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When congress passed the Health Insurance Portability and Accountability act in 1996, the goal was to create a simpler, more standardized system that would eventually lower health care costs; reduce errors through safe, universally accepted electronic communication of health care transactions; and eliminate paper claims. Ten years later, the jury is still out on whether HIPAA has been worth the time, energy, and financial investment for insurers. That's not to say, however, that HIPAA hasn't generated benefits while also creating new challenges. "Standards made sense," says Tom Fitzpatrick, Horizon Blue Cross Blue Shield of New Jersey's director of enterprise strategic planning, "but no one ever said it would be fast, cheap, or easy. It was challenging to integrate proprietary claims systems and legacy software with the new standards that took effect in October 2003. But that wasn't the end of the story. HIPAA's privacy and security rules and the standard identifiers have meant even more upgrades and improvements and have required payers to spend millions of additional dollars over the past three years on HIPAA compliance." According to a set of quarterly surveys conducted by HIMSS/Phoenix Health Systems, progress has actually been fairly rapid. On the other hand, some things have remained much the same. In 2003, payers cited "understanding/interpreting the legal requirements" as the most difficult aspect of the HIPAA remediation process, followed by "achieving successful integration of new policies and procedures" and "resolving issues with third parties". In 2006, the barriers are similar, with users citing the same top two struggles.