On March 23, 2010, the President signed the Patient Protection and Affordable Care Act (Affordable Care Act) (P.L. 111–148) into law, strengthening and modernizing health care. The Affordable Care Act makes health insurance coverage more secure and reliable for Americans who have it, makes coverage more affordable for families and small business owners, and brings down skyrocketing healthcare costs that have put a strain on individuals, families, employers, and our Federal budget.
HHS is responsible for implementing many of the health reform changes included in the Affordable Care Act. HHS is strengthening and modernizing health care to improve patient outcomes, promoting efficiency and accountability, ensuring patient safety, encouraging shared responsibility, and working toward high-value health care. HHS also is improving access to culturally competent, quality health care for uninsured, underserved, vulnerable, older, and special needs populations. These reforms and the resulting improvements in the care provided on a day-to-day basis will improve our foundation for emergency preparedness. Stronger health care will enhance our Nation’s ability to provide extra medical care capacity when needed. Individuals and communities also will be more resilient in the face of emergencies if they are healthy and have access to quality care on a regular basis.
The Secretary has identified several Strategic Initiatives related to strengthening health care, including promoting high-value, safe, and effective health care; securing and expanding health insurance coverage; and eliminating health disparities. A critical part of HHS’s strategy is to give the American public the means to make more informed choices to ensure optimal health care by improving transparency regarding the quality and costs of health services, better coordinating care, fostering patient-centered care, and promoting consumers’ participation in their health and health care.
HHS has made extensive use of program evaluation findings to identify new, and refine existing, priorities for strengthening health care. For example, findings from previously completed Medicare post–acute care evaluations have led to the refinement of HHS’s approaches to reducing costs while promoting high-value care. Evaluations of primary care services have helped to identify the need for linkages between primary care and community prevention services. Findings from evaluations of medical product clinical trials and post-market surveillance have helped to inform new medical product efficacy and patient safety activities.
HHS is continuing to use evaluation information to monitor progress on its efforts to strengthen health care. For example, HHS is conducting numerous evaluations, including those of the Children’s Health Insurance Program (CHIP); pharmacovigilance practices at the Food and Drug Administration (FDA); early childhood home visitation programs; and newly developed nursing home tools to reduce falls, pressure ulcers, and emergency room visits.
HHS’s Administration on Aging (AoA), Agency for Healthcare Research and Quality (AHRQ), Assistant Secretary for Preparedness and Response (ASPR), Centers for Medicare & Medicaid Services (CMS), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), Health Resources and Services Administration (HRSA), Indian Health Service (IHS), National Institutes of Health (NIH), and Substance Abuse and Mental Health Services Administration (SAMHSA) all have significant roles to play in strengthening health care. The Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office for Civil Rights (OCR), Office on Disability (OD), Office of Health Reform (OHR), Office of the National Coordinator for Health Information Technology (ONC), and Office of the Assistant Secretary for Health (OASH) also are critical to advancing this goal.
Today, more than 45 million Americans lack access to affordable health insurance. Additionally, many individuals who do have health insurance have incomplete coverage that may include exclusions for pre-existing conditions, or they may be one step away from losing coverage because of a change in employment. Individuals with health insurance face increasingly high premiums and medical costs that drive some to bankruptcy or force choices between maintaining health insurance coverage and paying for other household essentials.
The Affordable Care Act is providing relief from skyrocketing health insurance costs and is ensuring Americans have secure, stable, and affordable health insurance. In 2010 HHS began implementing new regulations affecting the health insurance market aimed at increasing consumer protections and at creating a more competitive insurance market. This increased oversight is making health care more responsive to the needs of its patients, healthcare providers, and other stakeholders.
Health insurance reform is creating health insurance Exchanges that pool together millions of individuals and small businesses and their employees to increase purchasing power and competition in the insurance market, a luxury that only large employers currently enjoy. Increased purchasing power and competition, in turn, will make premiums more affordable. The Exchanges will also reduce administrative costs for individuals and small businesses and their employees by enabling them to make more straightforward comparisons of the prices, benefits, and quality of health plans.
HHS created a new website, www.healthcare.gov, which provides consumers with easily comparable health insurance options specific to their life situation and local community. Healthcare.gov improves coverage transparency by providing consumers with meaningful information about what health insurance covers and how it works. Healthcare.gov is the first central database of health coverage options, combining information about public programs, from Medicare to the new Pre-Existing Conditions Insurance Plan, with information from more than 1,000 private insurance plans. The insurance options finder automatically sorts through a catalogue of options to help consumers identify the ones that may be right for them. Other highlights of the site include extensive information about consumer rights, how to navigate the health insurance marketplace, and quality rankings for local healthcare providers.
Within HHS, agencies and offices such as CMS, IHS, OCR, and OHR are working together to implement the reforms prescribed in the law to make affordable coverage more accessible. HHS is using the following key strategies to make coverage more secure for those who have insurance and to extend affordable coverage to the uninsured.
- Help create State-based health insurance Exchanges that will increase purchasing power, reduce administrative expenses, and increase competition to make premiums more affordable;
- Provide subsidized coverage through health insurance Exchanges to people who cannot afford to purchase insurance on their own;
- Increase the number of young adults under age 26 who are covered as a dependent on their parent’s employer-sponsored insurance policy;
- Expand Medicaid coverage to more low-income Americans;
- Reduce the prescription drug coverage gap (“donut hole”) for those receiving the Medicare Part D Prescription Drug Benefit;
- Ensure access to health insurance by prohibiting insurers from placing lifetime limits on medical care, prohibiting insurers from denying coverage based on pre-existing conditions, and prohibiting discriminatory premium rates based on health status;
- Prohibit insurance companies from dropping people from coverage when they get sick;
- Establish the Pre-Existing Condition Insurance Plan Program to provide affordable insurance for Americans who are uninsured, have a pre-existing condition; and have been without coverage for at least six months;
- Work with States to establish a rate review process that identifies and remedies unreasonable rate increases by health insurance plans;
- Operate a fully-accessible health insurance website, HealthCare.gov, that empowers consumers by increasing informed choice and promoting market competition;
- Require insurance companies to spend the majority of health insurance premiums on medical care, not on profits and overhead;
- Require new health plans to implement an appeals process for coverage determination; and
- Work with tribes, HHS tribal advisory bodies, and other tribal and urban Indian groups and programs to provide outreach, information, and assistance to assure that AI/ANs, and the entities that serve them, are aware of and able to use the benefits available under the Indian Health Care Improvement Act and other Indian-specific and generally applicable provisions of the Affordable Care Act.
Innovative therapies and cutting-edge technologies are fundamental to medical care in the United States. However, there are numerous opportunities for improvement that could significantly impact the health of the American people. The gap between the best possible care and the care that is routinely delivered is considerable. Despite modest improvements in the quality of care, the pace is slow, especially for preventive services and chronic disease management. Of particular concern is the continued slow progress in the area of patient safety and healthcare-associated infections as well as the persistent geographic variation in quality of care delivered. Disparities in care remain prominent; uninsured patients receive considerably lower quality care than insured patients on several dimensions.
HHS is committed to improving health care quality and patient safety for all Americans through its operating and staff divisions. FDA is protecting the Nation’s health by ensuring the safety, effectiveness, and security of human and veterinary drugs, vaccines, and other biological products and medical devices. SAMHSA is regulating the safe use of methadone for addiction treatment. HHS is also ensuring quality of care and patient safety through surveillance activities at FDA and CDC. AHRQ is developing strategies to strengthen quality measurement and improvement and is overseeing the operations of a task force focused on patient safety. OASH is coordinating the efforts of agencies to improve healthcare quality and public health quality with a special emphasis on reducing the burden of healthcare-associated infections, and is serving as the focal point for implementation of a national strategy to prevent health care-associated infections.
IHS is improving the quality of care in the clinical, public health, and preventive services it provides to AI/ANs in a number of ways. Strategies include providing training and support for innovative uses of paraprofessionals — enabling members of American Indian and Alaska Native communities to have access to a wider range of culturally and linguistically appropriate services. IHS’s Improving Patient Care Initiative is supporting tribal, IHS, and urban Indian health programs to improve quality and access to care through the development of an American Indian and Alaska Native health system medical home.
CMS is expanding its role beyond being simply a payer of claims, and becoming an agency that positively promotes the quality of care for its beneficiaries. Examples include developing physician- and hospital-quality reporting systems that link payments to the quality and efficiency of care; implementing nursing home initiatives that reduce the incidence of bed sores and dehydration among residents; employing initiatives to eliminate payment for certain medical errors (“never-events”); and applying payment incentives to avoid healthcare-acquired conditions and readmissions; and initiating a bundled-payment system that will align payments for services delivered across an episode of care, such as a heart bypass or hip replacement, rather than paying for services separately. Bundled payments will give doctors and hospitals new incentives to coordinate care, improve the quality of care, and save money for Medicare.
In addition, ASPR is working to expand equitable access to safe, quality care when an emergency requires the rapid expansion of healthcare delivery. OCR is enforcing civil rights laws to prevent discrimination in the delivery of health care on the basis of race, color, national origin, disability, age, and in many instances, gender and religion.
Within HHS, AHRQ, CDC, CMS, FDA, HRSA, IHS, OCR, OASH, and SAMHSA are working to improve healthcare quality and patient safety for all Americans, using the following key strategies.
- Increase the availability of patient-centered outcomes research to give patients and practitioners evidence on the most effective medical options;
- Implement payment reforms, such as bundled payments, that reward quality care and work with physicians and practitioners, and across the public and private sectors, in quality improvement efforts;
- Reduce healthcare-associated infections, adverse drug events, and other complications of healthcare delivery through quality and safety promotion efforts;
- Establish the Partnership for Patients, a new public-private partnership that will help improve the quality, safety, and affordability of health care for all Americans.
- Improve the quality of, and access to, care in the IHS system as well as patient safety by approaches such as implementing the Improving Patient Care initiative, which focuses on creating a medical home for patients;
- Improve medical products to enhance patient safety;
- Improve patient safety through the surveillance of adverse events, errors, or near misses in blood, organ, and tissue procedures; and
- Improve the quality and safety of healthcare delivery through Patient Safety Organizations.
Both improved access to primary care services and more effective public health measures are critical to ensuring that individuals have access to high-quality services at the place and time that best meets their needs. It is important that individuals be informed of existing community services that support health promotion, such as exercise programs, educational classes, self-management training, and nutrition counseling. If diagnosed with diseases or adverse health conditions, they can be linked to these same community services to enable them to take a holistic approach to improving their health.
The Affordable Care Act is expanding insurance coverage for Americans, supporting improvements in primary care, and makings new investments in community-based prevention. As part of this effort, HHS is focusing on creating key linkages between health care and effective community prevention services that support healthy living and disease management.
Basic and applied research at NIH and CDC is enabling the identification of the services that have the greatest potential to be effective in community settings. HRSA and SAMHSA programs are delivering healthcare services to millions of Americans, including vulnerable and underserved populations, especially for individuals with behavioral health conditions. CMS programs are providing payment for recommended preventive services through Medicare, Medicaid, and CHIP.
Within HHS, AHRQ, AoA, CDC, CMS, FDA, HRSA, IHS, NIH, and SAMHSA are committed to the effort to emphasize primary and preventive care, with a focus on community prevention services. These agencies will use the following key strategies.
- Increase the emphasis of Community Health Centers on providing preventive services and linking with the public health community;
- Remove financial barriers to accessing recommended preventive health services by providing health insurance that includes coverage of these services at no cost to the patient;
- Promote early entry into primary care, education, and coordinated services for pregnant women and infants;
- Expand community-based prevention programs to help improve the health and quality of life of individuals with, and at risk for, chronic diseases and conditions;
- Support implementation of the Prevention and Public Health Fund to assist state and community efforts to prevent disease, detect it early, manage conditions before they become severe, and provide states and communities the resources they need to promote healthy living;
- Build community and individual resilience and skills to cope with risk factors for behavioral health disorders;
- Disseminate best practices for use of substance abuse screening and intervention in acute healthcare settings;
- Promote emotional health by creating prevention-prepared communities that take coordinated action to prevent and reduce mental illness and substance abuse;
- Support rapid communication and coordination between public health practitioners and clinicians to increase use of evidence-based prevention strategies to address risk factors and conditions;
- Build and operate programs to identify, evaluate, disseminate, and promote effective clinical preventive services;
- Increase access to comprehensive primary, preventive, and specialty services by expanding the number of medical homes for children, youth, and adults; and
- Establish Medicare and Medicaid payment and delivery system policies (including accountable care organizations, medical homes, and bundled payments) that value primary care and promote prevention and wellness in a fiscally responsible way;
- Develop public-private sector partnerships to improve care and empower people to make healthier choices.
Healthcare costs consume an ever-increasing amount of our Nation’s resources, straining family, business, and Government budgets. Rising premiums hurt the competitiveness of American businesses and erode workers’ take-home pay. Healthcare costs take up a growing share of federal and state budgets and imperil the Government’s long-term fiscal outlook. In the United States, one of the sources of inefficiency that is leading to rising healthcare costs is payment systems that reward medical inputs rather than outcomes, contain high administrative costs, and lack focus on disease prevention.
The Affordable Care Act is bringing down costs for families, businesses, and government with the broadest package of healthcare cost-cutting measures that has ever been enacted. As part of health reform implementation, HHS is lowering costs for American families and individuals through insurance market reforms that ensure access to preventive care.
HHS is changing Medicare from a system that rewards volume of service to one that rewards efficient, effective care; reduces delivery system fragmentation; and better aligns reimbursement rates with provider costs. Efforts to strengthen program integrity in Medicare and Medicaid, and to encourage widespread adoption and meaningful use of health information technology also help reduce the growth of healthcare costs.
Within HHS, AHRQ, ASPE, CDC, CMS, FDA, HRSA, IHS, and SAMHSA have significant roles to play in realizing this objective. HHS will use the following key strategies to reduce the growth of healthcare costs while promoting high-value, effective care.
- Produce the measures, data, tools, and evidence that healthcare providers, insurers, purchasers, and policymakers need to improve the value and affordability of health care and to reduce disparities in costs and quality between population groups and regions;
- Develop and disseminate data and evidence-based information tools needed to inform policy and practice and to improve the efficiency and quality of health care (i.e., evidence-based, high-value services recommended by the Community Guide and Guide to Clinical Preventive Services);
- Increase the use of cost-effective telehealth mechanisms to make specialized care more available to AI/AN and other underserved populations;
- Design, implement, and evaluate healthcare provider incentives that encourage the delivery of effective, efficient healthcare services;
- Create new models of care including health delivery mechanisms, payment methods, or insurance Exchanges that align provider incentives with quality and efficiency goals; and
- Reform the Medicare and Medicaid payment systems, through value-based purchasing and other programs, to reward high-value services instead of high-volume services.
With the growing diversity of the U.S. population, healthcare providers are increasingly called on to address their patient’s unique social and cultural experience and language needs. Provision of culturally competent care can increase quality and effectiveness, increase patient satisfaction, improve patient compliance, and reduce racial and ethnic health disparities.
A number of HHS programs help make health care more available to people whose circumstances call for special attention, including older adults; children; people with disabilities; uninsured populations; and persons with Limited English Proficiency. For instance, to help healthcare professionals provide the highest quality of care to every patient regardless of race, ethnicity, cultural background, or the ability to speak English, the Office of Minority Health has developed a free interactive Web-based training course, A Physician’s Practical Guide to Culturally Competent Care, for physicians, nurses, nurse practitioners, and other healthcare providers.
While Medicare generally does not reimburse language services (except in the case of outpatient psychotherapy), some Medicare Advantage plans make translators available to their enrollees. Moreover, the Federal Government gives each state the option of receiving matching funds for the provision of language assistance services to Medicaid and CHIP beneficiaries.
In other instances, people also may have difficulty accessing high-quality care because they have low incomes or live in remote areas. For example, IHS, tribal, and urban Indian organization providers face challenges in addressing the needs of AI/ANs who experience health disparities and lack access to various kinds of care.
Military families may experience difficulty in accessing the needed and appropriate care. Lesbian, gay, bisexual, and transgender individuals may face problems in seeking and receiving care that meets their needs. The AHRQ-issued 2009 National Healthcare Disparities Report finds that, for many measures, racial and ethnic minorities have more limited access to care and receive lower quality care. Data from some Community Health Centers indicates that disparity gaps exist for racial and ethnic minorities regardless of economic status.
CMS programs open the door to health services for older adults, people with disabilities, and many low-income adults and children. CMS sets requirements for providers that help ensure a common level of healthcare quality. Through demonstration projects and other innovations, CMS seeks to find better ways to deliver high-quality care. Service delivery programs in HRSA, IHS, and SAMHSA help enhance the availability of care in areas of high need. These agencies strive to improve the quality of care their programs deliver. AHRQ regularly monitors healthcare quality and disparities, and through its grants and contracts, focuses on improving how care is delivered.
When fully implemented, the Affordable Care Act will provide for expanded access to insurance coverage, making care more accessible for vulnerable populations that are currently uninsured. For example, CMS’s Pre-Existing Condition Insurance Plan Program is providing healthcare coverage to many individuals with pre-existing conditions who are uninsured, while the establishment of health insurance Exchanges will provide access to subsidized health insurance coverage. As stated earlier, the Affordable Care Act also contains many provisions directed at improving healthcare quality in existing HHS programs and in health care generally. One provision of particular significance is the requirement within the Affordable Care Act to establish a program for measuring and reporting on the quality of care adults receive under Medicaid. This effort parallels a similar program addressing the quality of care children receive under the Medicaid and CHIP Programs that was enacted in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009 (P.L. 111–3). Expanded funding for Community Health Centers, which serve large numbers of ethnic and racial minorities, makes primary care more accessible across the Nation in inner cities, underserved suburbs, and rural areas. Civil rights protections in the Affordable Care Act ensures equal access to healthcare programs and activities for individuals regardless of race, color, national origin, disability, gender, and age. The Affordable Care Act contains many provisions to help patients receive help in managing their care and in successfully navigating a complex array of health supports.
Through its Departmental Oral Health Initiative, HHS is promoting the incorporation of oral healthcare services and oral disease prevention into primary healthcare delivery sites. Good oral health is essential to good overall health; conversely, poor oral health negatively impacts the quality of life, including pain, lost productivity at school and work, and implications for future disease patterns. HHS is promoting policies to integrate oral health into primary care, including prevention and improved health literacy. Improved availability of oral health services, including disease prevention, treatment, and health promotion and education are being promoted for poor and underserved populations as well as for the population at large.
Given our Government’s unique legal and political relationship with tribal governments, it has a special obligation to provide health services for American Indians and Alaska Natives (AI/ANs). HHS follows the President’s 2009 tribal consultation policy to partner with tribes to ensure access to quality health care for AI/ANs. In addition, the Affordable Care Act contains the permanent reauthorization of the Indian Health Care Improvement Act, which modernizes and updates a range of authorities for programs and functions operated by IHS, tribes, tribal organizations, and urban Indian organizations. The Affordable Care Act also includes other provisions that address the unique circumstances and needs of tribes and AI/AN individuals. As HHS is implementing the provisions of the new law, HHS is partnering with tribes and tribal organizations through tribally operated health programs, urban Indian organizations, and healthcare providers on how to ensure access to a broader array of health care for AI/ANs.
The Affordable Care Act highlights minority health by formally establishing minority health offices in the Department’s agencies, and contains provisions to improve data collected, analyzed, and reported (by the Department’s programs) on race, ethnicity, gender, age, primary language, and disability status—provisions that will help the Department better target its efforts in the years to come by providing data on subpopulation groups, whose health status issues were masked by their inclusion in general groupings. Similarly, a wide variety of health data will be available on the LBGT population, data that is generally not available today.
Within HHS, ACF, AHRQ, AoA, CDC, CMS, HRSA, IHS, OCR, OD, OASH, and SAMHSA have significant roles to play in realizing this objective. HHS will use the following key strategies to ensure access to quality, culturally competent care for elderly and vulnerable populations.
- Monitor access to and quality of care across population groups, and work with federal, state, local, tribal, urban Indian, and nongovernmental actors to address observed disparities and to encourage and facilitate consultation and collaboration among them;
- Promote expanded access to quality and culturally competent healthcare services to populations that have experienced health disparities, including African Americans, Latinos, AI/AN; individuals with disabilities; refugees as well as to populations with Limited English Proficiency;
- Improve access to quality care through the prevention and correction of discriminatory actions and practices;
- Increase access to comprehensive primary and preventive services to historically underserved areas by expanding the number of Community Health Centers and the range of services offered by these centers;
- Support concentrated approaches to quality improvement in service delivery programs, and build a comparable focus on improvement in the quality of behavioral health services;
- Implement quality improvement provisions of the Affordable Care Act and evaluate their impact;
- Improve access to mental health and substance abuse treatment through the implementation of the Wellstone and Domenici Mental Health Parity and Addiction Equity Act of 2008 and the development of the essential and benchmark packages under the Affordable Care Act;
- Expand quality improvement efforts in Medicare, Medicaid, and CHIP and continue to utilize Quality Improvement Organizations, as well as public reporting and payment changes, to foster reduction of hospital-acquired infections and other healthcare-acquired conditions;
- Increase access to primary oral healthcare services and to oral disease preventive services by expanding access to Community Health Centers, school-based health centers, and Indian Health Service–funded health programs that have comprehensive primary oral healthcare services, and state and community-based programs that improve oral health, especially for children and pregnant women;
- Implement the Strategic Plan in a manner that complies with the President’s Memorandum for the Heads of Executive Departments and Agencies of November 5, 2009, on tribal consultation; renews and strengthens our partnership with tribes; in the context of national health reform, brings reform to IHS; improves the quality of and access to care for AI/AN individuals; and is accountable, transparent, fair, and inclusive; and
- Work with the Departments of Defense and Veterans Affairs, the National Guard, and the states to improve access to needed behavioral health and supportive services for active duty, guard, reserve, and veterans and their families.
At the heart of HHS’s strategy to strengthen and modernize healthcare is the use of data to improve healthcare quality, reduce unnecessary healthcare costs, decrease paperwork, expand access to affordable care, improve population health, and support reformed payment structures. The nation’s health information technology infrastructure enables the flow of information to power these critical efforts—making possible the types of fundamental changes in access and healthcare delivery proposed in the Affordable Care Act.
HHS is taking a leading role in realizing health information technology’s potential benefits. The Health Information Technology for Economic and Clinical Health (HITECH) provisions of the Recovery Act committed billions to promote adoption and use of health information technology. This unprecedented investment in health information technology propelled a range of initiatives, including regulations on the meaningful use of health information technology and standards as well as the funding of regional extension centers, state health information exchanges, and Beacon communities. The rapid “wiring” of American health care, which is taking place under the law, is doing more than simply digitizing paper-based work. It is facilitating new means of improving the quality, efficiency, and patient-centeredness of care.
Augmenting this investment are a range of programs across the Department, including the electronic prescribing and personal health record programs at CMS, IHS’s continued expansion and deployment of its electronic health records system, and HHS’s healthcare workforce programs. Expanded telehealth programs at HRSA and at IHS use video and telecommunication technologies to help healthcare professionals diagnose, treat, and monitor patients, thus bringing services to people who live in tribal, rural, or other areas where necessary medical expertise is not available.
HHS has identified the adoption and meaningful use of health information technology nationwide as a top priority for changing health care and for making health care more accessible, affordable, and safe for all Americans.
The Office of the National Coordinator for Health Information Technology (ONC) serves as the Secretary’s principal advisor charged with coordinating nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. In addition to ONC, many HHS agencies and offices play a significant part in the advancement of health information technology for improving healthcare quality and efficiency and for reducing costs. These agencies and offices, including AHRQ, AoA, ASPE, CDC, CMS, FDA, HRSA, IHS, NIH, OCR, OMHA and SAMHSA, are contributing to this objective through the following key strategies.
- Encourage widespread adoption and meaningful use of health information technology through incentives, grants, and technical assistance;
- Endorse the active participation of consumers in accessing and engaging with their health information;
- Inspire confidence and trust in health information technology by ensuring the privacy and security of electronic health information;
- Encourage innovation; support pilots that demonstrate health IT-enabled reform; and develop policies, standards, and services that will enable the appropriate re-use of information to support quality, public health, and research;
- Support and promote use of telehealth to provide access to modern technology and healthcare specialty resources for tribal, rural, and other underserved communities;
- Explore the use of mobile technology to provide timely and culturally appropriate health information to vulnerable and hard-to-reach populations; and
- Enhance communication and support a public awareness campaign about the value of health information technology for outreach to all healthcare stakeholders, including providers, payers, and consumers of care. Develop and implement a public awareness campaign public about the basics, benefits, and privacy implications of health information technology for multiple audiences, including healthcare providers, other professionals, and patients and families.
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