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IOM Report: Today’s IT Systems and Implementation Efforts Aren’t Good Enough to Support IOM’s Quality Standards

January 9, 2009 News 9 Comments

A new report published today by the IOM’s research council concludes that today’s hospital systems "fall far short … of what is needed to support the IOM’s vision of quality health care."

In its summary, the report says, "IT related activities of health professionals observed by the committee in these institutions were rarely integrated into clinical practice. Health care IT was rarely used to provide clinicians with evidence-based decision support and feedback; to support data-driven process improvement; or to link clinical care and research. Health care IT rarely provided an integrative view of patient data. Care providers spent a great deal of time electronically documenting what they did for patients, but these providers often said they were entering the information to comply with regulations or to defend against lawsuits, rather than because they expected someone to use it to improve clinical care. Health care IT implementation time lines were often measured in decades, and most systems were poorly or incompletely integrated into practice. Although the use of health care IT is an integral element of health care in the 21st century, the current focus of the health care IT efforts that the committee observer is not sufficient to drive the kind of change in health care that is truly needed. The nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade."

Free access to the full text of the report is available here.

Bill Stead of Vanderbilt chaired the group, which conducted site visits at UPMC; the VA Medical Center in Washington, DC; HCA TriStar; Vanderbilt University Medical Center; Partners HealthCare; Intermountain Healthcare; UCSF; and Palo Alto Medical Foundation.

Given that the facilities observed have what is considered comparatively advanced IT systems and massive budgets compared to the average hospital, the report is sure to have far-ranging implications to the industry, especially as debate continues over whether the best use of federal stimulus money is to fund purchase current systems instead of revisiting whether they are adequate to deliver the changes needed in healthcare. 

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Currently there are "9 comments" on this Article:

  1. “Given that the facilities observed have what is considered comparatively advanced IT systems and massive budgets compared to the average hospital …”

    The haves and the “have nots” really see the world different. The “have nots” look to these facilities for healthcare IT leadership but can only look in awe, not of the technology, per se, but at how much money they have to spend on technology.

    Try providing leading-edge solutions on a lean budget and minimal staff. It’s a whole different ballgame.

  2. That’s all very true and one of the primary reasons for it is that we’re too busy spending billions of dollars tinkering with continually revised requirements on the billing and reimbursement side that add absolutely nothing to the process of delivering quality healthcare to the patients. Talk about wasting resources…

  3. I particulary appreciated the bullets at the top of page 4 of the pre-publication. It does a good job of (re)orienting where we’d like to be with our technology and its ultimate purpose in improving the quality and efficacy of our healthcare delivery. We’ve got such sophisticated tools and methodologies and have created such gleaming products only to discover we’ve got a highly expensive engine and are yet without a transmission, steering wheel or tires…much less a GPS system.

  4. So where did the IOM hospitals come out on the HIMSS EMR scale…according to IOM, they rate pretty low.

    Who’s scale should we use???
    After reading the report..I’d go w IOM. There wasn’t much in the report I disagree with based on my working decades in HIT.

  5. Perhaps the only ROI, or major ROI, for these systems anyone’s figured out (for providers, anyway) is improved billing. If we spend billions on HIT, we might bankrupt the Medicare Trust Fund faster, rather than saving money.

    The Bush administration’s initiative to stop paying for medical mistakes was earth-shattering, if only because it was not until after 2005 (40 years of Medicare) that someone did it.

  6. Is it really a surprise that Health IT in hospitals doesn’t function to support IOM’s quality standards?

    As Deep Throat said to Woodward and Bernstein, follow the money trail. Hospital providers get paid on a FFS, piecemeal basis and their IT systems have largely been designed to support this process on both the clinical and administrative sides.

  7. Amen to all the comments. Double-secret Probation – right-on.

    Imagine the situation now where our IT shops are going to be pummelled for work, asked to cut costs, keep-up with the run-of-the-mill regulatories, and then waste a ton of money on coordinating our vendors through the 5010s and ICD-10. Another potential waste of money if we (our country) don’t actually have a real ROI business case behind this. The insurers will need to re-write their rules and recoup their investment so it will roll downhill to the providers in more complex billing, denial, and follow-up schemas and more processing power and storage.

    In the mean time, people with their head in the right place are going to ask for throughput, patient safety, and quality of care enabling technologies. The financial times are going to force a ‘show me the real money’ business case and it may not be there. When it may be there, it’ll likely only be funded for a small, not enterprise, deployment. These piecemeal investments actually create more internal “haves and have-nots.” They also raise the cost of support or decreasing the service IT can provide. It is one more system to support with the same resources.

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