reporting requirements. With respect to substance-use treatment providers, for example, the telephone interviews conducted in 2003 with a random sample of 175 directors of inpatient/residential, outpatient, and methadone maintenance programs across the nation found that most of the programs had contracts with multiple managed care organizations and state agencies (e.g., justice, welfare), each requiring different data. Several programs reported that the data requirements of all these agencies required 2–4 hours of data collection per admission, and these administrative data were the only information collected by 30 percent of programs. Programs further indicated that “almost none” of these administrative data were clinically useful or employed in program planning. Staff described their collection as “just paperwork” (McLellan et al., 2003).

Simplifying these requirements will necessitate action across states—by insurers and/or by multiple state agencies. The committee calls attention to the need for a mechanism to examine variations in billing and reporting requirements and for efforts to reduce this variation to the extent possible across states and localities.

Financial Issues

Crossing the Quality Chasm (IOM, 2001) notes that deployment of IT requires a significant financial investment. Capital is needed by providers to purchase and install new technology (typically accompanied by temporary disruptions in patient care); specialized training and education are needed as well. With respect to EHRs, in two recent reports (IOM, 2003, 2004) the IOM has recommended that both public- and private-sector purchasers consider linking provider incentives to the acquisition of EHRs that possess the capabilities outlined by the IOM.

The strategic framework developed by the federal government also proposes three strategies for countering financial barriers to the adoption of EHRs: incentivizing the adoption of EHRs, reducing the risk of EHR investment, and supporting EHR diffusion in rural and underserved areas. Potential incentive mechanisms identified in the framework include incorporating support for EHRs in grants or contracts to regions, states, and communities for local IT infrastructure; making available low-interest loans for IT adoption; reimbursing for the use of EHRs; and incorporating EHR use in pay-for-performance projects (Thompson and Brailer, 2004).


The committee concludes that strong actions are needed to involve M/SU health care organizations, systems of care, and treatment providers quickly and directly in efforts to create the NHII, including initiatives to (1)

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