Priority conditions can provide a framework for the development of an information infrastructure that is aligned around the clinical conditions frequently faced by patients. The absence of well-designed care processes is currently an impediment to the development and application of effective information technology systems. To be most useful, information technology must be designed to support the work of the care team. Consciously and skillfully designed care processes for priority conditions are an important step in establishing a foundation from which to design supportive information technology applications.
Common information technology systems are needed to effectively measure outcomes and processes of care and to provide benchmarks for continuous improvement. Currently, each provider group may implement its own information system, but incompatibilities inhibit communication among the many people caring for an individual patient. Priority conditions can provide a focus for the development of standards and terminology for use in managing and using information technology to improve care for patients. Best practices can help define standard information needs and guide the development of information technologies that can be used to implement best practices (e.g., decision support systems).
A significantly enhanced information infrastructure is critical to achieving the aims set forth in Chapter 2 and the other potential applications of the priority conditions. Synthesizing the evidence base, linking it to clinical practice, and making it accessible to a variety of potential users will require good information systems and, most likely, greater use of the Internet. Greater use of the Internet and telemedicine should in turn facilitate access to clinical expertise and support care for patients in their own communities, especially in rural areas. Better flows of information are also necessary to improve the ways care is organized and coordinated, especially across settings and over time. Using payment methods to reward quality will require stronger information systems to track costs and link them to processes of care. Finally, measurement and evaluation cannot be advanced without better technology for data collection and management (see Chapter 7 for further discussion on using information technology).
A major barrier to quality improvement is the lack of reward that characterizes the most common payment methods used today (see Chapter 8). The current payment system often reinforces fragmentation by paying separately according to the setting of care and provider type, and by not giving providers the flexibility needed to customize care for individual patients. Furthermore, common payment methods can inhibit quality improvement to the extent that organizations that improve certain aspects of quality (e.g., by reducing readmission rates or office visits) can experience a reduction in their revenues, which serves as a disincentive for continuous improvement.