Modern information systems are a boon to both patients and physicians. Patient registries, for instance, can track whether people with conditions like diabetes or asthma are getting recommended follow-up care or if their conditions are well controlled. Decision-support systems can help physicians make diagnostic and treatment decisions, in some cases bringing patients into critical medical decisions. Information systems can also improve the efficiency of care, improve appointment scheduling, facilitate medication refills, and eliminate duplication of tests.

The health sector has been very slow to embrace information technology, despite wide recognition that it is very difficult to provide safe, high-quality, responsive care without ready access to good information. The greatest barrier to adoption has been cost—and unless financial incentives are provided, progress is likely to continue to be slow.

To encourage speedier implementation, private insurers may need to establish differential payments for providers with and without appropriate technology. Public programs could also use their leverage to accelerate change—as happened in 2003, for example, when the Medicare program implemented a new requirement that almost all doctors submit their claims electronically.

Two current Fund-supported projects are showing results in managing high-cost conditions. In one, advanced practice nurses are providing post-hospital care, including home visits, to congestive heart failure patients enrolled in private Medicare managed care plans. Randomized control trials have demonstrated that the technique reduces re-hospitalization, and thus annual care costs, by one-third.⁽¹⁶⁾ The other is evaluating a home device called "Asthma Buddy" that monitors the daily condition of children with asthma. Pilot tests have demonstrated markedly reduced use of emergency rooms and hospitalization.⁽¹⁷⁾

Fund-supported evaluation of "business cases" for quality improvements suggest other new approaches, from pharmaceutical monitoring of cholesterol-reducing drugs⁽¹⁸⁾ to redesigning primary care to make it more accessible to low-income patients.⁽¹⁹⁾ Hospitals and nursing homes have also implemented innovations that help retain nursing staff.⁽²⁰⁾ Other strategies include hospital self-assessment of medication safety,⁽²¹⁾ prospective medication review of nursing home patients,⁽²²⁾ physician participation in risk management training,⁽²³⁾ and error reporting in a blame-free environment.⁽²⁴⁾ Many of the most promising techniques involve team-based approaches to care, in which physicians and other professionals coordinate tasks to get the job done efficiently and effectively.

Another factor that makes the U.S. health system so costly is our far greater use of specialist procedures, such as radiological imaging and cardiac procedures. Regional cost variations are mainly associated with use of discretionary, or "supply-sensitive" services.⁽²⁵⁾ Many patients undoubtedly benefit from those services and enjoy better health outcomes and quality of life, yet it is a serious shortcoming in our system that we have developed no agreed-upon criteria for when those services are appropriate, and for which patients.⁽²⁶⁾ Both the United Kingdom and Australia have established national institutes to develop criteria for utilization of specialized procedures and pharmaceuticals;⁽²⁷⁾ we need to pursue a similar strategy.

Tapping the potential to improve quality and enhance value will require investment in the infrastructure required for widespread change. The Medicare program supports state Quality Improvement Organizations, which are dedicated to improving care for Medicare patients. Their mandate could be expanded to cover quality of care for all patients. The federal government supports learning collaboratives to improve primary care and disease management in community health centers. The approach could be extended to all safety net providers, including public hospitals and low-income primary care clinics. The Agency for Healthcare Research and Quality (AHRQ) currently supports research on quality improvement, but an expanded mandate and budget could support much more extensive research on cost-effectiveness, elimination of waste, efficient practices, and team approaches to care. A three-year fellowship program at AHRQ could train a new cadre of quality improvement and patient safety officers, analogous to the epidemiological intelligence and surveillance officers at the Centers for Disease Control and Prevention.