Improving patient safety requires much more than systems for reporting and analyzing events; errors must be prevented from occurring in the first place. Several effective tools are available that can assist in the prevention of adverse events. Clinical decision support systems (CDSSs), such as those for medication order entry, can prevent many errors from occurring (Bates et al., 1997, 1998, 1999). Computer-based reminder systems can facilitate adherence to care protocols (Balas et al., 2000); computer-assisted diagnosis and management programs can improve clinical decision making at the point of care (Durieux et al., 2000; Evans et al., 1998); and immediate access to clinical information, such as results of laboratory and radiology tests, can reduce redundancy, allowing for more efficient decision making. Incorporation of new research findings into clinical practice is also important for improving patient safety. Balas and Boren found that it takes an average of 17 years for research to reach clinical practice, whereas newer technological innovations take an average of 4 to 6 years. Actionable knowledge representation through the use of information systems holds promise for better connecting clinical research and patient care practices (Balas and Boren, 2000). In addition, the Internet can be used for customized health education for patients, thereby promoting more effective self-management of chronic and other medical conditions (Cain et al., 2000; Goldsmith, 2002). The Internet can be used as well for communication among all authorized members of the care team (e.g., primary care providers, specialists, nurses, pharmacists, home health aides, the patient, and lay caregivers), a capability that is especially important for the chronically ill. The capabilities provided by these clinical information systems cannot be achieved, however, without standards-based interoperability founded on the national health information infrastructure (NHII).

The NHII is defined as a set of technologies, standards, applications, systems, values, and laws that support all facets of individual health, health care, and public health (National Committee on Vital and Health Statistics, 2001). It encompasses an information network based on Internet protocols, common standards, timely knowledge transfer, and transparent government processes with the capability for information flows across three dimensions: (1) personal health, to support individuals in their own wellness and health care decision making; (2) health care providers, to ensure access to complete and accurate patient data around the clock and to clinical decision support systems; and (3) public health, to address and track public health concerns and health education campaigns (National Committee on Vital and Health

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