FIGURE 2-1 Conceptual drawing of a four-level health care system.

effective, efficient care encompasses the patient’s medical record, including real-time physiological data; the most up-to-date medical evidence base; and orders in process concerning the patient’s care. The patient and/or his or her clinician/counselor or family member must also have access to educational, decision-support, information-management, and communication tools that can help them integrate critical information from different sources.

From the patient’s perspective, improving the timeliness, convenience, effectiveness, and efficiency of care will require that the patient be interconnected to the health care system. Synchronous communication between patient and physician could improve the quality of care in a number of ways. For example, continuous, real-time communication of a patient’s physiological data to care providers could accelerate the pace of diagnosis and treatment, thereby reducing complications and injuries that might result from delays. Remote (e.g., in-the-home, on-the-go) monitoring, diagnosis, and treatment would make care much more convenient for patients, save them time, and conceivably improve compliance with care regimes (see paper by Budinger in this volume). Communication technologies also have the potential to change the nature of the relationship between patient and provider, making it easier for patients to develop and maintain trusting relationships with their clinicians.

Asynchronous communication also has the potential to significantly improve quality of care. The easy accessibility of the Internet and the World Wide Web should enable all but continuous inquiries and feedback between patients and the rest of the health care system (IOM, 2001). The World Wide Web has already changed patients’ ability to interact with the system and to self-manage aspects of their care. One of the fastest growing uses of the these communication technologies is as a source of medical information from third parties, which has made the consumer (i.e., the patient) both more informed, and, unfortunately, sometimes misinformed.

Some of the improvements just described are available today, some are under study, and some are as much as a decade away from realization. Thus, research is still an essential component in transforming the current system.

The Care Team

The care team, the second level of the health care system, consists of the individual physician and a group of care providers, including health professionals, patients’ family



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