A2:    Information interventions to improve quality and control cost in health care

Janet M Corrigan PhD MBA. Director, Board on Health Care Services, Institute of Medicine, The National Academies (USA)

Target level: BEGINNERS & INTERMEDIATES

The potential for the Internet to transform health care is enormous. A recent report by the National Research Council of The National Academies identified six major application domains; consumer health, clinical care, administrative and financial transactions, public health, professional education, and biomedical research. To better understand how IT can contribute to improving quality, the Institute of Medicine convened a group of experts in September 1999. Key areas identified included:

• Accessing the medical knowledge base. Through use of the web, it is possible to help providers and consumers gain access to clinical evidence more effectively and rapidly.
• Computer-based decision support systems (CDSS). Embedding knowledge in tools and training clinicians to use these tools to augment their own skills and practice experience is probably the only way to assure consistent application of the expansive science base to patient care.
• Collection and sharing of clinical information. The automation of patient-specific clinical information is essential for many types of CDSS applications (e.g., computer-aided diagnosis and management of common clinical conditions). Automated clinical data has the potential to improve coordination of care across clinicians and settings, which is critical to the effective management of chronic conditions.
• Reduction in Errors. IT can contribute to the reduction in errors by standardizing and automating certain decisions and by aiding in the identification of possible errors before they occur, such as potential adverse drug interactions.
• Enhanced Patient and Clinician Communication. IT can change the way individuals receive care and interact with their clinicians. Instead of a $65 office visit and a half-day off work, a ten-minute e-mail communication could meet many patients’ needs, more responsively and at lower cost. Similarly, patients will be able to go online and get test results, inform their clinicians about how they are doing and their functional status, participate in interactive chronic care management services and receive after-care instructions and participate in support groups. E-mail communication between patient and provider can also permit continuous monitoring of clinical conditions, especially for patients with chronic conditions that require self-management.

This tutorial will focus on 1) the critical role of IT in addressing the serious shortcomings in quality and patient safety, 2) discuss some of the current applications in each of the above areas; and 3) discuss policy, economic and organizational barriers to use of IT that must be addressed.