In September 2010, Vivek Kundra, the Federal Chief Information Officer, and I issued guidance articulating five key health IT policy and technology principles for Federal health IT projects. The goal of these principles is to encourage better strategic alignment of health IT investments by guiding modernization strategies for existing systems, as well as new investment decisions. Agencies were asked to demonstrate how they plan to incorporate the following policy and technology principles into future health IT investments and to provide specific examples from their fiscal year (FY) 2012 budget submissions:

• Improving health and health care: Agencies should design their health IT systems to support clinical decision-making and to measurably improve long term outcomes. For FY 2012, agencies will be asked to demonstrate their support for the universal attainment of Meaningful Use either by, if eligible, becoming Meaningful Users themselves or by assisting and encouraging others that are eligible, to become Meaningful Users.
• Promoting open government: Agencies should share information with their clients/patients, when possible and practicable. An FY 2012 priority is providing clients/patients a secure, timely, electronic copy of their own information in a format they can use and reuse.
• Securely sharing health information between providers for treatment purposes to enable better care: Agencies should ensure Federal HIT systems are interoperable.  In FY 2012, agencies should use standards and specifications adopted under the HITECH Act in communicating between applications and organizations.
• Being a trusted steward of taxpayer dollars: Agencies should incorporate interoperable voluntary consensus standards and terminologies where available, and contribute to their ongoing development, as their missions provide for and their resources permit. To this end, FY 2012 investments should use and re-use common, interoperable voluntary consensus standards and terminology, as well as employ modular, flexible solutions to ensure health IT systems are built for re-use and evolution.
• Protecting privacy and security: Agencies should align their health IT investments with the Fair Information Practice Principles and demonstrate this alignment in FY 2012.

Following submission, agency plans underwent a rigorous peer review process, and representatives from HHS, Department of Agriculture, Department of Commerce, Department of Defense, Department of Veterans Affairs, Social Security Administration, and Office of Personnel Management took an active role in evaluating the investments of the various Federal counterparts.

The development of principles and the use of peer review to review Federal health IT expenditures constitute a novel basis for coordinating these expenditures and providing the best possible advice to sister agencies.  In the future, we hope that this process will result in valuable learning for managers of health IT in the Federal Government, and lead to better value for patients and taxpayers.