into how they might apply to the health care problems of today and to identify opportunities for new advances. However, the study described in this report was conducted by an interdisciplinary committee of experts not only from the computer science community (including members with expertise in fields such as databases, security, networking, human-computer interaction, and large-scale system deployments), but also from health/biomedical informatics and from health care per se (e.g., physicians who have worked with information technologies) to provide a suitable grounding in the realities of and thinking in these disciplines.

By design, the effort of the Committee on Engaging the Computer Science Research Community in Health Care Informatics was both time-and resource-limited. In its work, the committee focused primarily on understanding the nature and impact of the IT investments made by major health care organizations. Thus, this study does not touch except in the most peripheral way on a myriad of complex social, political, and economic issues that complicate the task of health care reform.

The evidentiary basis for this study involves several threads. The primary observational evidence was derived from committee site visits to eight medical centers around the country—for the most part acknowledged leaders in applying IT to health care—on the theory that many of the important innovations and achievements for health care IT would be found in such organizations thought to be leaders in the field. In addition, this study built on previous work of the Institute of Medicine (IOM) and the National Academy of Engineering on health care (specifically, the committee adopted as a point of departure the IOM series “Crossing the Quality Chasm”1) and on a selective literature review.

These multiple sources of evidence—viewed from the committee’s perspective—suggest 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. Specifically, success in this regard will require greater emphasis on providing cognitive support for health care providers and for patients and family caregivers on the part of computer science and health/biomedical informatics researchers. Vendors, health care organizations, and government will also have to pay attention to cognitive support, which refers to computer-based tools and systems that offer clinicians and patients assistance for thinking about and solving problems related to specific instances of health care. This point is the central conclusion of this report.


Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century, The National Academies Press, Washington, D.C., 2005, available at

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