specific proposals for HHS oversight and coordination, supportive
action by Congress, and appropriate efforts by other organizations. The latter include State and local
governments, healthcare providers, health plans and purchasers, standards development organizations,
the information technology industry, consumer advocacy groups, community organizations, and
academic and research organizations.
NCVHS urges HHS to exercise leadership in building the National Health Information Infrastructure and
to give it the priority it deserves, in collaboration with the many stakeholders whose participation will be
crucial for success. The Committee would welcome annual status reports from the Department on this
project, beginning in 2002.
Finally, the Committee offers its advice and enthusiastic support for all efforts aimed at developing the
NHII.
Sincerely,
/s/
John R. Lumpkin, M.D., M.P.H.
Chair, National Committee on Vital and
Health Statistics
6525 Belcrest Road ● Room 1100 ● Hyattsville, MD 20782-2003 ● (301) 458-4200 ● Web site: www.ncvhs.gov

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