Fostering Rapid Advances in Health Care Learning from System Demonstrations (2003) / Chapter Skim
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4. Information and Communications Technology Infrastructure: A 'Paperless' Health Care System
4. Information and Communications Technology Infrastructure: A 'Paperless' Health Care System
Pages 57-68
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From page 57... ...
. — Demonstration projects in this category would be 5 years in duration and are intended to result in the establishment of a state-of-the-art health care ICT infrastructure in a state, community, or a multistate region that is accessible to all providers and all consumers.
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From page 58... ...
Phase 3 would proceed in parallel with phase 2 and continue indefinitely, producing stepwise benefits with enhancements to the applications performed using the platform. Demonstration projects in this category would be greatly facilitated by an immediate emphasis on accelerated development of 58 1~ national data standards in certain key areas.
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From page 59... ...
The development of a secure ICT platform to support clinical, administrative, and financial transactions, as well as the use of computer-based clinical records, should over time reduce some administrative costs and dramatically improve the effectiveness, safety, and timeliness of the health care system. As the ICT infrastructure expands beyond the boundaries of a single or several organizations to span a community, a state, and eventually the nation, there is the potential for it to support many additional clinical, research, professional education, and public health applications (National Research Council, 2000~.
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From page 60... ...
Ready access to information by clinicians and patients on a right- and need-to-know basis Eligibility, appointment, and account status information Computer-based patient records; for example, a summary of current problems, medications, and allergies, together with all results, notes, and summaries Disease management guidelines 2. Support tools for patients Educational materials Tools to monitor individual health status and needs Tools to track progress in meeting clinical goals and compliance with treatment plans Tools to model preferences and the impact of alternative treatment decisions and outcomes Tools to access patient records and to contribute information to these records 3.
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From page 61... ...
The increasing computerization of clinical data and the availability of knowledge management and other decision support tools would open up new opportunities to redesign care processes in ways that would improve safety, effectiveness, and efficiency and be more responsive to patient preferences and needs. Phase 3 would continue indefinitely as advances in medicine, science, and technology offer new possibilities, but by year 5, each demonstration site should be within reach of the goal of a near "paperless" health care system.
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From page 62... ...
For instance, when a participant requests patient information, the data exchange verifies the requester's digital credentials. Patients do not have unique identifiers; rather, the data exchange maintains a file with patient demographic data and correlates these data with those maintained by the provider organization to produce a validated patient search.
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From page 63... ...
In many geographic areas, there are pockets of innovation where strong ICT infrastructures are already available. A number of academic health centers, health systems, and large multispecialty groups have developed strong TCT capabilities (Doolan and Bates, 2002; McDonald et al., 1999; Overhage et al., 2000; Teich et al., 1999)
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From page 64... ...
Second, the capability to monitor and respond to infectious disease outbreaks and bioterrorist attacks requires a national if not global ICT infrastructure. The ICT infrastructures developed by the various demonstration sites should be able to interface with each other, and over time these state- or community-based systems should become part of a nationwide infrastructure.
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From page 65... ...
In particular, the report entitled Uniform Data Stanclards for Patient Medical Record Information contains a number of standards that deserve prompt use in the Medicare and Medicaid programs and within all portions of the federal government that utilize health data standards (National Committee on Vital and Health Statistics, 2000~. A partial list of these standards is Health Level 7 (HL7)
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From page 66... ...
An early product of this effort is an inventory of standards domains necessary to support computerbased records; these include reference information models, data types, terminology, clinical documents, clinical templates, data interchange, implementation manuals, rules, toot sets, terminology services, security, unique identifiers for patients and clinicians, and guidelines (Marble Foundation, 2002~. The IOM Committee on Patient Safety Data Standards, scheduled to release a report in fall 2003, is currently working to identify the types of standards needed for monitoring safety and quality, and is providing guidance to the federal government on actions it might take to facilitate the development of such standards.
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From page 67... ...
2000. "Uniform Data Standards for Patient Medical Record Information." Online.
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From page 68... ...
2002. "PSI Selects Two Washington State Communities to Demonstrate Innovative Patient Safety Communications Network." Online.
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