these tools to connect with providers and to manage care. Andrew Barbash then discusses possibilities to build on patient interests to connect with care and move toward true patient-provider collaboration. He notes that while the primary focus has been on building the tools that allow patients to take on new roles and responsibilities in managing personal health, equal effort should be put into thinking about new information models that can provide the types of information needed to appropriate users and into developing new rules of engagement for how accountability for the integrity of data, communication and response, and safeguarding privacy might be governed.

Understanding how to develop an evidence base that can incorporate patient preference is an important move toward a patient-centered system. James Weinstein’s and Kate Clay’s work at the Dartmouth-Hitchcock Medical Center has helped to develop the concepts of informed choice and shared decision making as a way to get the “right rates of treatment” and “catalyzing a patient-driven change of the healthcare system.” This approach is particularly useful in cases where there is no clear “best” treatment option because such conditions are particularly value sensitive with a clear role for patient preference. Implicit in such an approach will be the use of high-quality decision aids and evidence-based information.


Janet M. Marchibroda

eHealth Initiative

Over the last five years, there has been a growing consensus among recognized experts, including many of the nation’s leading providers, employers, health plans, and patient groups; members of both the House and the Senate; leaders in nearly every federal agency involved in health care; and state and local policy makers, that healthcare information technology, and specifically mobilizing health information exchange electronically, will contribute to significant improvements in the quality, safety, and efficiency of health care.

Because of the highly fragmented nature of the U.S. healthcare system, information about the patient is stored in a variety of locations, often in paper-based forms and is not easily accessed. As a result, clinicians often do not have comprehensive information about the patient when and where it is needed most—at the point of care—and those responsible for managing and improving the health of populations do not have the information they need to measure progress and facilitate improvement. In addition, those responsible for protecting the public’s health don’t have access to the information

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