diagnoses when the system was used (Friedman et al., 1999). Two additional recent studies have revealed that decision support tools could improve clinician compliance with established evidence-based guidelines and protocols (Morris, 2003; Starmer et al., 2000). Other studies on the use of decision support tools have not found improvements, however (Eccles et al., 2002; Rollman et al., 2002).

More sophisticated tools, such as artificial neural networks, have also demonstrated their effectiveness in detecting acute myocardial infarction, breast cancer, and cervical cancer (Bates and Gawande, 2003; Heden et al., 1997; Kok and Boon, 1996; Petrick et al., 2002). In addition, computerized tools can be used to identify and track the frequency of adverse events (Bates et al., 2001; Classen et al., 1991; Honigman et al., 2001) and hospital-acquired infections (Evans et al., 1986), as well as disease outbreaks and bioterrorism events (Pavlin, 2003; Tsui et al., 2003).

Electronic Communication and Connectivity

Effective communication—among health care team members and other care partners (e.g., laboratory, radiology, pharmacy) and with patients—is critical to the provision of quality health care. Its lack can contribute to the occurrence of adverse events (Bates and Gawande, 2003; Petersen et al., 1994; Schmidt and Svarstad, 2002; Wanlass et al., 1992). Improved communication among care partners, such as laboratory, pharmacy, and radiology, can enhance patient safety and quality of care (Schiff et al., 2003), and improve public health surveillance (Schiff and Rucker, 1998; Wagner et al., 2001). Electronic connectivity is essential in creating and populating EHR systems, especially for those patients with chronic conditions, who characteristically have multiple providers in multiple settings that must coordinate care plans (Wagner, 2000; Wagner et al., 1996). While communication interfaces are becoming well established for administrative data exchange, there are very few such interfaces for the exchange of clinical data.

Electronic communication tools, such as e-mail and web messaging, have been shown to be effective in facilitating communication both among providers and with patients, thus allowing for greater continuity of care (Balas et al., 1997; Liederman and Morefield, 2003; Worth and Patrick, 1997) and more timely interventions (Kuebler and Bruera, 2000). One recent study found that automatic alerts to providers regarding abnormal laboratory results reduced the time until an appropriate treatment was ordered (Kuperman et al., 1999). Another important communication tool is an integrated health record, both within a setting and across settings and institutions. Such



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