Abstract
The U.S. health care system is one of the world’s most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Kaiser Family Foundation and Health Research and Educational Trust. Employer Health Benefits 2003 Annual Survey. Kaiser Family Foundation. 2003. Available at: http://www.kff.org/insurance/ehbs2003-1-set.cfm. Accessed December 2004.
General Accounting Office. Use of Information Technology for Selected Health Care Functions. Washington, DC: Briefing for the Minority Staff of the Senate Committee on Health, Education, Labor, and Pensions; 2003.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163:1409–16.
Reid PP, Compton D, Grossman JH, Fanjiang G. Committee on Engineering and the Health Care System. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: National Academy Press; 2005.
The Commonwealth Fund. How Information Technology Can Improve Health Care Quality: Core Lessons. Washington, DC: Alliance for Health Reform/Commonwealth Fund Roundtable: 2003.
Morrissey J. An info-tech disconnect. Even as groups such as Leapfrog push IT as an answer to quality issues, doctors and executives say, “not so fast.” Mod Healthcare. 2003;33:6–7.
Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2003.
Cors WK. Physician executives must leap with the frog. Accountability for safety and quality ultimately lie with the doctors in charge. Physician Exec. 2001;27:14–6.
Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311–6.
Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6:313–21.
Barlow S, Johnson J, Steck J. The economic effect of implementing an EMR in an outpatient clinical setting. J Healthc Inf Manag. 2004;18:46–51.
Pagliari C. E-Health scoping exercise: review of the traditional research literature. The Service Delivery and Organization Programme, National Health Services; 2005.
Pagliari C. E-health scoping exercise: review of wider web-based information sources. Service Delivery and Organization Programme, National Health Services; 2005.
Altman RB. Ten grand challenges for medical informatics. Available at: www.smi.stanford.edu/pubs/smi_reports/smi-96-0655.pdf. Accessed December 2004.
McDonald CJ, Overhage JM, Dexter PR, et al. Canopy computing: using the web in clinical practice. JAMA. 1998;280:1325–9.
Hillestad R, Bigelow J, Bower A, et al. Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Aff (Millwood). 2005;24:1103–17.
Reuters. Report says 1,95,000 deaths due to hospital error. 7-27-2004. Available at: http://reuters.com/printerFriendly. Accessed December 2004.
McQueen L, Mittman BS, Demakis JG. Overview of the veterans health administration (VHA) quality enhancement research initiative (QUERI). J Am Med Inform Assoc. 2004;11:339–43.
Hynes DM, Perrin RA, Rappaport S, Stevens JM, Demakis JG. Informatics resources to support health care quality improvement in the veterans health administration. J Am Med Inform Assoc. 2004;11:344–50.
Fung CH, Woods JN, Asch SM, Glassman P, Doebbeling BN. Variation in implementation and use of computerized clinical reminders in an integrated healthcare system. Am J Manag Care. 2004;10:878–85.
President’s Information Technology Advisory Committee. Revolutionizing Health Care through Information Technology. 6-1-2004.
Weaver FM, Hatzakis M, Evans CT, et al. A comparison of multiple data sources to identify vaccinations for veterans with spinal cord injuries and disorders. J Am Med Inform Assoc. 2004;11:377–9.
Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs, and issues. Ann Intern Med. 2003;139:31–9.
Grimshaw JM, Thomas RE, MacLennan G, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assessment (Winchester, England). 2004;8:iii-iv.
Miller GA. The magical number seven plus or minus two: some limits on our capacity for processing information. Psychol Rev. 1956;63:81–97.
Fernandopulle R, Ferris T, Epstein A, et al. A research agenda for briding the “quality chasm.” Health Aff (Millwood). 2003;22:178–90.
Bakken S, Hripcsak G. An informatics infrastructure for patient safety and evidence-based practice in home healthcare. J Healthc Qual. 2004;26:24–30.
Bakken S, Cimino JJ, Hripcsak G. Promoting patient safety and enabling evidence-based practice through informatics. Med Care. 2004;42(suppl 2):II49–56.
Sittig DF, Hazlehurst BL, Palen T, Hsu J, Jimison H, Hornbrook MCA. Clinical information system research agenda for kaiser permanente. Permanente J. 2002;6:41–4.
Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc. 1996;3:399–409.
Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–46.
Litzelman DK, Dittus RS, Miller ME, Tierney WM. Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med. 1993;8:311–7.
Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994;120:135–42.
Lyons SS, Tripp-Reimer T, Sorofman BA, et al. VA QUERI informatics paper: information technology for clinical guideline implementation: perceptions of multidisciplinary stakeholders. J Am Med Inform Assoc. 2005;12:64–71.
Tan JK, Modrow RE. Strategic relevance and accountability expectations: new perspectives for health care information technology design. Top Health Inf Manag. 1999;19:84–97.
Poon EG, Wang SJ, Gandhi TK, Bates DW, Kuperman GJ. Design and implementation of a comprehensive outpatient results manager. J Biomed Inform. 2003;36:80–91.
Bobb A, Gleason K, Husch M, Feinglass J, Yarnold PR, Noskin GA. The epidemiology of prescribing errors: the potential impact of computerized prescriber order entry. Arch Intern Med. 2004;164:785–92.
Nebeker JR, Hurdle JF, Bair BD. Future history: medical informatics in geriatrics. J Gerontol A Biol Sci Med Sci. 2003;58:M820–5.
Celler BG, Lovell NH, Basilakis J. Using information technology to improve the management of chronic disease. Med Dir Aust. 2003;179:242–6.
Beun JG. Electronic healthcare record: a way to empower the patient. Int J Med Inform. 2003;69:191–6.
Nobel JJ, Norman GK. Emerging information management technologies and the future of disease management. Dis Manag. 2003;6:219–31.
Rogers EM. Lessons for guidelines from the diffusion of innovations. Jt Comm J Qual Improv. 1995;21:324–8.
Rogers EM. A prospective and retrospective look at the diffusion model. J Health Commun. 2004;9(suppl 1):13–9.
Valdes I, Kibbe DC, Tolleson G, Kunik ME, Petersen LA. Barriers to proliferation of electronic medical records. Inform Prim Care. 2004;12:3–9.
Goldsmith J, Blumenthal D, Rishel W. Federal health information policy: a case of arrested development. Health Aff (Millwood). 2003;22:44–54.
Miller RH, Sim I. Physicians’ use of electronic medical records: barriers and solutions. Health Aff (Millwood). 2004;23:116–26.
Doolan DF, Bates DW, James BC. The use of computers for clinical care: a case series of advanced U.S. sites. J Am Med Inform Assoc. 2003;10:94–107.
Johnson T, Ventura R. Applied informatics for quality assessment and improvement. J Nurs Care Qual. 2004;19:100–4.
Korner EJ, Oinonen MJ, Browne RC. The power of collaboration: using internet-based tools to facilitate networking and benchmarking within a consortium of academic health centers. J Med Syst. 2003;27:47–56.
Pagliari C, Gilmour M, Sullivan F. Electronic clinical communications implementation (ECCI) in Scotland: a mixed-methods programme evaluation. J Eval Clin Pract. 2004;10:11–20.
O’Connell RT, Cho C, Shah N, Brown K, Shiffman RN. Take note(s): differential EHR satisfaction with two implementations under one roof. J Am Med Inform Assoc. 2004;11:43–9.
Miller RH, Hillman JM, Given RS. Physician use of IT: results from the Deloitte Research Survey. J Healthc Inf Manag. 2004;18:72–80.
Militello L, Patterson E, Tripp-Reimer T, et al. Clinical reminders: why don’t they use them? The Human Factors and Ergonomics Society’s 48th Annual Meeting: 2004:1651–5.
Patterson ES, Doebbeling BN, Fung CH, Militello L, Anders S, Asch SM. Identifying barriers to the effective use of clinical reminders: boot-strapping multiple methods. J Biomed Inform. 2005;38:189–99.
de Lusignan S, Singleton A, Wells S. Lessons from the implementation of a near patient anticoagulant monitoring service in primary care. Inform Prim Care. 2004;12:27–33.
Stead WW, Lorenzi NM. Health informatics: linking investment to value. J Am Med Inform Assoc. 1999;6:341–8.
Simpson RL. Managing the three “P”s to improve patient safety: nursing administration’s role in managing information technology. Int J Med Inf. 2004;73:559–61.
Hendy J, Reeves BC, Fulop N, Hutchings A, Masseria C. Challenges to implementing the national programme for information technology (NPfIT): a qualitative study. BMJ. 2005;331:331–6.
McAlearney AS, Schweikhart SB, Medow MA. Organizational and physician perspectives about facilitating handheld computer use in clinical practice: results of a cross-site qualitative study. J Am Med Inform Assoc. 2005;12:568–75.
Saleem JJ, Patterson ES, Militello L, Render ML, Orshansky G, Asch SM. Exploring barriers and facilitators to the use of computerized clinical reminders. J Am Med Inform Assoc. 2005;12:438–47.
Finch E, Mayne C. Thinking beyond CPOE to integrated IT strategy and management. J Healthc Inf Manag. 2004;18:24–9.
Major LF, Turner MG. Assessing the information management requirements for behavioral health providers. J Healthc Manag. 2003;48:323–33.
Stablein D, Welebob E, Johnson E, Metzger J, Burgess R, Classen DC. Understanding hospital readiness for computerized physician order entry. Jt Comm J Qual Saf. 2003;29:336–44.
Lenz R, Kuhn KA. Towards a continuous evolution and adaptation of information systems in healthcare. Int J Med Inform. 2004;73:75–89.
McDonald CJ, Overhage JM, Tierney WM, et al. The regenstrief medical record system: a quarter century experience. Int J Med Inform. 1999;54:225–53.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors appreciate comments on the draft white paper from Denise Hynes, RN, PhD, and discussion of the issues surrounding it by experts at the Veterans Health Administration (VHA) State-of-The-Art Conference: “Attributes of an Ideal Integrated Informatics System that Supports Implementation of Evidence,” VHA State of the Art Conference (SOTA) VII, Implementing the Evidence: Transforming Practices, Systems, and Organizations, Washington, DC, August 2004. Responsibility for the positions outlined in the manuscript reside with the authors.
Rights and permissions
About this article
Cite this article
Doebbeling, B.N., Chou, A.F. & Tierney, W.M. Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice. J Gen Intern Med 21 (Suppl 2), S50–S57 (2006). https://doi.org/10.1007/s11606-006-0275-9
Issue Date:
DOI: https://doi.org/10.1007/s11606-006-0275-9