Principle 2: Seek Incremental Gain from Incremental Effort

An important corollary is to engage in a portfolio of activities, starting with ones that require modest investment and are likely to return perhaps modest, but short-term, visible improvements. If programs can be structured so that small investments yield visible success, stakeholders and the relevant decision makers are more likely to be persuaded to continue along such a path. In contrast, programs that require large initial investments of money, effort, and/or time before exhibiting useful results are difficult to sustain and are often politically vulnerable.

Principle 3: Record Available Data So That They Can Be Used for Care, Process Improvement, and Research

Systematic improvement of health care is data-driven. Therefore, health care providers should aggregate as much data as feasible about people, processes, and outcomes from all sources, acknowledging the never-ending challenge of maintaining reasonable degrees of patient confidentiality in such a data collection effort. Of potential relevance are data about people (e.g., their medical condition and health status, their diet and environmental conditions), processes (e.g., actual health care services received, when, and where with detailed process logs), and outcomes (e.g., clinical and functional status at multiple points in time in multiple different conditions). Even if such collected data cannot immediately be regularized to a common semantic standard necessary for full data interoperability, they are still potentially useful for incremental care or process improvement and for research—future needs cannot be fully foreseen, especially in light of anticipated needs for clinical and environmental data to correlate with personalized genomic data. Moreover, systematic advances in process improvement and knowledge may require collection of new data types that cannot be anticipated today, suggesting the need for a collection infrastructure whose scope can be easily expanded. Automatic recording of actions and interactions at the source will facilitate data capture and is needed to avoid increasing the workload of caregivers and ancillary personnel.

Principle 4: Design for Human and Organization Factors

Providers of health care IT can design systems to support people in doing the right thing—by providing incentives for and eliminating barriers to doing those things. Entirely apart from technology, barriers and incentives can be sociological, psychological, emotional, cultural, legal, economic, or organizational. Human-centered design pays attention to all of these factors as they relate to technical function and form. Such

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