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The quality nexus: Office of the National Coordinator for Health Information Technology


In April, Farzad Mostashari, MD, ScM, became the fourth National Coordinator of Health Information Technology within the Office of the National Coordinator for Health Information Technology (ONC) at the Department of Health and Human Services (HHS). A relatively young federal agency, ONC came about by executive order and a 2004 pronouncement by President George W. Bush that every person would have an electronic health record (EHR) in 10 years. Passage of the American Recovery and Reinvestment Act in 2009 provided almost $30 billion to advance EHR adoption, which thrust ONC into the spotlight of national health policy. That year, President Obama renewed the pledge to computerize all health records by 2014.

The ambitious health information technology (IT) agenda includes community, state, regional, and federal initiatives that foster the implementation of health IT and electronic exchange of health information to improve the quality of care and help lower costs. Such programs as the nationwide health information network, federal health IT architecture, cybersecurity, adoption and meaningful use of EHRs, and clinical decision support all bolster the aims of improving health care. Other major initiatives focus on preparing an IT-competent workforce and research that will lead to breakthroughs to speed adoption of health IT.

Two federal advisory committees guide the work of ONC, along with collaborative workgroups across a variety of federal agencies responsible for addressing the nation’s healthcare needs. The Health Information Technology (HIT) Policy Committee recommends actions to guide the development of a nationwide health-information infrastructure. Its numerous workgroups address such issues as meaningful use, certification, a nationwide health-information network, information exchange, and privacy, security, and quality measures. The HIT Standards Committee works in tandem with the Policy Committee and advises on standards implementation specifications and certification criteria for information exchange. Together, these groups are shaping the national health IT infrastructure to revolutionize the stewardship of patient data from paper to electronic systems, which will enable health­care providers and organizations to collect, analyze, and share data to improve care and outcomes.

A number of nurses serve on these federal advisory committees and their workgroups. Dr. Connie Delaney sits on the HIT Policy Committee. Judy Murphy and Elizabeth Johnson are on the HIT Standards Committee. Dr. Rosemary Kennedy, Dr. Norma Lang, Joyce Sensmeier, and Dr. Tim Cromwell serve on various workgroups. Leaders of the Alliance for Nursing Informatics (ANI) and American Nurses Association (ANA) are making a concerted effort to keep ready a list of qualified nurses to recommend for appointment to national health IT groups. The perspectives of nursing and patient-centered care are crucial to these discussions.

In June, I joined ANI in a meeting with Dr. Mostashari to reinforce the importance of nurses and nursing informatics in the successful adoption of health IT. As a follow-up to that meeting, I interviewed him for American Nurse Today. (See page 8.) In September, ANA and ANI representatives attended the Consumer Health Summit convened by HHS Secretary Kathleen Sebelius, Dr. Mosta­shari, and other federal health IT leaders to give patients greater access to their health information and help them be more active partners in their care by using health IT. ANA pledged to educate consumers on avenues for making informed choices about their health care through information briefs and social media. ANI pledged to coordinate a campaign with other nursing organizations to pro- mote use of personal health records and patient portals. Announcing these pledges, U.S. Chief Technology Officer Dr. Aneesh Chopra stressed how much patients trust their nurses and lauded nursing’s commitment to this effort.

Initiatives across HHS underscore the role of health IT in transforming health care to make it safer, better, and more cost effective. Whether it’s a commitment to helping consumers access and act on their health information or striving to reduce patient harm in healthcare facilities, the journey to improve the quality of care and patient experience is a long one—often led by nurses. The most important connection we can make is with health IT, which offers the structure and toolkit needed to make that journey faster, more efficient, and more rewarding. By using health IT in a meaningful way, we take what we learn from the system and commit to ongoing improvement. Health care and health IT are inextricably linked in the quality connection.

Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN

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