consumers, and the families. Health providers will demand integrated systems when patients arrive at their offices saying things like, “Here is my electronic health record. Why can’t you download your standard information to me? Where are my MRIs? You should be able to e-mail those to me or put them on my thumb drive.” The Commission on Systemic Interoperability took the position that more people need to demand interoperability. If that were done, health providers would be motivated to demand integrated systems.

Isham concluded the session by saying that many important questions remain about the integration of health literacy with developing HIT systems. For example, do the current methods used for assessing health literacy apply to the human–IT interface? There were many anecdotes throughout the day about how people interact with their machines and their PDAs and about how games are important. Are the NAALs and the other tools for assessing health literacy valid for assessing how effectively people understand and use information to improve health when that information is mediated through technology?

Another question for future exploration relates to the source of the $86.6 billion in savings spoken of earlier that it is estimated will be realized from the implementation of health care IT systems. While some might find it difficult to understand how such savings will accrue, it is likely that the interface between people and IT machines is a critical component in harvesting that savings. Perhaps if we understood that interface better, many would think that health literacy contributes more to savings than is currently realized and, therefore, would conclude that it is a much more important objective for Healthy People 2020 and other efforts.

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