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A new report from the Institute of Medicine blames much of the health care systems inadequacies on fragmentation and says IT can play a key role in creating a more integrated, patient-centric approach. But the IT infrastructure is fragmented itself, stymieing efforts to improve patient care.
The report, “Crossing the Quality Chasm Summit: A Focus on Communities,” comes out of a meeting of regional and national health care leaders last January. The meeting was part of ongoing efforts inspired by a year 2000 report, which concluded that tens of thousands of deaths each year are due to medial errors.
The resulting recommendations stress that improvement efforts should focus on the system of health care rather than on individual practitioners. For this, the more recent report said, “few innovations in health care delivery are as promising as ICT [information and communications technology].”
IT is needed throughout the health care system, the report found. “Every community project described by participants identified a set of disease-specific interventions that would be easier, more effective or less expensive to implement if a functioning ICT infrastructure were in place.”
The report focuses on integration of information systems. Patient information should be readily transportable, the report said, and retrieval should not depend on particular software or system requirements.
Of particular concern, the report said, is the inability to transmit information across regions and organizations. This means that organizations that push forward with “standalone” electronic health care records will likely have difficulty integrating their systems, a situation that will grow worse over time.
The report calls standards the “building blocks” for enabling features such as computerized reminders for preventive services, warnings of contraindicated treatments and access to other medical information.
Scott Wallace, president of the National Alliance for Health Information Technology, said efforts to increase interoperability are making process. The most significant advance, he said, was the creation of the Certification Commission for Healthcare IT, which met for the first time Tuesday.
Wallace said the commission could take “standards from theory to reality.” Without a certification program, he said, “No one really knows if products comply with standards. Purchasers dont really know what standards they should be looking for. This committee will give people certainty that these products will give the people the functionality they are looking for.”
But he warned that standards alone would not be enough. “The existence of standards itself doesnt ensure interoperability. Right now, there are not clear legal and technical definitions of interoperability. Without them, you cant hold vendors to the development of truly interoperable systems.”
A recent survey by HIMSS (Healthcare Information and Management Systems Society) found that standards to transmit data vary widely and that health care providers are largely unaware of relevant IT initiatives, stalling implementation.
The Institute of Medicine report calls on the federal government to increase consumer awareness of the importance of IT tools and to promulgate national standards. In addition, the report says the government will need to find ways for health care providers to finance electronic health records.
The financial benefits of implementing electronic records currently do not flow to those who pay to set up and maintain the record. More empirical evidence that IT prevents errors also would help convince clinicians that investments are worthwhile, the report says.
In addition to IT, the report calls for strategies to improve health care through better use of measurements, financial incentives, community building, coordinating care and supporting patient self-management.