directed at both the micro and macro levels, with the ultimate goal of having EHRs in physicians’ offices in every community and a transportable health record available to every patient.


The session participants proposed three strategies for overcoming barriers to successful integration of ICT into the delivery of care: (1) use standardized systems, (2) provide federal leadership to accelerate the adoption of EHRs, and (3) create a public utility that holds data at the local level.

Use Standardized Systems

There was a resounding call for national data standards during the ICT session, accompanied by an expression of frustration with the current inability to transmit health information across organizational and regional boundaries. Participants voiced a strong sense of urgency to the initiation of change, suggesting that any delay in the adoption of standards would exacerbate or worsen the lack of interoperability that has hindered the spread of best practices and the exchange of patient information among providers. Thus as the number of “stand-alone” EHRs proliferates, it will only become more difficult for those who have tried to move forward despite this barrier to integrate systems in which they have invested such considerable resources into standards-based data storage and communication systems that may or may not be compatible with those existing systems.

Standards are also the building blocks for an ICT infrastructure that enables patient health information to be shared at the point of care (IOM, 2003a). By having this information readily available at the time of care delivery—along with computerized reminders for preventive services—clinicians are better able to provide the right care at the right time to their patients (Balas et al., 2000). The ICT-enhanced program of Madigan Army Medical Center (MAMC) illustrates the critical need for national data standards to provide this type of decision support up front, not after the fact, and to facilitate the diffusion of effective programs, such as MAMC’s diabetes initiative (see Box 3-1).

Box 3-1.
ICT-Enhanced Program: Barriers and Opportunities

Madigan Army Medical Center (MAMC) is a tertiary care academic medical center with approximately 250 staff and residents who support all Department of Defense direct health care in the Pacific Northwest region. In the community served by MAMC, 76,000 beneficiaries are enrolled in primary care, including 3,000 patients with adult onset diabetes. MAMC also is a purchaser of health care services under the TRICARE program, covering tertiary care for 460,000 beneficiaries in Washington, Oregon, and Alaska.

MAMC has launched an initiative to improve the quality of care for diabetics within its targeted population. This initiative includes an emphasis on “preventive maintenance” and the use of ICT to provide decision support for clinicians and actively engage patients. The centerpiece of the program is an electronic scorecard keyed to evidence-based Diabetes Quality Improvement Program (DQIP) measures and populated automatically from the laboratory, the pharmacy, and other clinical

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