guide successful use of health care IT to support a 21st century vision of health care. In most instances, these principles are not new—but even “old” principles applied properly in a given field or to a given organization can have the impact and significance of new ones. To place emphasis on the importance of each, the text below categorizes these principles into ones related to evolutionary change and those related to revolutionary change.


Principle 1: Focus on Improvements in Care—Technology Is Secondary

The most important principle for guiding evolutionary change in health care is to focus efforts on achieving the desired improvements in health care rather than on the adoption of health care IT as a goal in itself.2 For example, efforts should be structured around clear health care goals (such as those described by the IOM criteria), and with a transparent understanding of the gap between the existing baseline and goal. Only then should there be a focus on process changes needed to close the gap, and an identification of what technology if any is needed to enable the process changes. If early experience shows that the gap is not closing, process and technology can be adapted until the improvement is achieved. In this approach, health care IT is selected and implemented on an as-needed basis to support iterative improvement, instead of being implemented for its own sake at the outset and then potentially becoming a constraint rather than a facilitator of iterative improvement.

2003; J. Øvretveit et al., “Improving Quality Through Effective Implementation of Information Technology in Healthcare,” International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care 19(5):259-266, October 2007; Jane Hendy et al., “Challenges to Implementing the National Programme for Information Technology (NPfIT): A Qualitative Study,” British Medical Journal 331:331-336, August 6, 2005; Heather Heathfield, David Pitty, and Rudolph Hanka, “Evaluating Information Technology in Health Care: Barriers and Challenges,” British Medical Journal 316:1959-1961, June 27, 1998; C. Sicotte, J.L. Denis, P. Lehoux, and F. Champagne, “The Computer-Based Patient Record Challenges Towards Timeless and Spaceless Medical Practice,” Journal of Medical Systems 22(4):237-256, August 1998; J.P. Glaser, “Too Far Ahead of the IT Curve?,” Harvard Business Review 85(7-8):29-33, 190, July-August 2007.


A similar perspective can be found in Carol C. Diamond and Clay Shirky, “Health Information Technology: A Few Years of Magical Thinking?,” Health Affairs 27(5):383-390, August 19, 2008.

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