ing clinical information, upgrading administrative and billing systems to reduce errors and lower administrative costs, and installing internal networks for sharing information among affiliated entities. Organizations are also beginning to experiment with the use of public networks, such as the Internet, to allow employees and physicians to access clinical information from off-site locations and to enable organizations to share information for purposes of care, reimbursement, benefits management, and research.5 Others are using the Internet to disseminate information about health plans and research.6 The National Library of Medicine recently awarded 19 contracts to a variety of health care organizations across the country to investigate innovative uses of the national information infrastructure for health care, including telemedicine and information sharing (see Appendix C). Much of the demand for information technology is driven by changes in the underlying structure of the health care industry itself and its methods of care, as well as by concerns over rising health care costs. A central part of all these initiatives is the creation of EMRs, which serve as the central clinical repository of information pertaining to patient care.7

Changes in the Health Care Delivery System

The application of new technology to health care both drives and is driven by a fundamental restructuring of the U.S. health care delivery system. In recent years, the health care industry has seen (1) significant consolidation of providers and mergers of care-financing and provider organizations, (2) use of increasingly sophisticated management approaches to share financial risks for care between industry segments, and (3) new entrants into the market for analysis of clinical practice. This transformation is largely the result of pressures to reduce the cost of care, enhance the ability to measure and improve the quality of care, and move care delivery to less expensive settings. Overall, these changes have led to a significant increase in the collection and use of patient health data and in the sharing of these data across organizational boundaries. The

5  

Health Data Network News. 1996. "Claims Over the Internet? It's Happening," May 20, p. 1. See also Fisher, Lawrence M. 1996. "Netscape's Founder Begins a New Venture," New York Times, June 18.

6  

Fisher, Lawrence M. 1996. "Health On-Line: A Participatory Brand of Medicine," New York Times, June 24.

7  

Many terms are used to describe the electronic storage of patient-specific information; apart from electronic medical record (EMR), the two most commonly used terms are computer-based patient record and electronic health record. The committee chose to use EMR without intending to resolve the debates that surround the use of each term.



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