An influential new report identifies fragmentation as a key cause of problems in the American healthcare system and says IT can play a key role in creating a more integrated, patient-centric approach. The report says, however, that the IT infrastructure in use in US healthcare is itself fragmented, hindering efforts to improve patient care. It calls for an integrated health IT infrastructure, backed by common standards that will ensure patient records and data are portable and not locked into proprietary systems. “Crossing the Quality Chasm Summit: A Focus on Communities," was produced by the US Institute of Medicine, which in 2001 published the seminal report ‘Crossing the Quality Chasm’ on how better IT could help prevent 10,000s of deaths each year caused by avoidable medical errors. The latest report, part of ongoing efforts to implement recommendations of the 2001 report, grew out of a meeting of US regional and national health care leaders earlier this year. The summit identified three strategies for overcoming barriers to the successful integration of ICT into the delivery of healthcare. First, the use of standardised systems. Second, to provide federal leadership to accelerate the adoption of electronic health records. And third to create a public utility that holds data at the local level. Analysing health care organisations as complex systems, the new report also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change. A key recommendations of the report emphasises that improvement efforts should focus on improving the overall safety of the system of health care delivery, rather than on individual practitioners. On the value of ICT to support such a systemic approach the latest IOM report states, “Few innovations in health care delivery are as promising as ICT." In particular the new report focuses on integration of information systems. It stresses that patient information should be readily transportable. Similarly it recommends that the retrieval and access of patient information and data should not depend on particular software or system requirements. One of themes reiterated at the summit was the importance of patients “having access to and control of their health records”. The report says “Ideally, patient health information would be stored in a transportable electronic format easily retrieved from any computer regardless of software or system requirements." Keynote speaker at the summit Professor Don Berwick called for patients’ unfettered access to their health records – “no cost, no barriers, no limitations" – and pointed to patient-carried records as an attainable first step. A particular concern highlighted by the report is the inability to transmit information across regions and organisations. This means that organisations that push forward with “standalone" electronic health care records will likely have difficulty integrating their systems, a situation that will grow worse over time. The report says that without adoption of standards the lack of interoperability between stand-alone EHRs will be exacerbated. “Standards are the building blocks for an ICT infrastructure that enables patient health information to be shared at the point of care." The report identifies standards as essential “building blocks" for enabling features such as computerised reminders for preventive services, warnings of contraindicated treatments and access to other medical information. “Standards are important steps to enable functions such as computerised reminders for preventive services, warnings of potentially dangerous treatments and access to medical information." The government should help advance these standards. The IOM report also says the government will need to find ways for healthcare providers to finance electronic health records, as the financial benefits of implementing electronic records currently do not flow to those who pay to set up and maintain the record. “Accelerating the update of information and communications technology would involve a dual strategy of new financial incentives for clinicians from the private sector to invest in the necessary infrastructure," states the report. More empirical evidence that IT prevents errors also would help convince clinicians that investments are worthwhile, the report says. In addition to IT, the report calls for strategies to improve health care through better use of measurements, financial incentives, community building, coordinating care and supporting patient self-management.
