Commentary: Demonstrating the potential, closing barriers for health IT

Carolyn M. Clancy

Modern health care is fundamentally an information-based activity. So, in the 21st century, it is surprising how little IT has penetrated the health care sector. Paper records and filing cabinets are still the rule in the great majority of physicians' offices. And even in our hospitals, where IT has made inroads, the basic flow of work has not often been adapted to take advantage of IT's real power.

The slow progress of IT in health care is costing not only money but also the opportunity for improved health outcomes. When records are missing or incomplete, the physician is left in the dark and the patient is put at risk. Even the notoriously scribbled handwriting of physicians stops being a joke and becomes a potentially deadly hazard when the wrong medication or combination of drugs is given.

The most important aspect of health information technology is its power to improve the quality of health care:
  • Through electronic health records, health IT can make complete, up-to-date patient information available when and where it's needed.

  • Health IT can deliver not only patient information but also treatment information. Physicians and nurses can use information systems available at the bedside to ensure that best available practices and treatments are being employed for the patient.

  • Health IT can also help prevent medical errors. Computer-assisted ordering can help prevent errors in drug prescribing and other treatments.

  • Electronic records can help providers work together for the patient. By sharing e-records, different providers can act effectively as a team.

  • IT features such as telemedicine can extend the reach of high-quality care, especially for rural and remote areas where such advantages might otherwise be unavailable.

  • Electronic health data also can be used to measure the performance of providers'meaning consumers can choose, based on quality measures.

  • And health IT can mean greater patient involvement and empowerment.

The federal government is working with the private sector to bring health IT fully online. My agency, the Agency for Healthcare Research and Quality, is building on years of research to demonstrate the potential and identify the barriers.

Two fundamental areas need to be addressed to realize the benefits of health IT: preparing the technical groundwork for health information exchange, and preparing our health care professionals themselves so they are ready to use this new capacity to improve quality of care.

Health and Human Services secretary Mike Leavitt has taken rapid steps to bring the public and private sectors together to address the technical challenges. Efforts are being launched to agree on needed common standards, develop the capacity for certification, and examine legal and business practice barriers. This effort also will support prototype projects. A new advisory group, the American Health Information Community, is intended to bring together the many stakeholders who need to share in steering this effort. And when standards are developed, federal health programs will adopt them to provide leadership and a sound foundation.

At my agency, the focus is especially on helping to prepare the people and the settings where health IT will need to work. Technical preparation alone won't deliver the quality improvements that health IT is really about. Those improvements will come about as doctors and nurses use this new capacity'a process that will be as challenging as it is promising.

The health IT initiative at AHRQ is about this marriage of new technologies with the way health care is actually delivered. We need to make that process a cooperative venture, not a collision. AHRQ's initiative is helping build capacity by supporting IT planning and implementation, especially in rural and underserved areas.

The initiative is supporting advanced health information exchange projects in five states. And the lessons we learn are being shared through AHRQ's Health Information Technology Resource Center.

Health IT is a rare opportunity to improve health care quality even as we save money. But the task will be complex and challenging, on both the technical and the human sides. We need to address both sides of this equation now, working closely with the private sector and listening to the experience of health care providers themselves, to achieve the promise of health IT.

Carolyn M. Clancy, M.D., is director of the Agency for Healthcare Research and Quality in the Health and Human Services Department.

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