making. Appropriately designed EHRs not only serve as a means for practitioners to access best practices and evidence guidelines, but they also capture a broad array of information important to the diagnosis and treatment of individual patients. To provide policy makers with “order of magnitude” estimates of the spending needed to speed broad adoption of CISs in care delivery organizations throughout the nation, Robert H. Miller from the University of California at San Francisco describes current EHR adoption, future EHR capital and operating expenditure requirements, and prospects for EHR adoption in the hospital and in physician and clinical services sectors.
Work is also needed to develop the technical capacity, methods, standards, and policies for the efficient exchange of information from EHRs and other data sources (e.g., administrative databases, clinical registries) and to disseminate evidence syntheses and other resources to guide practice. Although large databases and clinical registries offer immediate opportunities for learning what works in health care, Carol C. Diamond from the Markle Foundation argues that the greatest promise of health information technology (HIT) lies in its ability to enable quick and efficient learning via a networked and distributed approach to information sharing and evidence development. To maximize this potential, approaches to data and information hubs will need to evolve to address four key challenges: (1) clearly defining the ultimate goal; (2) being open to reset our definitions and assumptions about health data and research approaches; (3) articulating new, broadly accepted working principles based on 21st-century information paradigms; and (4) developing an information policy framework that broadly addresses public hopes and concerns. Diamond illustrates how these challenges are a jumping-off point for moving to a distributed approach to research—one characterized by connectivity, networks, and feedback loops.
Finally, an essential function of any system dedicated to developing a robust evidence base for medical practice is the synthesis of information derived from relevant trials, studies, and insights emerging from clinical practice. As data resources and networks expand, demand will also grow for synthesis work to ensure studies are appropriately reviewed, vetted, and incorporated into the evolving evidence base. Lorne A. Becker from the Cochrane Collaborative provides an overview of current approaches to evidence review, synthesis, coordination, and dissemination—internationally and within the United States—and offers some suggestions on key opportunities for expanding capacity to meet the anticipated demand.