Building a Better Delivery System A New Engineering/Health Care Partnership (2005) / Chapter Skim
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4 Information and Communications Systems: The Backbone of the Health Care Delivery System
4 Information and Communications Systems: The Backbone of the Health Care Delivery System
Pages 63-82
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From page 63... ...
Proximate Causes To diagnose and treat individual patients effectively, individual care providers and care teams must have access to at Although information gathering, processing, communileast three major types of clinical information -- the patient's cation, and management are essential to health care delivery, health record, the rapidly changing medical-evidence base, the health care sector as a whole has historically trailed far and provider orders guiding the process of patient care. In behind most other industries in investments in information/ addition, they need information on patient preferences and communications technologies (DOC, 1999)
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From page 64... ...
. Inspired by the 1999 IOM report, To Err Is Human, NATIONAL HEALTH INFORMATION INFRASTRUCTURE the Leapfrog Group for Patient Safety, a coalition of large companies established expressly for the purpose of using The idea of transforming paper medical records into elec- their market power as major purchasers of health care to tronic medical records (EMRs)
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From page 65... ...
the information gathering, exchange, processing, and application capabilities of stakeholders at all four levels of the health care system. Care Team Level At the care team level, progress toward an NHII would The Promise of a National Health Information accelerate the development, diffusion, and use of a broad Infrastructure spectrum of information/communications technologies to help care providers capture, tap into, and integrate critical The NHII would provide a platform for the application information streams for patient-centered care -- the patient's of a wide range of proven and emerging information/ health record, information on the patient's preferences and communications technologies that could have a dramatic values, the evolving medical-evidence base, the status of impact on health care processes and outcomes.
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From page 66... ...
It is worth noting that most of these forerunner, nology necessary for the realization of NHII exists today, integrated systems were used by organizations with corporate- and will certainly improve in the decade ahead, there will be type structures and management (e.g., the Mayo Clinic, many challenges to putting it in place. Very serious privacy Kaiser-Permanente, Veterans Health Administration, and concerns must be addressed, as well as training issues at all others with salaried physicians and wholly owned hospitals levels of the health care system.
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From page 67... ...
of the hensive transformation of health care delivery. Health Level 7 clinical-data standards "to support increased interoperability of systems and comparability of clinical data, as well as patient safety," and underscored the need FOUNDATIONS OF A NATIONAL HEALTH for "implementation guides and conformance testing/ INFORMATION INFRASTRUCTURE certification procedures .
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From page 68... ...
. County Care Data Exchange, Patient Safety Institute's National Benefit Trust Network, and the Markle Foundation Healthcare Collaborative Network (CareScience, 2003; Core Clinical Applications Kolodner and Douglas, 1997; Markle Foundation, 2003; Clinical information systems provide a mechanism for New England Healthcare EDI Network, 2002; Overhage, sharing data collected from various sources (e.g., EHRs in 2003; Patient Safety Institute, 2002; Zachariah in this volume)
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From page 69... ...
a health information infrastructure that provides decision support for population health management; (2) an integrated patient record and care system that includes clinical decision support for providers; and (3)
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From page 70... ...
When CPOE systems are integrated with other Digital Sources of Evidence and Knowledge core clinical applications, their impact on patient safety is even greater. One component of a CPOE system is comput- Another key component of the health information infraerized decision support.
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From page 71... ...
For and communicated to all relevant parties. The collection of example, if there are too many steps in a program for a user data, the consideration of the decision support offered, to follow or if a program is too complicated, various "work followed by the ordering and carrying out of the diagnostic arounds" will be developed, and patient safety or some other and or treatment plan is an iterative process.
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From page 72... ...
. Summary patients with unprecedented access to health information and made possible more continuous, asynchronous communica The implementation of core clinical applications of tion between patients and their care providers.
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From page 73... ...
. Moreover, most In the preceding discussion of major components of the private and public insurance reimbursement models actively NHII, a number of technical impediments to implementation discourage delivery-related applications of information/ of these systems were identified (e.g., lack of interoperability communications technology by care providers, for example, standards, human-factors barriers; patient and caregivers' by refusing to reimburse patient care/consultations delivered concerns about usability, reliability, and security; patients' via e-mail (Leape, 2004; Leatherman, et al., 2003; concerns about the privacy of integrated health information, Robinson, 2001)
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From page 74... ...
tem options for measuring the impact of information/ communications technologies will require much more sup- Finding 4-2. A critical step toward realizing the National port from federal agencies (e.g., National Institutes of Health, Health Information Infrastructure will be the development National Science Foundation, Agency for Healthcare and widespread adoption of network standards for health care Research and Quality, Veterans Health Administration, and data and software.
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From page 75... ...
, public and private support of Data Standards for Patient Safety, which called for continued community-based health information network demonstration development of health care data standards and a significant projects, the Leapfrog Group's purchaser-mediated rewards increase in the technical and material support provided by to providers that use information/communications techthe federal government for public-private partnerships in nologies, and others. this area.
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From page 76... ...
Comparable redesigning of the health care integrated circuit technology has resulted in microelectro- system will be necessary at every level to take advantage mechanical systems, which can be combined with micro- of WIMS. electronics and wireless interfaces to create wireless integrated microsystems (WIMS)
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From page 77... ...
Microsystems implemented as wearable and implantable More than 90,000 cochlear implants are in use worldwide devices connected to clinical information systems through today, enabling many profoundly deaf and severely hearing wireless communications could provide diagnostic data and impaired individuals to function normally in a hearing world deliver therapeutic agents for the treatment of a variety of (House and Berliner, 1991; Spelman, 1999)
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From page 78... ...
But it is imperative that to clinical information systems through wireless communi- research, development, demonstration, and training be cations could provide diagnostic data and deliver therapeutic expanded and accelerated. agents for the treatment of a variety of chronic conditions, Putting together a system that can make use of informathereby improving the quality of life for senior citizens and tion microtechnology, nanotechnology, and biotechnology chronically ill patients.
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From page 79... ...
1998. Physician Order Entry in Assembling the Scientific Basis for Progress on Patient Safety.
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From page 80... ...
an Interconnected Electronic Health Information Infrastructure. Avail Hoffmann, and A.L.
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From page 81... ...
Improve Patient Safety. Washington, D.C.: American Psychological Middleton.
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