meeting of June 9–10, 2003, to the development of this letter report. The IOM Committee’s full report on data standards will be issued in fall 2003.
The development of an IT infrastructure has enormous potential to improve the safety, quality, and efficiency of health care in the United States (Institute of Medicine, 2001). Computer-assisted diagnosis and chronic care management programs can improve clinical decision making and adherence to clinical guidelines, and can provide focus on patients with those diseases (Durieux et al., 2000; Evans et al., 1998). Computer-based reminder systems for patients and clinicians can improve compliance with preventive service protocols (Balas et al., 2000). More immediate access to computer-based clinical information, such as laboratory and radiology results, can reduce redundancy and improve quality. Likewise, the availability of complete patient health information at the point of care delivery, together with clinical decision support systems such as those for medication order entry, can prevent many errors and adverse events (injuries caused by medical management rather than by the underlying disease or condition of the patient) from occurring (Bates et al., 1998, 1999; Evans et al., 1998). Via a secure IT infrastructure, patient health information can be shared amongst all authorized participants in the health care community (National Research Council, 2000).
An IT infrastructure also has great potential to contribute to achieving other important national objectives, such as enhanced homeland security and improved and informed public health services (Institute of Medicine, 2002b; National Committee on Vital and Health Statistics, 2001; Wagner et al., 2001). EHRs, combined with Internet-based communication, may enable early detection of and rapid response to bioterrorism attacks, including the organization and execution of large-scale inoculation campaigns and ongoing monitoring, detection, and treatment of complications arising from exposure to biochemical agents or immunizations (Tang, 2002; Teich et al., 2002). A more advanced health information infrastructure is also crucial for various forms of biomedical and health systems research, as well as educating patients, informal caregivers, and citizens about health (Detmer, 2003; National Committee on Vital and Health Statistics, 2001).
EHR system implementation and its continuing development is a critical element of the establishment of an IT infrastructure for health care. In 1991, the IOM issued a report calling for the elimination of paper-based patient records within 10 years, but progress has been slow, and this goal has not yet been met (Institute of Medicine, 1991; Overhage et al., 2002). It should be noted that the motivation is not to have a paperless record per se, but to make important patient information and data readily available and useable. In addition, computerizing patient data enables the use of various computer-aided decision supports.
There are some noteworthy examples of health care settings in both the private and public sectors in which EHRs have been deployed. A handful of communities and systems have established secure platforms for the exchange of data among providers; suppliers; patients; and other authorized users, such as the Veterans Health Administration, the New England Healthcare Electronic Data Interchange Network, the Indiana Network for Patient Care, the Santa Barbara County Care Data Exchange, the Patient Safety Institute’s National Benefit Trust Network, and the Markle Foundation’s Healthcare Collaborative Network (CareScience, 2003; Kolodner and Douglas, 1997; Markle Foundation, 2003b; New England Healthcare EDI Network, 2002; Overhage, 2003; Patient Safety Institute, 2002). But these examples are the exception, not the