National Academy of Medicine: HIT agenda must be reset

Doc and computer

The U.S. has met only one of four federal health IT goals outlined by the White House in 2004, according to the National Academy of Medicine, which notes in a new discussion paper that the agenda for the next five years should be "reset."

The paper, part of NAM’s Vital Directions for Health and Health Care initiative, notes that while the national goal of electronic health record adoption has been reached, the three other goals outlined in 2004--interoperability, supporting consumers with information and public health, clinical trials and other data-intensive activities--have not. It identifies nine central themes in three focus areas that it suggests should be the major goals for health IT over the next five years, including:

Technical underpinnings:

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  • Data standards and achieving interoperability at scale
  • Interoperability with consumer health technology
  • Improving patient identification matching to support interoperability
  • Service-oriented architectures and web-based services

Use cases:

  • Enfranchising vulnerable populations and improving care for chronic diseases
  • Health data and public health
  • Accelerating use of aggregated health information and research


  • Building a health IT workforce
  • Creating a trust fabric with health services: privacy and security

The paper outlines current problem areas, including Meaningful Use’s mixed success and inadequate EHR design. It also identifies opportunities and policy alternatives, such as authorizing the Department of Health and Human Services to adopt and promulgate standards through formal rule making for patient identification and matching.

The authors recommend three “vital directions” to take:

  1. End-to-end interoperability from devices to EHRs
  2. Aggressively address cybersecurity vulnerabilities
  3. Develop a data strategy that supports a learning health system

“Instead of increasing the pace of HIT or picking the more advantageous innovations, policy and policy makers should ensure that the changes that are already under way improve utility and advance the broader principles that the United States maintains for safe, privacy-preserving, equitable, responsive, high-quality and cost-effective health care,” the authors say.

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