President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry

Building the Capacity to Improve Quality

Chapter Fourteen
Investing in Information Systems

Health care information systems of the 21st century must be able to guide internal quality improvement efforts; generate data on the individual and comparative performance of plans, facilities, and practitioners; help improve the coordination of care; advance evidence-based health care; and support continued research and innovation. Existing information systems generally are not adequate for these purposes. The health care industry invests a lower share of its revenues in information technology than many other information-intensive industries. Costs associated with fixing the "Year 2000 problem" also are diverting resources away from other system improvements. While many health care organizations recognize the considerable long-term benefits of expanding their investments in this area, a number of barriers still remain. Reducing or eliminating these barriers will require a comprehensive plan, long-term commitment, and significant and sustained investment over time. These actions are critical if the health care industry is to realize the promise of improved information systems.


Information Systems Are Critical to Quality

There is a growing consensus that existing health care information systems are inadequate for the many tasks that the health care industry is being asked to undertake. The demand for improvement is coming from virtually all of the stakeholders in the system, each of which requires information for different purposes.

Consumers, group purchasers, policymakers, and others need information on health care quality and the individual and relative performance of health plans, facilities and systems of care, and individual practitioners. Such information is critical to support market-based efforts to improve quality (see Chapter 6 and Chapter 7). In many cases, however, much of the information needed to make risk-adjusted assessments of performance is scattered in dozens of different places in both computer and paper records, making it difficult to aggregate. Creating valid performance measurements will also require data that have not been routinely collected for patient care or payment purposes, such as information on the experiences and perspectives of patients and health care professionals; clinically detailed data of the type needed to measure quality for chronic care; and information on health care outcomes, including functional status.

Types of Improvements Needed

Existing information systems need to be improved in several ways. There is a need for a significant increase in investment in such systems; improvement in data quality; and improvement in linkages between different health databases while simultaneously protecting confidentiality.

Barriers to Systems Improvement

Despite general recognition of the benefits of computerized information systems, the progress of computerization has been slow. Perhaps the most important reason for this is that the health care market was not structured to reward significant investments in information technology. This is beginning to change. Both individual consumers and group purchasers are demanding more detailed clinical and administrative information as part of their value-based purchasing strategy. Health plans need to obtain such information from their affiliated providers in order to manage care effectively. These changes in the market may gradually remove many of the barriers to more effective information systems, although removing other barriers may require coordinated action between government, industry, and other stakeholders.


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Last Revised: Sunday, July 19, 1998