In the last decade, many breakthrough efforts have helped lay the foundation for a national health information infrastructure. Informatics systems for processing administrative and financial information have progressed from stand-alone to networked systems. The promise of advanced computing and telecommunications technology stimulated work on an electronic patient record to facilitate the capture and analysis of health care information. Congress passed the High Performance Computing Act in 1991 to promote work on the technical infrastructure, followed by the Next Generation Internet Act of 1998, and the Networking and Information Technology Research and Development Act of 2000, all of which address the health care sector. The President's Information Infrastructure Initiative of 1993 focused on the deployment of information technology to the home and workplace and included a Health Information and Applications Work Group. Attention to applications for public health produced a path-breaking report, "Making a Powerful Connection: The Health of the Public and the National Information Infrastructure" in 1995. The Health Information and Applications Work Group issued a final report on "Health Care and the NII" and a "Consumer Health Information White Paper" in 1996.
The work of other countries to define and implement their own national health information infrastructures also has produced useful models. Australia established a National Health Information Agreement (NHIA) in 1993, including the Commonwealth, State and Territory health authorities, the Australian Bureau of Statistics, and the Australian Institute of Health and Welfare. The NHIA seeks to improve the quality of health data and information and foster cooperation in the development of a national health information infrastructure. It ensures that the collection, compilation, and interpretation of national information are carried out appropriately and efficiently. The agreement has produced the National Health Information Management Group, National Health Data Committee, National Health Information Model, National Health Data Dictionary, national minimum data sets, and the National Health Information Knowledgebase. [http://www.aihw.gov.au/]
In 1997, Canada created an Advisory Council on Health Infostructure, which issued the 1999 report, "Canada Health Infoway: Paths to Better Health." The Canadian strategy has four goals: empowering the general public; strengthening and integrating health care services; creating the information resources for accountability and continuous feedback on factors affecting the health of Canadians; and improving privacy protection within the health sector. The Infoway builds on existing provincial, territorial, and federal health infostructure initiatives such as the Canadian Health Network, the National Health Surveillance Network, and the First National Health Information System. The Roadmap Initiative was established in 1998, with a budget of $95 million over 4 years, to develop more integrated statistical systems and obtain consensus on the indicators and determinants of health. Canada also launched the Canada Health Infostructure Partnerships Program (CHIPP) a two-year, $80 million, shared-cost incentive program, aimed at supporting the implementation of innovative applications of information and communications technologies. [http://www.hc-sc.gc.ca/ohih-bsi/menu_e.html]
In 1998, the United Kingdom National Health Service released "Information for Health 1998 - 2005: An Information Strategy for the Modern NHS." The strategy commits the NHS to: lifelong electronic health records for every person in the country; round-the-clock on-line access to patient record and information about best clinical practices for all NHS clinicians; genuinely seamless care for patients through GPs, hospitals and community services sharing information across the NHS information highway; fast and convenient public access to information and care through on-line information services and telemedicine; and the effective use of NHS resources by providing health planners and managers with the information they need. Committing £1 billion to this initiative, the government established a new NHS Information Authority that is responsible for developing national products and standards for local use and the availability of high-quality information. [http://www.nhsia.nhs.uk/