There also is consensus that although creating the NHII requires a partnership of public- and private-sector leaders, the federal government needs to play a leadership role in several ways, including promulgating certain data and other IT standards (IOM, 2004; Thompson and Brailer, 2004). The federal government also needs to provide financial support in three main areas. First, federal funds should support the development of critical components of the NHII that are unlikely to receive support from private-sector stakeholders. These include the establishment of a secure platform for the exchange of data across all providers and maintenance of a process for ongoing promulgation of national data standards. Second, the federal government should provide financial incentives to stimulate private-sector investment in EHR systems through the use of special loans, payment incentives to providers, or other mechanisms. Finally, federal funding of safety net providers is needed to support their adoption of IT (IOM, 2004).

Development of the NHII is expected to take many years, perhaps as long as a decade (Thompson and Brailer, 2004).² To jump-start the process, in 2004 the President established the Office of the National Coordinator for Health Information Technology (ONCHIT), charged with the following (DHHS, 2005b):

• Serving as the senior advisor to the President and the Secretary of the Department of Health and Human Services (DHHS) on all health IT programs and initiatives.

• Developing and maintaining a strategic plan to guide the nationwide implementation of interoperable EHRs in both the public and private health care sectors.

• Coordinating the spending of approximately $4 billion for health IT programs and initiatives across the federal government.

• Coordinating all outreach activities to private industry and serving as the catalyst for health industry change.

Three months later, ONCHIT’s National Coordinator put forth a framework for strategic action, The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care, which included a 10-year plan to develop the NHII in partnership with the private sector. This plan addresses the development of EHRs, data standards, and interoperable technologies for the exchange of patient data across providers and settings of care (Thompson and Brailer, 2004).