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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.

Recommendations

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.

References

American Association of Medical Colleges, Taking Charge of the Future: AAMC Strategic Plan (Washington, DC: 1997).

Appleby, Chuck, "PAYOFF@InfoTech.NOW," Hospitals and Health Networks 71(19):58-60, October 5, 1997.

Berwick, Donald M., A. Blanton Godfrey, and Jane Roessner, Curing Health Care: New Strategies for Quality Improvement (San Francisco: Jossey-Bass, 1990).

Chute, Christopher, Simon P. Cohn, Keith E. Campbell, et al., "The Content Coverage of Clinical Classifications," Journal of the American Medical Informatics Association 3(3):224-233, 1996.

College of Healthcare Information Management Executives, The Healthcare CIO: A Decade of Growth, 1987-1997 (Ann Arbor, MI: 1997).

Coltin, Kathryn, interview with Advisory Commission staff, January 6, 1998.

Council on Competitiveness, Highway to Health: Transforming U.S. Health Care in the Information Age (Washington, DC: 1996).

Department of Health and Human Services, Health Insurance Portability and Accountability Act of 1996: Implementation of Administrative Simplification Requirements by HHS, posted on US HHS Web site (http://aspe.hhs.gov) August 25, 1997.

Dowling, Alan F., "Do Hospital Staff Interfere With Computer System Implementation?" in James G. Anderson and Stephen J. Jay, eds., Use and Impact of Computers in Clinical Medicine (New York: Springer-Verlag, 1987).

Evans R. Scott, David C. Classen, Stanley L. Pestotnik, et al., "Improving Empiric Antibiotic Selection Using Computer Decision Support," Archives of Internal Medicine 154(8):878-884, April 25, 1994.

Hohnloser, Joerg H., Florian Puerner, and Hooman Soltanian, "Improving Clinician's Coded Data Entry Through the Use of an Electronic Patient Record System: 3.5 Years Experience With a Semiautomatic Browsing and Encoding Tool in Clinical Routine," Computers in Biomedical Research 29(1):41-47, February 1996.

Institute of Medicine, The Computer-Based Patient Record: An Essential Technology for Health Care (Washington, DC: National Academy Press, 1991).

Institute of Medicine, The Computer-Based Patient Record: An Essential Technology for Health Care, revised edition (Washington, DC: National Academy Press, 1997).

Jollis, James G., Mark Ancukiewicz, Elizabeth R. DeLong, et al., "Discordance of Databases Designed for Claims Payment Versus Clinical Information Systems: Implications for Outcome Research," Annals of Internal Medicine 119:844-850, 1993.

Kohane, Isaac S., F.J. van Wingerde, James C. Fackler, et al., "Sharing Electronic Medical Records Across Multiple Heterogeneous and Competing Institutions," Proceedings of the American Medical Informatics Association Annual Fall Symposium, 1996.

Marin, K.D., M.P. Ramos, L.A. Santos, and D. Ancao-Sigulem, "Expert System in Prenatal Care: Validation and Implementation," in Susan J. Grobe and Elly S.P. Pluyter-Wenting, eds., Nursing Informatics: An International Overview for Nursing in a Technological Era (Amsterdam: Elsevier, 1994).

National Committee for Quality Assurance, A Road Map for Information Systems: Evolving Systems to Support Performance Measurement (Washington, DC: 1997).

Petrucci, K., P. Petrucci, K. Canfield, et al., "Evaluation of UNIS: Urological Nursing Information Systems," in Paul D. Clayton, ed., Proceedings of the Fifteenth Annual Symposium on Computer Applications in Medical Care (New York: McGraw Hill, 1992).

Rossi, C.R., V. Alberti, G. Mancino, et al., "Comparison Between Manual and Automatic Coding of Medical Record Statistical Cards at a University Hospital," Medical Informatics 18(1):53-59, January 1993.

Safran, Charles, David M. Rind, Roger B. Davis, et al., "Effects of a Knowledge-Based Electronic Patient Record on Adherence to Practice Guidelines," M.D. Computing 13(1): 55-63, January-February 1996.

Starr, Paul, "Smart Technology, Stunted Policy: Developing Health Information Networks," Health Affairs 16(3):95-105, May/June 1997.

Tierney, William M., "Seizing the Day: Barriers and Bridges to Realizing the Promise of Academic Medicine," paper presented at the American Association of Medical Colleges conference on Information Resources: An Integrated Strategic Asset in Academic Medicine, Leesburg, Virginia, September 10, 1996.

van Wingerde, F.J., James Schindler, Peter Kilbridge, et al., "Using HL7 and the World Wide Web for Unifying Patient Data from Remote Databases," Proceedings of the American Medical Informatics Association Annual Fall Symposium 1996, 643-647.

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Last Revised: Sunday, July 19, 1998