President's Message
The Best Health System
in the World

1. What's Wrong: A Snapshot
2. Lessons from the Scorecard
3. What's Right: A Blueprint for Change

Printable version of this article
(18 pages)

5. Expand the Use of Information Technology
Case in Point: Rhode Island Information Exchange
Progress in improving health system performance will be difficult without widespread use of modern information technology. Electronic health records, decision support for physicians, computerized order entry systems, and patient access to their own medical information can help to reduce costs and improve safety and efficiency. Such systems are costly, and the benefits often accrue to insurers rather than providers who adopt such systems.
A Commonwealth Fund-supported set of case studies of smaller physician practices' adoption of electronic medical records found, however, that even in these settings providers can recover the capital costs of relatively simple systems in two to three years. Some health systems, such as Intermountain Health Care in Utah, Partners HealthCare in Boston, and Geisinger Health System in Pennsylvania, have used decision support systems to guide physicians in ordering expensive imaging tests or suggest lower-cost medications that might be suitable. Kaiser Permanente is rolling out a multi-billion-dollar integrated electronic medical and health information system that links clinical records with online patient information, the largest civilian EMR project in the U.S.
In order for the health system to maximize benefits from these individual systems, however, innovation must focus on more sophisticated applications and linking all pieces into an interoperable network. For example, if emergency room physicians have access to a patient's history, they may be able to avoid hospitalizing a patient or prescribing inappropriate medications.
A number of states, including New York and Rhode Island, are promoting an "interconnected" health information system. A Fund-supported evaluation of regional information systems in New York will evaluate the costs and benefits of such systems, as well as determine whether benefits accrue primarily to insurers and costs primarily to hospitals.
The Rhode Island Health Information Exchange (HIE) initiative is a public-private effort to allow providers, with their patients' permission, to electronically access important patient health information from a variety of sources. The sharing of data will be phased in, according to the following stages: 1) laboratory data; 2) medication histories; 3) emergency department and hospital discharge summaries, pathology reports, outpatient procedure records, and child health data; and 4) administrative data. The ultimate goals are to:
Give consumers access to their health information, and enable them to decide when and with whom they want to share it.
Use patient index functions to allow for unique identification of individual patients and locate where their health information is stored.
Present data from a variety of sources in an integrated, patient-centered manner using a com-mon interface, such as a portal or local platform.
Integrate data into electronic health record applications and support the exchange of these data with others, as permitted.
Provide decision-support capability.
Aggregate and utilize data for public health purposes, such as population-based analysis, quality improvement, evaluation, bio-surveillance, and research.(14)
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