that it would make care more accessible, increase administrative efficiencies, and decrease paperwork.

Health information technology can produce many public health benefits, as well, enabling

  • early detection of outbreaks of infectious diseases or bioterrorism and tracking short- and long-term effects of exposures to environmental hazards,

  • improved monitoring and proactive management of chronic disease patterns,

  • more coordinated care for clients of publicly funded clinics, and

  • identifying adverse events once drugs are in real-world use.

In the IOM’s widely referenced report on achieving health care quality, Crossing the Quality Chasm, the authors say that achievement of every one of the health care attributes they describe as essential to quality care—that it be safe, effective, patient-centered, timely, efficient, and equitable—would be aided by improved information technology (IOM, 2001). However, financial and technical assistance may be necessary to help small physician practices and safety-net providers adopt these systems. Progress has been slow in many areas: standards development, private physician adoption, achieving interoperability across systems and within institutions, and achieving confidentiality—areas in which government carrots (financial incentives) and sticks (penalties) could move the field forward more quickly, such as those set forth in the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. This act provides phased incentive payments for doctors who begin e-prescribing, and eventually, penalties for those who don’t comply.

Health information technology is a tool that can facilitate change. However, it cannot create change. The potential benefits of health information technology, in terms of quality and cost-effectiveness, cannot be realized without substantial changes in the organizational arrangements of the health system. Otherwise, the new information capacity will only perpetuate and further institutionalize the built-in problems we have today (Diamond and Shirky, 2008).

Having available timely electronic data from both the public and the private sectors will enable the secretary to provide Congress and the American people with a more complete picture of the state of Americans’ health, unmet needs, the costs and effectiveness of health



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