A framework for systematic evaluation of health information infrastructure progress in communities

It is widely agreed that major improvements in the safety, quality, and efficiency of health care in the US require a National Health Information Infrastructure. To accomplish this, efforts are now underway in many communities to build local or regional health information infrastructures (HIIs) that provide secure, ubiquitous access to complete health care information. To facilitate the assessment and monitoring of the progress of operational HIIs toward completion, we propose a framework of four key measures of requirements that must be ultimately be met: (1) completeness of information, (2) degree of usage, (3) types of usage, and (4) financial sustainability. To evaluate the framework, it was used by the authors to qualitatively assess HII projects in cooperation with four leading communities, resulting in ratings of 78% for Bellingham, WA, 63% for Indianapolis, IN, 60% for South Bend, IN, and 74% for Spokane, WA. Qualitative assessment of community HII systems may be helpful in monitoring progress, comparing projects, and understanding the remaining tasks needed for completion. Additional testing and refinement of the proposed framework is needed to further understand and improve HII progress measurement capabilities.