Crossing the Quality Chasm A New Health System for the 21st Century (2001) / Chapter Skim
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7 using Information Technology
7 using Information Technology
Pages 164-180
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From page 164... ...
There are many opportunities to use IT to make care more patientcentered, for example, by facilitating access to clinical knowledge through understandable and reliable Web sites and online support groups (Cain et al., 2000~; customized health education and disease management messages (Goldsmith, 2000~; and the use of clinical decision support systems to tailor information according to an individual patient's characteristics, genetic makeup, and specific conditions (Garibaldi, 1998) (see Chapter 6 for additional discussion)
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From page 165... ...
Chapter 5 emphasizes the importance of a strong information infrastructure in supporting efforts to reengineer care processes, manage the burgeoning clinical knowledge base, coordinate patient care across clinicians and settings and over time, support multidisciplinary team functioning, and facilitate performance and outcome measurements for improvement and accountability. Chapter 6 stresses the importance of building such an infrastructure to support evidence-based practice, including the provision of more organized and reliable information sources on the Internet for both consumers and clinicians, and the development and application of clinical decision support tools.
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From page 166... ...
should be invested in projects that implement and evaluate IT applications and are likely to contribute to quality improvements. Recommendation 9: Congress, the executive branch, leaders of health care organizations, public and private purchasers, and health informatics associations and vendors should make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education.
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From page 167... ...
As discussed in Chapter 6, the Internet is playing an increasingly critical role in making scientific publications, syntheses of the evidence, practice guidelines, and other tools required to support evidence-based practice available to both patients and clinicians. Examples of information technologies that are of growing importance in the health care arena are reminder systems (Alemi et al., 1996~; telemedicine applications, such as teleradiology and e-mail; and online prescribing (National Health Policy Forum, 2000; Schiff and Rucker, 1998~.
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From page 168... ...
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From page 169... ...
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From page 170... ...
AUTOMATED CLINICAL INFORMATION Much of the potential of IT to improve quality is predicated on the automation of at least some types of clinical data. Automated clinical data are required by many of the most promising IT applications, including computer-aided decision support systems that couple medical evidence with patient-specific clinical data to assist clinicians and patients in making diagnoses and evaluating treatment options (see Chapter 6)
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From page 171... ...
General Accounting Office issued a report stating that automated medical records offer great potential to improve patient care, increase efficiency, and reduce costs, and calling for the development of standards to ensure uniform electronic recording and transmission of medical information. A 1993 report of the U.S.
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From page 172... ...
At the same time, there are many different sources and types of health data, and clinical information must be available to all clinicians and others involved in care delivery whenever needed. Well-crafted policies can be implemented to ensure timely access for those with a valid need to access the data, including treating clinicians and patients, while denying access to unauthorized users.
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From page 173... ...
To begin addressing the need for comprehensive national standards, Congress passed the Health Insurance Portability and Accountability Act in 1996, creating a federal mandate to develop standards for all electronic health transmissions (Health Care Financing Administration, 2000~. The law directed the Secretary of Health and Human Services to make recommendations to Congress regarding the privacy of individually identifiable health information by August 1997, and if Congress failed to pass privacy legislation by August 1999, the Secretary of DHHS was directed to issue health privacy regulations by January 2000.
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From page 174... ...
Financial Requirements The 21st-century health care system will require a significant financial investment in information technology far greater than current investments by most health care organizations. Capital will be needed to purchase and install new technology, while installation of the new systems is likely to produce temporary disruptions in the delivery of patient care and result in sizable short-term costs to manage the transition.
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From page 175... ...
IT will undoubtedly alter the clinician and patient relationship, and in some cases, these changes may be threatening to clinicians. The standardization and automation of various types of clinical data opens up many new opportunities to make comparative quality data available to consumers who must chose among clinicians, sites of care, and treatment options, and to bolster oversight and accountability programs (Kleinke, 2000~.
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From page 176... ...
Many medical errors, ubiquitous throughout the health care system, could be prevented if only clinical data were accessible and readable, and prescriptions were entered into automated order entry systems with built-in logic to check for errors and oversights in drug selection and dosing. The pace of change is unacceptably slow.
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From page 177... ...
Moreover, these standards should be reevaluated and fine-tuned periodically to strike the right balance between protecting consumer privacy and providing access to clinical data for legitimate purposes, such as care delivery, quality evaluation, research, and public health (Detmer, 2000a)
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From page 178... ...
Teich, Joshua Lee, et al. The Impact of Computerized Physician Order Entry on Medication Error Prevention.
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From page 179... ...
National Committee on Vital and Health Statistics. Uniform Data Standards for Patient Medical Record Information: Report to the Secretary of the U.S.
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From page 180... ...
Automated Medical Records: Leadership Needed to Expedite Standards Development.
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