1. McCartney, Patricia PhD, RN, FAAN

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Internet discussion lists have been buzzing the last few weeks about the electronic health record (EHR). Simultaneous threads have appeared on lists such as Nursing Informatics, Telehealth, and Adolescent Health, with list members providing updates on the National Health Information Infrastructure (NHII), which is a U.S. policy initiative you need to understand. The NHII is a 10-year national action plan developed by the U.S. Department of Health and Human Services (DHHS) to harness information technology for improving healthcare efficiency, safety, and quality (DHHS, 2001). There are three dimensions to NHII: 1. public health statistics, 2. healthcare delivery (EHR, data standards, practice guidelines, decision support, and prescribing programs), and 3. personal health (privacy and security of personal health information and consumer control of personal health records). The NHII has been developed to provide leadership to foster electronic records capacity and collaboration among stakeholders such as government policymakers, health-care agencies and providers, researchers, industry personnel, and consumers. The NHII Web site (DHHS, 2004) is a comprehensive resource for NHII objectives, news, meetings, and policy archives.


NHII Developments

In July 2003, the DHHS convened the first national conference on developing a health information infrastructure; scripts of the conference proceedings are available on the NHII Web site. Two major steps toward establishing a common and interoperable system were unveiled at the conference. The first was an agreement with the College of American Pathologists to purchase a license for its standardized vocabulary, Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT), for free use by healthcare agencies in the United States. SNOMED CT is an interdisciplinary vocabulary that includes several nursing vocabularies. The second was an agreement with Health Level Seven (HL7), a technology standards organization, to draft a model EHR. The HL7 model, called the Electronic Health Record System Functional Model, has just been approved by the major health information technology professional organizations and will become a draft standard for 2 years of trial use before becoming a full standard.


The National Health Information Infrastructure has been developed to provide leadership to foster electronic record capacity throughout the United States.


A second national conference scheduled for July 2004AQ1 includes a nurse presenter (Patricia Brennan) and is sponsored by several professional organizations important in nursing practice (American Nurses Association, American Association of Colleges of Nursing, American Nursing Informatics Association, Joint Commission on Accreditation of Health Care Organizations), as well as leading information technology organizations.


Several of the standards have been adopted by DHHS or are in the process of being adopted. In February 2004, the Food and Drug Administration issued new regulations to require bar codes on the labels of all prescription drugs, selected nonprescription drugs, and all blood components for transfusion. National standards are already in place for medication terminologies, gene nomenclature, interfaces between medical devices and computer systems, and the electronic transmission of laboratory test orders, laboratory results, and digital images. Public hearings are planned to discuss electronic prescribing standards, practices, incentives, and barriers.


In May 2004, HHS created the Office of National Health Information Technology and named David Brailer as its first National Coordinator. The National Coordinator serves as the principle advisor to the Secretary of the DHHS on health information technology and directs DHHS technology programs. The new Coordinator was specifically charged to create policies and incentives that promote the adoption of interoperable health information technology in the public and private sectors.


This is just one brief snapshot of the dynamic national activity surrounding electronic health information. This vital work is continually changing, and nurses need to stay informed to position nursing practice prominently in this landscape!!




U.S. Department of Health and Human Services (DHHS). (2001). Information for health: A strategy for building the national health information infrastructure. Retrieved May 18, 2004, from [Context Link]


U.S. Department of Health and Human Services (DHHS). (2004). The national health information infrastructure. Retrieved May 18, 2004, from [Context Link]