Open Access Debate

A draft framework for measuring progress towards the development of a national health information infrastructure

Dean F Sittig1*, Richard N Shiffman2, Kevin Leonard3, Charles Friedman4, Barbara Rudolph5, George Hripcsak6, Laura L Adams7, Lawrence C Kleinman8 and Rainu Kaushal109

Author Affiliations

1 Department of Medical Informatics, Northwest Permanente, P.C., Portland, OR USA

2 Center for Medical Informatics, Yale University School of Medicine, New Haven, CT USA

3 Department of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario Canada

4 National Library of Medicine, Rockville, MD USA

5 The Leapfrog Group, Washington, DC USA

6 Department of Biomedical Informatics, Columbia University, New York, NY USA

7 Rhode Island Quality Institute, Providence, RI USA

8 Center for Research Evaluation and Planning, Nemours Foundation, Newark, DE USA

9 Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA USA

10 Department of Public Health, Cornell Medical School, NY, NY USA

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BMC Medical Informatics and Decision Making 2005, 5:14  doi:10.1186/1472-6947-5-14

Published: 13 June 2005



American public policy makers recently established the goal of providing the majority of Americans with electronic health records by 2014. This will require a National Health Information Infrastructure (NHII) that is far more complete than the one that is currently in its formative stage of development. We describe a conceptual framework to help measure progress toward that goal.


The NHII comprises a set of clusters, such as Regional Health Information Organizations (RHIOs), which, in turn, are composed of smaller clusters and nodes such as private physician practices, individual hospitals, and large academic medical centers. We assess progress in terms of the availability and use of information and communications technology and the resulting effectiveness of these implementations. These three attributes can be studied in a phased approach because the system must be available before it can be used, and it must be used to have an effect. As the NHII expands, it can become a tool for evaluating itself.


The NHII has the potential to transform health care in America – improving health care quality, reducing health care costs, preventing medical errors, improving administrative efficiencies, reducing paperwork, and increasing access to affordable health care. While the President has set an ambitious goal of assuring that most Americans have electronic health records within the next 10 years, a significant question remains "How will we know if we are making progress toward that goal?" Using the definitions for "nodes" and "clusters" developed in this article along with the resulting measurement framework, we believe that we can begin a discussion that will enable us to define and then begin making the kinds of measurements necessary to answer this important question.