Full text of the report is available here.
The report calls for a change in approach to health care IT.
This conclusion does not reflect negatively on the sites visited. To the contrary, their pioneering work and suggestions let the committee see the way forward. It does not contradict calls for increased investment in health care IT. Better management and use of information are essential to improving the health care system.
The report suggests that a larger dose of today’s health care IT will result in both improvement and harm. It will cost more and take longer than people expect. Collectively, the result will fall far short of what is needed.
For example, today’s clinical applications tend to be monolithic and complex. Rather than enabling small improvements in practice, the many information system interdependencies actually slow down improvement! Instead, clinical applications should reduce barriers to clinicians and patients doing what is best for care – even if doing what is best requires rapid cycle, iterative change in clinical behaviors and work flows.
A different outcome is possible. We do not need to wait for better IT before we move aggressively forward. However, near-term success will require a fresh approach to managing the investment by health care organizations, our health care IT vendors, and the government.
The report lays out five principles for use of IT to support evolutionary change in health care that are actionable in the near term. With a longer view, it identifies four principles to support revolutionary change and several research challenge problems.
It includes six recommendations directed at the senior management of health care organizations and, through them, to their vendors. Let me highlight a couple.
Organize incentives, roles, workflow process and supporting infrastructure to encourage, support and respond to opportunities for clinical performance gains.
In other words, the IT infrastructure should evolve with the improvement process, not lead it.
For example, if your goal is to reduce medication administration errors, start with incentives and infrastructure for blame-free reporting. Next, identify the situations with a high rate of "wrong patient, wrong dose" errors. Then, target deployment of technology support like bar code medication administration to those situations. Finally, continue to monitor performance, refining the combination of process and technology if needed, or extending to the next highest problem area.
In this way, you guarantee improvement. Use the technology only where needed and correct unintended consequences early.
Balance the institution’s IT portfolio among the four domains of automation, connectivity, decision support, and data mining capabilities.
The majority of today’s health care IT is designed to support automation, with some investment in supporting connectivity and little support of decision making or data mining. Yet the IOM’s vision for 21st century health care expects support for cognitive activities (helping providers and patients think about complex choices as they make decisions) and a learning health care system (mining related bodies of data to recognize and respond to patterns).
These activities are much more about connectivity, decision support, and data mining than about automation. The required shift in focus is large. Technology exists to support movement in these directions, but it is outside the comfort zone of many health care organizations and the established health care IT vendors.
Finally, read the report! It is short. It reflects careful study and review. With complex issues, one sentence may balance another. Hearing one sound bite without the others can mislead.
Health care organizations and health care IT vendors should read section 3 (rebalancing the portfolio), section 4 (principles for success), and section 6.3 (recommendations for health care organizations. They add up to only 12 pages.
In addition, I would point vendors to Appendix C, which summarizes the committee’s observations, the consequences, and opportunities for action, with the latter tagged as short term or research. Check your current offering and product direction against the ones tagged as short term.
William W. Stead, MD is associate vice chancellor for strategy/transformation, director of the Informatics Center (which includes the Department of Biomedical Informatics of the School of Medicine, the Eskind Biomedical Library, and the Center for Better Health), and CIO at Vanderbilt University Medical Center; and chief information architect for Vanderbilt University. He is chair of the Committee on Engaging the Computer Science Research Community in Health Care Informatics, which produced Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions under the auspices of the National Research Council.