personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

The IOM vision calls for a health care system that is systematically organized and acculturated in ways that make it easy and rewarding for providers and patients to do the right thing, at the right time, in the right place, and in the right way. This vision entails many different factors (e.g., systemic changes in paying for health care, an emphasis on disease prevention rather than disease treatment). But none is more important than the effective use of information.2

Based on its observations and expertise, the committee identified a number of information-intensive aspects of the IOM’s vision for 21st century health care. Each bullet phrase below summarizes one of these important health care IT capabilities, followed by an illustrative vignette of what might be possible. The vignettes (displayed in italic type) are not comprehensive (i.e., they do not cover all aspects of the capability).

  • Comprehensive data on patients’ conditions, treatments, and outcomes.

    A clinician needs to know what medications an elderly, memory-challenged patient is taking. Recognizing the important difference between medications prescribed and medications taken, the clinician asks the patient to bring all of his pill containers, both prescription and over-the-counter, to the appointment. She asks the patient to place all of the containers on a surface table computer, which automatically identifies the medications in each of the containers and counts the number of pills remaining in each container. The pill containers also carry RFID [radio-frequency identification] tags, on which the initial fill-up quantities of the containers are stored. The table can read these tags, and thereby make an inference about what pills were actually taken and provide information about likely compliance with a particular medication regime.3 Farther in the future, recognizing the differences in how

2

Institute of Medicine, The Computer-Based Patient Record: An Essential Technology for Health Care (Revised Edition), National Academy Press, Washington, D.C., 1997, available at http://www.nap.edu/openbook.php?isbn=0309055326; Institute of Medicine, Key Capabilities of an Electronic Health Record System: Letter Report, The National Academies Press, Washington, D.C., 2003, available at http://www.nap.edu/catalog.php?record_id=10781; Institute of Medicine, Patient Safety: Achieving a New Standard for Care, The National Academies Press, Washington, D.C., 2004, available at http://www.nap.edu/openbook.php?isbn=0309090776.

3

If purchase history were available to provide information on when the container was filled, inferences could be made about the frequency and timing of pill-taking, rather than only the total number of pills taken.



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