enue in the billions—that the committee visited had invested over a half-billion dollars in IT in the past decade. The health care organizations visited demonstrated both deep and sustained organizational and financial commitment to using information technology to improve health care. Yet their health care IT implementation time lines are measured in decades, and it is common to see the implementation of a new generation of health care IT begin while rollout of the prior generation is still underway [C4O16]. Centralization of management and reduction in the number of systems are the predominant method for standardization [C4O15], whereas innovation requires systems that can adapt to local needs [C6O25]. System response times are often slow and long downtimes are common [C4O18].

Consistent with many other reports,2 the committee recognizes commitment to 21st century use of IT in health care as an essential part of achieving the IOM’s vision of 21st century health care. But health care IT is merely a means to the desired end, namely better and/or less expensive health care. The committee believes that clinicians and other providers will, appropriately, be drawn to IT only if, where, and when it can be shown to enable them to do their jobs more effectively. Blanket promotion of IT adoption where benefits are not clear or are oversold will only waste resources and sour clinicians on the true potential of health care IT.

In short, the nation faces a health care IT chasm that is analogous to the quality chasm highlighted by the IOM over the past decade. In the quality domain, various improvement efforts have failed to improve health care outcomes, and have sometimes even done more harm than good.3 Similarly, based on an examination of the multiple sources of evidence described above and viewing them from the committee’s perspective, the committee believes that the nation faces the same risk with health care IT—that current efforts aimed at the nationwide deployment of health care IT will not be sufficient to achieve the vision of 21st century health care, and may even set back the cause if these efforts continue wholly without change from their present course. Success in this regard


See, for example, Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, National Academy Press, Washington, D.C., 2001; President’s Information Technology Advisory Committee, Revolutionizing Health Care Through Information Technology, National Coordination Office for Networking and Information Technology, Washington, D.C., 2004, available at http://www.nitrd.gov/pitac/reports/20040721_hit_report.pdf; Office of the National Coordinator for Health Information Technology, The ONC-Coordinated Federal Health Information Technology Strategic Plan: 2008-2012, U.S. Department of Health and Human Services, Washington, D.C., 2008, available at http://www.hhs.gov/healthit/resources/HITStrategicPlan.pdf.


See, for example, the studies of the Dartmouth Atlas Project at http://www.dartmouthatlas.org/.

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