Incentives, such as reductions in Medicare Part B premiums, could be used to encourage beneficiaries to make this designation. The mechanisms for this involvement should be easy for beneficiaries to understand and apply. Moreover, all activities related to this process should protect patient confidentiality and be completed in compliance with the regulations of the Health Insurance Portability and Accountability Act.

The committee recognizes the many technical difficulties associated with implementing such a process. Nonetheless, the committee believes enhancing care coordination is essential to improving the overall quality of care and should be promoted through the use of incentives to the extent possible.

Information technologies might be used as a transformative tool in systems change to enhance health care delivery. For example, computerized provider order entry systems can help minimize errors in prescribing medications. Electronic health records can facilitate clinical documentation and potentially allow providers to have more complete and comprehensive information about their patients available at the point of care, and can enable improvements in the safety, effectiveness, and efficiency of treatment by making a patient’s medical records portable among multiple providers.

With respect to pay for performance, health information technologies can assist providers in data collection and reporting activities. Although the evidence is limited, use of these technologies may reduce the burden on providers and their staffs associated with reviewing medical records for reporting purposes as the number of measures grows, improve the accuracy of the data reported, and expedite the implementation of pay for performance. The sooner data are received and validated, the sooner rewards can be determined and distributed to providers. It is also true that pay for performance can encourage adoption of information technologies. If information technologies are indeed found to greatly facilitate improvement, their adoption may increase significantly. The following discussion assesses the current state of adoption, current activities, and barriers to implementation of health information technologies.

Despite the potential importance of health information technologies, their adoption has been slow in both inpatient and ambulatory settings,