ues will change—e.g., more care will be provided at home, and patients will be required to assume greater responsibilities for care (with the assistance of professional care providers). Policy is likely to change—there will be different payment models or reimbursement rates, for example. Thus, any IT-based infrastructure to support today’s health care needs must be designed to accommodate changes in roles and process tomorrow—a point suggesting that architectures based on standard interconnection protocols are much easier to change in comparison to monolithic, tightly integrated all-encompassing systems. Otherwise, even deployment of health care IT successful in solving a problem today could stand in the way of solving tomorrow’s challenges.

Principle 7: Archive Data for Subsequent Re-interpretation

Vendors of health care IT should provide the capability of recording any data collected in their measured, uninterpreted, original form, archiving them as long as possible to enable subsequent retrospective views and analyses of those data.4 Advances in biomedical science and practice will change today’s interpretation of data. In addition, advances in computer science and related disciplines will lead to new ways to extract meaningful and useful knowledge from existing data stores allowing reanalysis of pre-existing data to reveal medically significant relationships and correlations that are currently unknown. Perhaps most importantly, the committee believes that the availability of large amounts of data is itself a driver for progress likely to inspire medically oriented research in machine learning, display technology, data mining, and so on.

Principle 8: Seek and Develop Technologies That Identify and Eliminate Ineffective Work Processes

Organizations should seek and develop technologies that allow identification and elimination of ineffective work processes and implementation of new approaches to achieving their purpose. Automation of work processes developed in an era when paper was the medium for communicating and archiving is fraught with cost and unintended consequences. For example, some of the work done within the health care system might be accomplished outside health care by providing support for patients


See, for example, Werner Ceusters and Barry Smith, “Strategies for Referent Tracking in Electronic Health Records,” Journal of Biomedical Informatics 39(3):362-378, June 2006. Some of the technology issues involved in archiving are discussed in National Research Council, Building an Electronic Records Archive at the National Archives and Records Administration: Recommendations for Initial Development, The National Academies Press, Washington, D.C., 2003.

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