Increasingly sophisticated clinical (as opposed to financial) information systems are being developed rapidly, and the progress of computer technology has led to efforts to aggregate health data from many sources such as hospitals, offices, pharmacies, and laboratories. Such data aggregation has tremendous potential for ensuring the continuity of medical information. Two IOM reports, The Computer-Based Patient Record: An Essential Technology for Health Care (1991) and Health Data in the Information Age: Use, Disclosure, and Privacy (1994b), have explored the benefits and risks of computer-based patient records and community-level information databases. Meeting the need for continuity of care is a significant element of computer-based patient records.

Continuity can apply to an integrated delivery system, a primary care practice or team, and a single primary care clinician. Although the ideal may be an individual seeing the same clinician at each visit, there may be trade-offs between continuity and access. Continuity of clinician may be more important for some people and in some circumstances than others. For example, for a patient with hypertension who makes appointments at regular intervals, it is particularly helpful to both the clinician and the patient to ensure continuity over a succession of visits so that progress and the need to adjust medications can be assessed. Continuity can also be a major source of satisfaction both to patients and clinicians as it fosters the long-term relationships that represent, for many clinicians, a significant reward of medical practice.

Sometimes, however, patients have an acute illness or injury and would prefer quick access to a clinician who might be known to them as a member of a team or practice or might even be a complete stranger at an urgent care center or emergency room. Balancing the competing values of continuity and access represents one of primary care's important challenges and one for which integrated delivery systems may offer some solution.

Accessible

The term accessible means “easy to approach, reach, enter, speak with or use” (Random House, 1983). It refers to the ease with which a patient can initiate an interaction for any problem with a clinician (e.g., by phone or at a treatment location). It includes efforts to eliminate barriers such as those posed by geography, administrative hurdles, financing, culture, and language.

Accessibility is also used to refer to the ability of a population to obtain care. For example, having public insurance coverage does not guarantee access to care if no local clinicians are willing to see individuals with that form of insurance. Accessibility is also a characteristic of an evolved system of which primary care is a basic unit. Potential enrollees of a health plan want to know whether they have “access” to other specialists or subspecialists, how to obtain that access, and



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