The National Committee on Vital and Health Statistics published its first report on the NHII in 1998. 7 The Committee concluded that the national information infrastructure that had been evolving with Federal support conspicuously lacked a health dimension. Over the ensuing 2 years, the Committee's NHII Workgroup developed a multifaceted vision for the National Health Information Infrastructure, which it described in a June 2000 Interim Report. (See the Appendix, page A-1.) In keeping with recent usage, the Workgroup on the NHII uses a very broad notion of infrastructure that emphasizes health-oriented interactions and information-sharing among individuals and institutions, rather than just the physical, technical, and data systems that make those interactions possible.
Following publication of the Interim Report, a wide range of stakeholders validated the Committee's vision for the NHII in four NCVHS hearings held around the country. 8-11 Stakeholder comments contributed to the development of the recommendations that are the centerpiece of this Final Report, building on the vision and seeking to move it toward implementation. Taken together, the NCVHS recommendations outline a collaborative public-private process with key leadership and support from the Federal Government — the one partner with the resources and the authority to take the lead. The Committee's ultimate objective is the development of a comprehensive NHII that serves the public interest and meets the needs of all those who make health decisions.
This introductory section is followed by a brief overview of the NHII as envisioned by NCVHS. Section 3 then surveys the existing technical and functional components to build on for the infrastructure. It draws on authoritative reports by the National Research Council of the National Academy of Sciences, the President's Information Technology Advisory Committee (PITAC), and the NCVHS Report on Standards for Patient Medical Record Information (PMRI). Section 4 looks at current public-and private-sector programs and activities that can contribute to the NHII. The Canadian Health Information Roadmap and Infoway/ Infostructure are described as exemplary plans whose implementation is well ahead of that in the United States.
Section 5 sets the stage for the Committee's recommendations by discussing key aspects of an effective implementation strategy, highlighting the importance of leadership and resources, and noting the gaps and barriers that stand in the way of realizing the NHII vision. The recommendations, which conclude the report, are directed at nine groups of stakeholders: the Federal Government, State and local government, providers, plans and purchasers, standards organizations, the information technology industry, consumer and patient advocacy groups, community organizations, and academic and research organizations.