Discussion Post1 - Healthcare Information Systems

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Read the two Institute of Medicine Reports "To Err is Human" and "Crossing the Quality Chasm." Discuss the effect that these reports had on the US healthcare system by describing the roles that national, private sector, and government initiatives play in the advancement of HIT. Evaluate the success that healthcare delivery has had in achieving those goals and the barriers to goal achievement.

To Err is Human: ATTACHED

Crossing the Quality Chasm: ATTACHED

Support your ideas with research from attached sources and/or outside, scholarly sources using the.

Composed of a minimum of two - three paragraphs - at least 400 words.

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Include references as they are required, minimum of 2 articles.

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November 1999 I N S T I T U TE OF M E D I C I N E Shaping the Future for Health TO ERR IS HUMAN: BUILDING A SAFER HEALTH SYSTEM H ealth care in the United States is not as safe as it should be--and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have been prevented, according to estimates from two major studies. Even using the lower estimate, preventable medical errors in hospitals exceed attributable deaths to such feared threats as motor-vehicle wrecks, breast cancer, and AIDS. Medical errors can be defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. Among the problems that commonly occur during the course of providing health care are adverse drug events and improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or death, falls, burns, pressure ulcers, and mistaken patient identities. High error rates with serious consequences are most likely to occur in intensive care units, operating rooms, and emergency departments. Beyond their cost in human lives, preventable medical errors exact other significant tolls. They have been estimated to result in total costs (in­ cluding the expense of additional care necessitated by the errors, lost income and household productivity, and disability) of between $17 billion and $29 billion per year in hospitals nationwide. Errors also are costly in terms of loss of trust in the health care system by patients and diminished satisfaction by both patients and health professionals. Patients who experience a long hospi­ tal stay or disability as a result of errors pay with physical and psychological discomfort. Health professionals pay with loss of morale and frustration at not being able to provide the best care possible. Society bears the cost of er­ rors as well, in terms of lost worker productivity, reduced school attendance by children, and lower levels of population health status. A variety of factors have contributed to the nation’s epidemic of medi­ cal errors. One oft-cited problem arises from the decentralized and frag­ mented nature of the health care delivery system--or “nonsystem,” to some observers. When patients see multiple providers in different settings, none of whom has access to complete information, it becomes easier for things to go Errors…are costly in terms of loss of trust in the health care system by pa­ tients and dimin­ ished satisfaction by both patients and health profes­ sionals. Types of Errors Diagnostic Error or delay in diagnosis Failure to employ indicated tests Use of outmoded tests or therapy Failure to act on results of monitoring or testing Treatment Error in the performance of an operation, procedure, or test Error in administering the treatment Error in the dose or method of using a drug Avoidable delay in treatment or in responding to an abnormal test Inappropriate (not indicated) care Preventive Failure to provide prophylactic treatment Inadequate monitoring or follow-up of treatment Other Failure of communication Equipment failure Other system failure Health Care System at Odds with Itself The Quality of Health Care in America Committee of the Institute of Medicine (IOM) concluded that it is not acceptable for patients to be harmed by the health care system that is supposed to offer healing and comfort--a system that promises, “First, do no harm.” Helping to remedy this problem is the goal of To Err is Hu­ man: Building a Safer Health System, the IOM Committee’s first report. In this report, issued in November 1999, the committee lays out a compre­ hensive strategy by which government, health care providers, industry, and con­ sumers can reduce preventable medical errors. Concluding that the know-how already exists to prevent many of these mistakes, the report sets as a minimum goal a 50 percent reduction in errors over the next five years. In its recommenda­ tions for reaching this goal, the committee strikes a balance between regulatory and market-based initiatives, and between the roles of professionals and organi­ zations. One of the report’s main conclusions is that the majority of medical er­ rors do not result from individual recklessness or the actions of a particular group--this is not a “bad apple” problem. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. For example, stocking patient-care units in hospitals with certain full-strength drugs, even though they are toxic unless diluted, has re­ sulted in deadly mistakes. Thus, mistakes can best be prevented by designing the health system at all levels to make it safer--to make it harder for people to do something wrong and easier for them to do it right. Of course, this does not mean that individuals can be careless. People still must be vigilant and held responsible for their actions. But when an error occurs, blaming an individual does little to make the system safer and prevent someone else from committing the same error. SOURCE: Leape, Lucian; Lawthers, Ann G.; Brennan, Troyen A., et al. Pr eventing Medical Injury. Qual Rev Bull. 19(5):144–149, 1993. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. wrong. In addition, the processes by which health professionals are licensed and accredited have focused only limited attention on the prevention of medical er­ rors, and even these minimal efforts have confronted resistance from some health care organizations and providers. Many providers also perceive the medical liabil­ ity system as a serious impediment to sys­ tematic efforts to uncover and learn from errors. Exacerbating these problems, most third-party purchasers of health care provide little financial incentive for health care organizations and providers to im­ prove safety and qua lity. 2 Strategy for Improvement To achieve a better safety record, the report recommends a four-tiered approach: • Establishing a national focus to create leadership, research, tools, and protocols to enhance the knowledge base about safety. Health care is a decade or more behind many other high-risk industries in its attention to ensuring basic safety. This is due, in part, to the lack of a single designated government agency devoted to improving and monitoring safety throughout the health care delivery system. Therefore, Congress should create a Center for Patient Safety that would set national safety goals and track progress in meeting them; develop a research agenda; define prototype safety systems; de­ velop, disseminate, and evaluate tools for identifying and analyzing errors; de­ velop methods for educating consumers about patient safety; and recommend ad­ ditional improvements as needed. Funding for the center should be adequate and secure, starting with $30 million to $35 million per year and growing over time to at least $100 million an­ nually--modest investments relative to the consequences of errors and to the resources devoted to other public safety issues. The center should be housed within the Agency for Healthcare Research and Quality (AHRQ), which already is in­ volved in a broad range of quality and safety issues, and has established the infra­ structure and experience to fund research, education, and coordinating activities. • Identifying and learning from errors by developing a nationwide public mandatory reporting system and by encouraging health care organi­ zations and practitioners to develop and participate in voluntary reporting systems. Under the mandatory reporting system, state governments will be required to collect standardized information about adverse medical events that result in death and serious harm. Hospitals should be required to begin reporting first, and eventually reporting should be required by all health care organizations. This system will ensure a response to specific reports of serious injury, hold health care organizations and providers accountable for maintaining safety, provide incen­ tives to organizations to implement internal safety systems that reduce the likeli­ hood of errors occurring, and respond to the public’s right to know about patient safety. Currently, about a third of the states have mandatory reporting require­ ments. Voluntary reporting systems will provide an important complement to the mandatory system. Such systems can focus on a much broader set of errors, mainly those that do no or minimal harm, and help detect system weaknesses that can be fixed before the occurrence of serious harm, thereby providing rich info r­ mation to health care organizations in support of their quality improvement ef­ forts. To foster participation in voluntary systems, Congress should enact laws to protect the confidentiality of certain information collected. Without such legisla­ tion, health care organizations and providers may be discouraged from partic i­ pating in voluntary reporting systems out of worry that the information they provide might ultimately be subpoenaed and used in lawsuits. 3 Health care is a decade or more behind many other high-risk industries in its attention to ensuring basic safety. Voluntary reporting systems will provide an important complement to the mandatory system. • Raising performance standards and expectations for improve­ ments in safety through the actions of oversight organizations, professional groups, and group purchasers of health care. The process of de­ Setting and enforcing explicit performance standards for patient safety veloping and through regulatory and related mechanisms, such as licensing, certification, and adopting standards accreditation, can define minimum performance levels for health professionals, also helps to form the organizations in which they work, and the tools (drugs and devices) they use expectations for to care for patients. The process of developing and adopting standards also helps safety among pro­ to form expectations for safety among providers and consumers. viders and con­ Standards and expectations are not only set through regulations, however. sumers. The values and norms set by the health professions influence the practice, train­ ing, and education for providers. Thus, professional societies should become leaders in encouraging and demanding improvements in patient safety, by such actions as setting their own performance standards, convening and communicat­ ing with members about safety, incorporating attention to patient safety in training programs, and collaborating across disciplines. The actions of large purchasers of health care and health care insurance, as well as actions by individual consumers, also can affect the behaviors of health care organizations. Public and private purchasers, such as businesses buying in­ surance for their employees, must make safety a prime concern in their contract­ ing decisions. Doing so will create financial incentives for health care organiza­ tions and providers to make needed changes to ensure patient safety. Medication errors now occur fre­ quently in hospi­ tals, yet many hos­ pitals are not mak­ ing use of known systems for im­ proving safety… • Implementing safety systems in health care organizations to ensure safe practices at the delivery level. Health care organizations must develop a “culture of safety” such that their workforce and processes are focused on improving the reliability and safety of care for patients. Safety should be an explicit organizational goal that is dem­ onstrated by strong leadership on the part of clinicians, executives, and governing bodies. This will mean incorporating a variety of well-understood safety princ i­ ples, such as designing jobs and working conditions for safety; standardizing and simplifying equipment, supplies, and processes; and enabling care providers to avoid reliance on memory. Systems for continuously monitoring patient safety also must be created and adequately funded. The medication process provides an example where implementing better systems will yield better human performance. Medication errors now occur fre­ quently in hospitals, yet many hospitals are not making use of known systems for improving safety, such as automated medication order entry systems, nor are they actively exploring new safety systems. Patients themselves also could provide a major safety check in most hospitals, clinics, and practice. They should know which medications they are taking, their appearance, and their side effects, and they should notify their doctors of medication discrepancies and the occurrence of side effects. 4 Progress Under Way The response to the IOM report was swift and positive, within both government and the private sector. Almost immediately, the Clinton administration issued an executive order instructing government agencies that conduct or oversee health-care programs to implement proven techniques for reducing medical errors, and creating a task force to find new strategies for reducing errors. Congress soon launched a series of hearings on patient safety, and in December 2000 it appropriated $50 million to the Agency for Healthcare Research and Quality to support a variety of efforts targeted at reducing medical errors. The AHRQ already has made major progress in developing and imple­ menting an action plan. Efforts under way include: • Developing and testing new technologies to reduce medical errors. • Conducting large-scale demonstration projects to test safety interve n­ tions and error-reporting strategies. • Supporting new and established multidisciplinary teams of researchers and health-care facilities and organizations, located in geographically diverse locations, that will further determine the causes of medical errors and develop new knowledge that will aid the work of the demonstration projects. • Supporting projects aimed at achieving a better understanding of how the environment in which care is provided affects the ability of providers to im­ prove safety. • Funding researchers and organizations to develop, demonstrate, and evaluate new approaches to improving provider education in order to reduce er­ rors. Casting its net even more broadly, the AHRQ has produced a booklet of practical tips on what individual consumers can do to improve the quality of health-care services they receive. The booklet focuses on key choices that indi­ viduals and their families face, such as choosing doctors, hospitals, and treat­ ments, and it stresses the importance of individuals taking an active role in se­ lecting and evaluating their care. (The booklet is available on the organization’s Web site at www.ahrq.gov.) In efforts focused at the state level, during the past year the National Academy for State Health Policy (NASHP) convened leaders from both the ex­ ecutive and legislative branches of the states to discuss approaches to improving patient safety. The NASHP also helped lead an initiative to better understand how states with mandatory hospital error-reporting requirements administer and enforce their programs. (A report on this initiative is available on the organiza­ tion’s Web site at www.nashp.org). In addition, the Agency for Healthcare Research and Quality has contracted with the National Quality Forum to produce a list of so-called “never events” that states might use as the basis of a mandatory reporting system. Among activities in the private sector, the Leapfrog Group, an association of private and public sector group purchasers, unveiled a market-based strategy to improve safety and quality, including encouraging the use of computerized phys i5 cian-order entry, evidence-based hospital referrals, and the use of ICUs staffed by physicians credentialed in critical care medicine. Professional groups within the health-care community also have been ac­ tive. As but one example, the Council on Graduate Medical Education (COGME) and the National Advisory Council on Nurse Education and Practice (NACNEP) held a joint meeting on “Collaborative Education Models to Ensure Patient Safety.” Participants addressed such issues as the effect of the relationships between physicians and nurses on patient safety, the impact of physician-nurse col­ laboration on systems designed to protect patient safety, and educational programs to ensure interdisciplinary collaboration to further patient safety. (A report on the meeting is available on the COGME’s Web site at www.cogme.org.) Pulling Together With adequate leadership, atten­ tion, and resources, improvements can be made. Although no single activity can offer a total solution for dealing with medical er­ rors, the combination of activities proposed in To Err is Human offers a roadmap toward a safer health system. With adequate leadership, attention, and resources, improvements can be made. It may be part of human nature to err, but it is also part of human nature to create solutions, find better alternatives, and meet the challenges ahead. For More Information… Copies of To Err is Human: Building a Safer Health System are available for sale from the National Academy Press; call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP home page at www.nap.edu. The full text of this report is available at http://www.nap.edu/books/0309068371/html/ Support for this project was provided by The National Research Council and The Commonwealth Fund. The views presented in this report are those of the Institute of Medicine Committee on the Quality of Health Care in America and are not necessarily those of the funding agencies. The Institute of Medicine is a private, nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright ©2000 by the National Academy of Sciences. All rights reserved. Permission is granted to reproduce this document in its entirety, with no additions or alterations � � � 6 COMMITTEE ON QUALITY OF HEALTH CARE IN AMERICA WILLIAM C. RICHARDSON (Chair), President and CEO, W.K. Kellogg Foundation, Battle Creek, MI DONALD M. BERWICK, President and CEO, Institute for Healthcare Improvement, Boston J. CRIS BISGARD, Director, Health Services, Delta Air Lines, Inc., Atlanta LONNIE R. BRISTOW, Past President, American Medical Association, Walnut Creek, CA CHARLES R. BUCK, Program Leader, Health Care Quality and Strategy Initiatives, General Electric Company, Fairfield, CT CHRISTINE K. CASSEL, Professor and Chairman, Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York City MARK R. CHASSIN, Professor and Chairman, Department of Health Policy, The Mount Sinai Medical Center, New York City MOLLY JOEL COYE, Vice President and Director, West Coast Office, The Lewin Group, San Francisco DON E. DETMER, Dennis Gillings Professor of Health Management, University of Cambridge, UK JEROME H. GROSSMAN, Chairman and CEO, Lion Gate Management, LLC, Boston BRENT JAMES, Executive Director, Intermountain Health Care, Institute for Health Care Delivery Research, Salt Lake City, UT DAVID McK. LAWRENCE, Chairman and CEO, Kaiser Foundation Health Plan, Inc., Oakland, CA LUCIAN LEAPE, Adjunct Professor, Harvard School of Public Health ARTHUR LEVIN, Director, Center for Medical Consumers, New York City RHONDA ROBINSON-BEALE, Executive Medical Director, Managed Care Management and Clinical Programs, Blue Cross Blue Shield of Michigan, Southfield JOSEPH E. SCHERGER, Associate Dean for Clinical Affairs, University of California at Irvine College of Medicine ARTHUR SOUTHAM, Partner, 2C Solutions, Northridge, CA MARY WAKEFIELD, Director, Center for Health Policy and Ethics, George Mason University GAIL L. WARDEN, President and CEO, Henry Ford Health System, Detroit � � � 7 Study Staff JANET M. CORRIGAN, Director, Division of Health Care Services, Director, Quality of Health Care in America Project MOLLA S. DONALDSON, Project Codirector LINDA T. KOHN, Project Codirector TRACY McKAY, Research Assistant KELLY C. PIKE, Senior Project Assistant Auxiliary Staff MIKE EDINGTON, Managing Editor KAY HARRIS, Financial Advisor SUZANNE MILLER, Senior Project Assistant Copy Editor FLORENCE POILLON � � � 8 March 2001 I N S T I T U TE OF M E D I C I N E Shaping the Future for Health CROSSING THE Q UALITY CHASM: A NEW HEALTH SYSTEM FOR THE 21ST CENTURY T he U.S. health care delivery system does not provide consistent, highquality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scien­ tific knowledge--yet there is strong evidence that this frequently is not the case. Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm. A number of factors have combined to create this chasm. Medical sci­ ence and technology have advanced at an unprecedented rate during the past half-century. In tandem has come growing complexity of health care, which today is characterized by more to know, more to do, more to manage, more to watch, and more people involved than ever before. Faced with such rapid changes, the nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to apply new technology safely and appropriately. And if the system cannot consistently deliver today’s science and technology, it is even less prepared to respond to the ex­ traordinary advances that surely will emerge during the coming decades. The public’s health care needs have changed as well. Americans are living longer, due at least in part to advances in medical science and techno l­ ogy, and with this aging population comes an increase in the incidence and prevalence of chronic conditions. Such conditions, including heart disease, diabetes, and asthma, are now the leading cause of illness, disability, and death. But today’s health system remains overly devoted to dealing with acute, episodic care needs. There is a dearth of clinical programs with the multidisciplinary infrastructure required to provide the full complement of services needed by people with common chronic conditions. The health care delivery system also is poorly organized to meet the challenges at hand. The delivery of care often is overly complex and uncoor­ dinated, requiring steps and patient “handoffs” that slow down care and decrease rather than improve safety. These cumbersome processes waste resources; leave unaccountable voids in coverage; lead to loss of information; Faced with such rapid changes, the nation’s health care delivery system has fallen far short in its ability to translate knowledge into practice and to ap­ ply new technology safely and appro­ priately. CARE SYSTEM Supportive payment and regulatory en­ vironment Organizations that facilitate the work of patientcentered teams High perform­ ing patientcentered teams Outcomes: • Safe • Effective • Efficient • Personalized • Timely • Equitable REDESIGN IMPERATIVES: SIX CHALLENGES • Reengineered care processes • Effective use of information technologies • Knowledge and skills management • Development of effective teams • Coordination of care across patientconditions, services, sites of care over time and fail to build on the strengths of all health professionals involved to ensure that care is appropriate, timely, and safe. Organizational problems are particularly apparent regarding chronic conditions. The fact that more than 40 percent of people with chronic conditions have more than one such condition argues strongly for more sophisticated mechanisms to coordinate care. Yet health care organizations, hospitals, and physician groups typically operate as separate “silos,” acting without the benefit of complete information about the patient’s condition, medical history, services provided in other settings, or medications provided by other clinicians. Making change possible. Strategy for Reinventing the System Advances must begin with all health care con­ stituencies… committing to a national statement of purpose… Bringing state-of-the-art care to all Americans in every community will require a fundamental, sweeping redesign of the entire health system, according to a report by the Institute of Medicine (IOM), an arm of the National Academy of Sciences. Crossing the Quality Chasm: A New Health System for the 21st Century, prepared by the IOM’s Committee on the Quality of Health Care in America and released in March 2001, concludes that merely making incremental improvements in current systems of care will not suffice. The committee already has spoken to one urgent care problem--patient safety--in a 1999 report titled To Err is Human: Building a Safer Health System. Concluding that tens of thousands of Americans die each year as a result of pre­ ventable mistakes in their care, the report lays out a comprehensive strategy by which government, health care providers, industry, and consumers can reduce medical errors. Crossing the Quality Chasm focuses more broadly on how the health sys­ tem can be reinvented to foster innovation and improve the delivery of care. Toward this goal, the committee presents a comprehensive strategy and action plan for the coming decade. Six Aims for Improvement Advances must begin with all health care constituencies--health professionals, federal and state policy makers, public and private purchasers of care, regulators, organization managers and governing boards, and consumers--committing to a 2 national statement of purpose for the health care system as a whole. In making this commitment, the parties would accept as their explicit purpose “to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.” The parties also would adopt a shared vision of six specific aims for improvement. These aims are built around the core need for health care to be: • Safe: avoiding injuries to patients from the care that is intended to help them. • Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. • Patient-centered: providing care that is respectful of and responsive to in­ dividual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions. • Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care. • Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy. • Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. A health care system that achieves major gains in these six areas would be far better at meeting patient needs. Patients would experience care that is safer, more reliable, more responsive to their needs, more integrated, and more available, and they could count on receiving the full array of preventive, acute, and chronic services that are likely to prove beneficial. Clinicians and other health workers also would benefit through their increased satisfaction at being better able to do their jobs and thereby bring improved health, greater longevity, less pain and suffering, and increased personal productivity to those who receive their care. A health care sys­ tem that achieves major gains in these six areas would be far better at meeting patient needs. Ten Rules for Redesign To help in achieving these improvement aims, the committee deemed that it would be neither useful nor possible to specify a blueprint for 21st-century health care delivery systems. Imagination abounds at all levels, and all promising routes for innovation should be encouraged. At the same time, the committee formu­ lated a set of ten simple rules, or general principles, to inform efforts to redesign the health system. These rules are: 1. Care is based on continuous healing relationships. Patients should re­ ceive care whenever they need it and in many forms, not just face-to-face visits. This implies that the health care system must be responsive at all times, and ac­ cess to care should be provided over the Internet, by telephone, and by other means in addition to in-person visits. 2. Care is customized according to patient needs and values. The system should be designed to meet the most common types of needs, but should have the capability to respond to individual patient choices and preferences. 3. The patient is the source of control. Patients should be given the nec3 …the health care system must be responsive at all times, and access to care should be provided over the Internet, by tele­ phone, and by other means in addition to inperson visits. Reducing risk and ensuring safety require greater a t­ tention to systems that help prevent and mitigate er­ rors. essary information and opportunity to exercise the degree of control they choose over health care decisions that affect them. The system should be able to accom­ modate differences in patient preferences and encourage shared decision making. 4. Knowledge is shared and information flows freely. Patients should have unfettered access to their own medical information and to clinical knowl­ edge. Clinicians and patients should communicate effectively and share informa­ tion. 5. Decision making is evidence-based. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place. 6. Safety is a system property. Patients should be safe from injury caused by the care system. Reducing risk and ensuring safety require greater attention to systems that help prevent and mitigate errors. 7. Transparency is necessary. The system should make available to pa­ tients and their families information that enables them to make informed decisions when selecting a health plan, hospital, or clinical practice, or when choosing among alternative treatments. This should include information describing the system’s performance on safety, evidence-based practice, and patient satisfaction. 8. Needs are anticipated. The system should anticipate patient needs, rather than simply react to events. 9. Waste is continuously decreased. The system should not waste resources or patient time. 10. Cooperation among clinicians is a priority. Clinicians and institutions should actively collaborate and communicate to ensure an appropriate exchange of information and coordination of care. Taking the First Steps To initiate the pro­ cess of change, Congress should establish a Health Care Quality Inno­ vation Fund To initiate the process of change, Congress should establish a Health Care Quality Innovation Fund--roughly $1 billion for use over three to five years to help pro­ duce a public-domain portfolio of programs, tools, and technologies of widespread applicability, and to help communicate the need for rapid and significant change throughout the health system. Some of the projects funded should be tar­ geted at achieving the six aims of improvement. The committee also calls for immediate attention on developing care proc­ esses for the common health conditions, most of them chronic, that afflict great numbers of people. The federal Agency for Healthcare Research and Quality (AHRQ) should identify 15 or more common priority conditions. (The agency has requested guidance from the IOM on selection of these conditions, and the Institute expects to issue its report in September 2002.) The AHRQ then should work with various stakeholders in the health community to develop strategies and action plans to improve care for each of these priority conditions over a five-year period. 4 Changing the Environment Redesigning the health care delivery system also will require changing the struc­ tures and processes of the environment in which health professionals and organi­ zations function. Such changes need to occur in four main areas: • Applying evidence to health care delivery. Scientific knowledge about best care is not applied systematically or expeditiously to clinical practice. It now takes an average of 17 years for new knowledge generated by randomized controlled trails to be incorporated into practice, and even then application is highly uneven. The committee therefore recommends that the Department of Health and Human Services establish a comprehensive program aimed at making scientific evidence more useful and more accessible to clinicians and patients. It is critical that leadership from the private sector, both professional and other health care leaders and consumer representatives, be involved in all aspects of this effort to ensure its applicability and acceptability to clinicians and patients. The infrastructure developed through this public-private partnership should focus initially on priority conditions. Efforts should include analysis and synthesis of the medical evidence, delineation of specific practice guidelines, identification of best practices in the design of care processes, dissemination of the evidence and guidelines to the professional communities and the general public, development of support tools to help clinicians and patients in applying evidence and making decisions, establishment of goals for improvement in care processes and outcomes, and development of measures for assessing quality of care. • Using information technology. Information technology, including the Internet, holds enormous potential for transforming the health care delivery sys­ tem, which today remains relatively untouched by the revolution that has swept nearly every other aspect of society. Central to many information technology ap­ plications is the automation of patient-specific clinical information. Such infor­ mation typically is dispersed in a collection of paper records, which often are poorly organized, illegible, and not easy to retrieve, making it nearly impossible to manage various illnesses, especially chronic conditions, that require frequent monitoring and ongoing patient support. Many patients also could have their needs met more quickly and at a lower cost if they could communicate with health professionals through e-mail. In addition, the use of automated systems for or­ dering medications can reduce errors in prescribing and dosing drugs, and com­ puterized reminders can help both patients and clinicians identify needed services. The challenges of applying information technology should not be underestimated, however. Health care is undoubtedly one of the most, if not the most, complex sectors of the economy. Sizable capital investments and multiyear commitments to building systems will be needed. Widespread adoption of many information technology applications also will require behavioral adaptations on the part of large numbers of clinicians, organizations, and patients. Thus, the committee calls for a nationwide commitment of all stakeholders to building an information infrastructure to support health care delivery, consumer health, qua l­ ity measurement and improvement, public accountability, clinical and health services research, and clinical education. This commitment should lead to the elimination of most handwritten clinical data by the end of the decade. 5 It is critical that leadership from the private sector, both professional and other health care leaders and consumer repre­ sentatives, be in­ volved in all as­ pects of this ef­ fort… Information tech­ nology…holds enormous poten­ tial for transform­ ing the health care delivery system… Clinicians should be adequately compensated for taking good care of all types of pa­ tients… …the importance of adequately preparing the workforce to make a smooth transi­ tion into a thor­ oughly revamped health care sys­ tem cannot be un­ derestimated. Now is the right time to begin work on reinventing the nation’s health care delivery sys­ tem. • Aligning payment policies with quality improvement. Although pay­ ment is not the only factor that influences provider and patient behavior, it is an important one. The committee calls for all purchasers, both public and private, to carefully reexamine their payment policies to remove barriers that impede quality improvement and build in stronger incentives for quality enhancement. Clinicians should be adequately compensated for taking good care of all types of patients, neither gaining nor losing financially for caring for sicker patients or those with more complicated conditions. Payment methods also should provide an opportu­ nity for providers to share in the benefits of quality improvement, provide an op­ portunity for consumers and purchasers to recognize quality differences in health care and direct their decisions accordingly, align financial incentives with the im­ plementation of care processes based on best practices and the achievement of better patient outcomes, and enable providers to coordinate care for patients across settings and over time. To assist purchasers in their redesign of payment policies, the federal go v­ ernment, with input from the private sector, should develop a program to identify, pilot test, and evaluate various options for better aligning payment methods with quality improvement goals. Examples of possible means of achieving this end include blended methods of payment designed to counter the disadvantages of one payment method with the advantages of another, multiyear contracts, payment modifications to encourage use of electronic interaction among clinicians and between clinicians and patients, and bundled payments for priority conditions. • Preparing the workforce. Health care is not just another service in­ dustry. Its fundamental nature is characterized by people taking care of other people in times of need and stress. Stable, trusting relationships between a patient and the people providing care can be critical to healing or managing an illness. Therefore, the importance of adequately preparing the workforce to make a smooth transition into a thoroughly revamped health care system cannot be un­ derestimated. Three approaches can be taken to support the workforce in this transition. One approach is to redesign the way health professionals are trained to emphasize the six aims for improvement, which will mean placing more stress on teaching evidence-based practice and providing more opportunities for interdisciplinary training. Second is to modify the ways in which health professionals are regu­ lated and accredited to facilitate needed changes in care delivery. Third is to use the liability system to support changes in care delivery while preserving its role in ensuring accountability among health professionals and organizations. All of these approaches likely will prove valuable, but key questions remain about each. The federal government and professional associations need to study these ap­ proaches to better ascertain how they can best contribute to ensuring the strong workforce that will be at the center of the health care system of the 21st century. No Better Time Now is the right time to begin work on reinventing the nation’s health care deliv­ ery system. Technological advances are making it possible to accomplish things today that were impossible only a few years ago. Health professionals and or6 ganizations, policy makers, and patients are becoming all too painfully aware of the shortcomings of the nation’s current system and of the importance of finding radically new and better approaches to meeting the health care needs of all Americans. Although Crossing the Quality Chasm does not offer a simple pre­ scription--there is none--it does provide a vision of what is possible and the path that can be taken. It will not be an easy road, but it will be most worthwhile. � � � For More Information… Copies of Crossing the Quality Chasm: A New Health System for the 21st Century are available for sale from the National Academy Press; call (800) 624-6242 or (202) 3343313 (in the Washington metropolitan area), or visit the NAP home page at www.nap.edu. The full text of this report is available at http://www.nap.edu/books/0309072808/html/ Support for this project was provided by: the Institute of Medicine; the National Research Council; The Robert Wood Johnson Foundation; the California Health Care Foundation; the Commonwealth Fund; and the Department of Health and Human Services’ Health Care Finance Administration, Public Health Service, and Agency for Healthcare Research and Quality. The views presented in this report are those of the Institute of Medi­ cine Committee on the Quality of Health Care in America and are not necessarily those of the funding agencies. The Institute of Medicine is a private, nonprofit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright ©2000 by the National Academy of Sciences. All rights reserved. Permission is granted to reproduce this document in its entirety, with no additions or al­ terations � � � COMMITTEE ON QUALITY OF HEALTH CARE IN AMERICA WILLIAM C. RICHARDSON (Chair), President and CEO, W.K. Kellogg Foundation, Battle Creek, MI DONALD M. BERWICK, President and CEO, Institute for Healthcare Improvement, Boston, MA J. CRIS BISGARD, Director, Health Services, Delta Air Lines, Inc., Atlanta, GA LONNIE R. BRISTOW, Former President, American Medical Association, Walnut Creek, CA CHARLES R. BUCK, Program Leader, Health Care Quality and Strategy Initiatives, General Electric Company, Fairfield, CT CHRISTINE K. CASSEL, Professor and Chairman, Department of Geriatrics and Adult Development, The Mount Sinai School of Medicine, New York, NY 7 MARK R. CHASSIN, Professor and Chairman, Department of Health Policy, The Mount Sinai School of Medicine, New York, NY MOLLY JOEL COYE, Senior Fellow, Institute for the Future, and President, Health Technology Center, San Francisco, CA DON E. DETMER, Dennis Gillings Professor of Health Management, University of Cambridge, UK JEROME H. GROSSMAN, Chairman and CEO, Lion Gate Management Corporation, Boston, MA BRENT JAMES, Executive Director, Intermountain Health Care Institute for Health Care Delivery Research, Salt Lake City, UT DAVID McK. LAWRENCE, Chairman and CEO, Kaiser Foundation Health Plan, Inc., Oakland, CA LUCIAN L. LEAPE, Adjunct Professor, Harvard School of Public Health, Boston, MA ARTHUR LEVIN, Director, Center for Medical Consumers, New York, NY RHONDA ROBINSON-BEALE, Executive Medical Director, Managed Care Manage­ ment and Clinical Programs, Blue Cross Blue Shield of Michigan, Southfield JOSEPH E. SCHERGER, Associate Dean for Primary Care, University of California, Irvine College of Medicine ARTHUR SOUTHAM, President and CEO, Health Systems Design, Oakland, CA MARY WAKEFIELD, Director, Center for Health Policy, Research, and Ethics, George Mason University, Fairfax, VA GAIL L. WARDEN, President and CEO, Henry Ford Health System, Detroit, MI Study Staff JANET M. CORRIGAN, Director, Quality of Health Care in America Project Director, Board on Health Care Services, MOLLA S. DONALDSON, Project Codirector LINDA T. KOHN, Project Codirector SHARI K. MAGUIRE, Research Assistant KELLY C. PIKE, Senior Project Assistant Auxiliary Staff MIKE EDINGTON, Managing Editor JENNIFER CANGCO, Financial Advisor Consultant RONA BRIER, Brier Associates, Inc. � � � 8
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Running head: HEALTHCARE INFORMATION SYSTEMS

Healthcare Information Systems

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HEALTHCARE INFORMATION SYSTEMS

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Effect of the Reports on the U.S. Healthcare System
The two reports not only shed light on the current state of the U.S. healthcare system but
they also form a hallmark for institutionalizing healthcare reforms in the country. The ‘To Err is
Human’ report highlights the systemic flaws in the healthcare sector that account for errors in
service delivery. On logical grounds, it could be argued that the IOM committee’s ‘To Err is
Human’ report discerns errors in healthcare as the leading cause of the ever-increasing annual
health expenditure in the country. The ‘Crossing the Quality Chasm’ (CQC) report, on the other
hand, offers a robust framework for implementing healthcare reforms. Therefore, there seems to
be a...


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