reducing redundant laboratory tests (Bates et al., 1998b). Finally, Internet-based health communication can enhance equity by providing a broader array of options for interacting with clinicians, although this can only happen if all people, regardless of race, ethnicity, socioeconomic status, geographic location, and other factors, have access to the technology infrastructure (Science Panel on Interactive Communication and Health, 1999).

The committee believes IT must play a central role in the redesign of the health care system if a substantial improvement in health care quality is to be achieved during the coming decade. This is a theme underlying many of the topics addressed in this report. Chapter 5 emphasizes the importance of a strong information infrastructure in supporting efforts to reengineer care processes, manage the burgeoning clinical knowledge base, coordinate patient care across clinicians and settings and over time, support multidisciplinary team functioning, and facilitate performance and outcome measurements for improvement and accountability. Chapter 6 stresses the importance of building such an infrastructure to support evidence-based practice, including the provision of more organized and reliable information sources on the Internet for both consumers and clinicians, and the development and application of clinical decision support tools. And Chapter 9 considers the need to build information-rich environments for undergraduate and graduate health education, as well as the potential to enhance continuing education through Internet-based programs.

Central to many IT applications is the automation of patient-specific clinical information. Efforts to automate clinical data date back several decades, and have tended to focus on creation of an automated medical record. For example, in 1991 the IOM set forth a vision and issued a strong call for nationwide implementation of computer-based patient records (Institute of Medicine, 1991). But progress has been slow. It is important to recognize that a fully electronic medical record, including all types of patient information, is not necessary to achieve many if not most of the benefits of automated clinical data. For example, use of medication order entry systems using data on patient diagnoses, current medications, and history of drug interactions or allergies can result in sizable reductions in prescribing errors (Bates et al., 1998a; Leapfrog Group, 2000). The automation and linking of data on services provided to patients in ambulatory and institutional settings (e.g., encounters, procedures, ancillary tests) would provide a rich source of information for quality measurement and improvement purposes.

The challenges of applying IT to health care should not be underestimated. Consumers and policy makers share concerns about the privacy and confidentiality of these data (Cain et al., 2000). The United States still lacks national standards for the protection of health data and the capture, storage, communication, processing, and presentation of health information (Work Group on Computerization of Patient Records, 2000). Sizable capital investments will also be required. Moreover, widespread adoption of many IT applications will require



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