will not be possible for providers to adhere to the ambitious timetable for quality enhancement proposed in this report.

RECOMMENDATION 5: The federal government should take steps immediately to encourage and facilitate the development of the information technology infrastructure that is critical to health care quality and safety enhancement, as well as to many of the nation’s other priorities, such as bioterrorism surveillance, public health, and research. Specifically:

  1. Congress should consider potential options to facilitate rapid development of a national health information infrastructure, including tax credits, subsidized loans, and grants.

  2. Government health care programs that deliver services through the private sector (Medicare, Medicaid, SCHIP, and a portion of DOD TRICARE) should adopt both market-based and regulatory options to encourage investment in information technology. Such options might include enhanced or more rapid payments to providers capable of submitting computerized clinical data, a requirement for certain information technology capabilities as a condition of participation, and direct grants.

  3. VHA, DOD, and IHS should continue implementing clinical and administrative information systems that enable the retrieval of clinical information across their programs and can communicate directly with each other. Whenever possible, the software and intellectual property developed by these three government programs should rely on Web-based language and architecture and be made available in the public domain.

In addition to offering financial incentives to providers, the federal government should play a stronger role in the establishment of national standards for the collection, coding, and classification of clinical and other health care data (National Committee on Vital and Health Statistics, 2001). Some degree of technical assistance may also be required, especially for safety net providers.

Comparative Quality Reporting

There are many potential uses of comparative quality data. First, providers and care systems that are working to achieve continuous improvement might use the data for benchmarking purposes and to inform decisions regarding referral of patients to specialists and hospitals. Second, patients and group purchasers might access the data when choosing health plans or providers. Third, professional groups, including board

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