- What is NHII?
- Need for NHII
- HHS Role
- How to Accomplish
- Additional Information
he National Health Information Infrastructure (NHII) is:
- an initiative set forth to improve the effectiveness, efficiency and overall quality of health and health care in the United States
- a comprehensive knowledge-based network of interoperable systems of clinical, public health, and personal health information that would improve decision-making by making health information available when and where it is needed.
- the set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health.
- NOT a centralized database of medical records or a government regulation
- To improve patient safety (alert for medication errors, drug allergies, etc)
- To improve healthcare quality (includes having the availability of complete medical records, test results and x-rays at the point of care, integrating health information from multiple sources and providers, incorporating the use of decision support tools with guidelines and research results, etc)
- For Bioterrorism detection (NHII will enable real-time aggregation of health data to detect patterns)
- To better inform and empower health care consumers regarding their own personal health information
- To better understand health care costs
The NHII dimensions are represented by three overlapping circles, each representing a particular focus with overlap into the adjacent areas. Additionally, the scope would include healthcare research. The three dimensions are:
- Personal Health-includes a personal health record that is created and controlled by the individual or family, plus non-clinical information such as self-care trackers and directories of health care providers. The confidentiality of personal health records and consumers' control over their own records are basic tenets of this vision, consistent with the HHS privacy regulations.
- Health care delivery -includes information such as provider notes, clinical orders, decision-support programs, digital prescribing programs, and practice guidelines. Healthcare providers will retain responsibility for their own patients' medical records.
- Public health-enable sharing of information to improve the clinical management of populations of patients such as vital statistics, population health risks and disease registries.
The nature of health care:
- Health care is a large sector of the economy that involves multiple provider associations, health systems, payer organizations, consumers, and local, state, and federal agencies. It is highly fragmented and largely delivered by the private sector. Medical information is complex and there are few incentives in place for information sharing. Organizational and change management issues are also difficult to manage in a clinical environment.
The nature of Information Technology in health care:
- Information Technology is expensive and it has been difficult to generate the capital needed for IT investment. It is often regarded as an add-on cost.
- Connectivity -electronic connections must exist among all providers and institutions. Currently there is fragmented use of technology with minimal interoperability, legacy systems, etc
- Standards for content (how the meaning of medical terms are represented) are not yet agreed upon nor are the standards for how messages are to be sent and received.
- Information capture -it is difficult to capture medical information in machine readable form
- Privacy and security has not yet been assured--authentification of users, data encryption, etc must be in place
- Lack of Standards (prevents interoperability and sharing of data)
- Lack of Incentives (value of collecting data electronically not appreciated at the point of care)
- Insufficient Funding (refers to the funding of projects that lead to improved health care delivery using measures of better quality, improved patient safety and reduced costs based on evidence.)
- Privacy concerns (security and confidentiality)
The stakeholders include the Federal Government, State and local governments, Health care provider organizations, Health care provider membership and trade organizations, Health care plans and purchasers, Standards development organizations, the information technology industry, consumer and patient advocacy groups, community organizations and academic and research organizations. It is essential for all stakeholders to participate in developing the national action plan.
The major role is one of leadership--a facilitator in the development of NHII to bring about the collaboration between stakeholders in the private and public sectors and among all levels of government. The federal government can play a major role in helping to adopt Standards for communication and interoperability between systems, incorporate Privacy and Security matters, and fund projects where there is evidence that specific projects have benefited health care. At HHS, The National Committee on Vital and Health Statistics (NCVHS) serves as a public advisory committee to the Secretary of Health and Human Services on national health information policy. Their report "Information for Health: A Strategy for Building the National Health Information Infrastructure" released in November 2001 outlines a vision and a process for building the NHII. Complete report available at:
The objectives of NHII can be met by:
- Using Information Technology to enhance connectivity and knowledge sharing (via appropriate system architecture and use of data standards)
- Fostering collaboration between the public and private sectors (include all relevant stakeholders in the health sector--patients, citizens, practitioners, public health officials, managers, policy-makers, and researchers.)
- Encouraging capital investment and promoting market-based solutions
- Having the federal government assume a leadership role in guiding its development though appropriate funding, use of incentives, application of standards with attention to privacy issues (confidentiality and security)
- Using evidence of effectiveness (patient safety, quality, cost, access) to guide future directions in changes to our health care system.
- Providing incentives for collecting data electronically
- Using "Lessons-learned" from other National systems (Canada, United Kingdom, Australia) and ongoing projects.
The NCVHS report outlines a three-stage process over 10 years for achieving the vision. The first stage (within 2 years) includes developing leadership within the Department of Health and Human Services (HHS) and other agencies and fleshing out the vision for implementation and policy. The second stage (within 5 years) focuses on building collaboration among stakeholders. The third stage (within 10 years) involves carrying out the plan in all relevant public and private sectors.
The NHII website from the US Department of Health and Human Services will be a resource for ongoing projects, meetings and documents relevant to this initiative. It can be found at:
Public meetings of the NCVHS NHII working group can be found at: