cussed in Chapter 8, current payment policies do not adequately reward improvements in quality.

There are some indications that the use of IT is slowly becoming more widespread. In 1997, the health information technology industry sold $15 billion worth of products to health care organizations (Kleinke, 1998). The development of Web-based applications for use on the Internet may also open the door to new forms of financing the expenses of IT. For example, if IT shifts from an equipment purchase to a service expense, it can be bought on a monthly basis and upgraded easily in response to both technological advances and changes in medical practice. Maintaining up-to-date applications that reflect the evolution of technology and the knowledge base and making them available by subscription at a Web site rather than requiring users in individual organizations to purchase and maintain them is likely to provide great impetus for the development and use of these systems.

Human Factors Issues

One of the most challenging, and least understood, barriers to the application of useful information technologies in health care relates to human factors. These barriers include both workforce and patient issues.

The health care sector is labor-intensive, with about 700,000 physicians, over 2 million nurses, and many other health care workers being involved in the delivery of patient care to varying degrees (Health Resources and Services Administration, 2000). The workforce is highly variable in terms of IT-related knowledge and experience, and probably also in terms of receptivity to learning or acquiring these skills. Some clinicians may also be wary of embracing new IT applications because of frustrating experience with earlier IT applications that failed to prove useful in solving diagnostic and therapeutic problems (Kassirer, 2000). Moreover, the development of new data infrastructures and the incorporation of new IT applications into clinical practice generally entails disruptions in patient care, resulting in lost revenues for many clinicians.

Many IT applications require the forging of new relationships between clinicians and institutional providers, which may be slow to develop. For example, some have observed that the deeply ingrained economic distrust and cultural conflict between physicians and hospitals has impeded the adoption of IT applications that require Web-based integration (Kleinke, 2000).

IT will undoubtedly alter the clinician and patient relationship, and in some cases, these changes may be threatening to clinicians. The standardization and automation of various types of clinical data opens up many new opportunities to make comparative quality data available to consumers who must chose among clinicians, sites of care, and treatment options, and to bolster oversight and accountability programs (Kleinke, 2000). The availability of clinical knowledge on

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