Health IT Strategic Framework
Vision for Consumer-centric and Information-rich Health Care
The President has set an overarching vision for improving the quality, safety, and service of health care, and also for using health care resources more efficiently. This vision can be realized by making the health care industry consumer-centered and information rich, where information that is required for good decision making is available whenever and wherever care is provided. To do this, consumer information needs to follow the consumer. Basic information such as past medical history, laboratory results, radiographs, and current diagnoses, as well as history of medications and treatments, should all be available at the bedside or in the physician's office at the time of care. This information would be available to consumers and clinicians at the point of care whenever and wherever they need them and no matter where it was originally gathered. Sophisticated decision-support tools that help identify treatments that are best suited to a given patient would be available to help reduce unnecessary treatments and to ensure prevention procedures, both of which result in better outcomes. Medications would be ordered with computerized systems that eliminate handwriting errors and automatically check for doses that are too high or too low. Information tools would also search for harmful interactions with other drugs and for allergies. Prescriptions would be checked against the health plan's formulary, and the out-of-pocket costs of the prescribed drug would be compared with alternative medications. Patient information would be readily available for clinicians at the point of care and would help patients improve their own care.
This is a different way of delivering health care that which currently exists, but one that many have envisioned. In this health care system, everyone will benefit by:
Fewer medical errors. People being treated for an illness would not have to face the risk of being harmed by an error. The majority of medical errors would be prevented. Physicians and other authorized clinicians would be able to get up-to-date information on their patients and would have instant access to breaking news in science and research, and to medical guidelines for treatment. They would know which treatments are the most beneficial to their patients at the time they were making their clinical decisions. Overall, clinicians would be able to spend the majority of their time supporting and treating their patients, and not looking for information, waiting for returned phone calls, or facilitating administrative functions to deliver care.
Less variation in care. Consumers would be able to access and compare the quality of clinical services regardless of their geographic location, socioeconomic status, disease condition, or disability. This health care would be culturally sensitive, technologically advanced, and would emphasize timely access to specialists and enhanced clinical decision support so that no consumer or family would experience unnecessary delays in access to care.
Consumer-centered care. Consumers would have ready access to their personal medical information, as well as details on the cost, quality, and service ratings of the care they were receiving or seeking. This type of information would maximize consumer choice and involvement in health care and treatment decisions. Consumers would also be able to access their treatment information so that they could make better decisions and take more control over their health status, maintenance, and treatments. Patients could specify their treatment preferences and make these preferences readily available to authorized care providers.
Medical information moves with consumers. As they move from clinician to clinician, patients' information would move seamlessly with them. Clinicians would be optimally informed about their patients, and patient care would not be interrupted or compromised. This would reduce the need for duplicate tests and redundant orders, and eliminate clinical guesswork when a new patient receives treatment.
Care is delivered electronically as well as in person. As clinical practice enters into the information technology age, information should be available to clinicians whenever and wherever it is needed. Telemedicine should be used to enhance access to the best specialists when they are needed for a specific disease or treatment.
Medical records are protected from unauthorized access. An information-rich health care system will make information electronically available that can support treating patients, making information accessible for public health and research, and improving care for all. This information has been and will be safeguarded in order to prevent unauthorized access to personal health data and to prevent improper uses and disclosures of individually identifiable information. This information would then be used for quality improvement, health services, scientific and genomic research, biosurveillance and response, and disaster recovery activities.
Clinicians can spend more time on patient care. Clinicians should be able to focus on care delivery. Care delivery will be enriched by having the most relevant information - including up-to-date medical evidence - at the point of care. Clinicians and consumers will have more time together free of distractions such as searching for traditional paper records. The reporting that every clinician has to do should be accurate and timely, but also simple and automated. The data needed to conduct research on health care improvement, improve quality and efficiency, and monitor disease outbreaks should be available with little work and distraction to clinicians.
The steps that need to be taken across the nation are already under way in some places. In the past three years, many communities, hospitals, clinicians, and consumer groups have taken the initiative and demonstrated breakthroughs in improving the health care system. In these communities, even at this early stage, the process of health care is being modernized - and the experiences of both clinicians and consumers are better because of the changes. Here are some examples:
When arriving at a physician's office, a new patient does not have to enter his or her personal information, allergies, medications, or medical history, since this information is already available.
A father, who previously had to carry his chronically ill daughter's medical records and x-rays in a large box when seeing a new consultant, can now keep his daughter's important medical history on a key chain drive that plugs into a USB port on a computer.
Arriving at an emergency room, a senior citizen with chronic illness and memory difficulties authorizes her physicians to access her medical information from a recent hospitalization at another facility, thus avoiding a potentially fatal drug interaction between the planned treatment and the patient's current medications.
While at home, a physician receives a call from a worried mother about her infant son and can access, via a secure network, recent lab tests and x-rays online instantly, avoiding a trip to the emergency room.
While with a patient, a physician enters a prescription on a computer, where potential allergies and contraindications are shown immediately, and managed care authorization occurs instantly.
Clinicians in rural emergency departments routinely send radiology studies to university radiologists and receive telephone consultation regarding these studies within minutes.
Because of worsening angina, a senior citizen is being evaluated by her physician, who decision support to augment clinical decision making, and concludes that the patient's life expectancy would be safely extended by angioplasty.
At home, a senior citizen consults an online database of physicians to assist in choosing a physician to perform an angioplasty for her angina.
An intensive care specialist remotely monitors intensive care units in several different hospitals, providing coverage 24 hours a day, 7 days a week, reducing mortality, length of stay, and total cost of the ICU stay.
A small number of cases of an unusual, sudden-onset fever and cough are instantly reported to public health officials from area emergency rooms, alerting authorities of a possible disease outbreak.
A busy professional with a skin rash uses his health plan's consumer health portal to securely e-mail his clinician, who recommends that the patient schedule an appointment to be evaluated in person.
A soldier returning home from Iraq undergoes a standardized health assessment. This information is collected with a personal digital assistant device and sent electronically to a central database, where it will be available for review and ongoing care in the decades to come by DoD and VA medical providers.
Automation of the health care industry through widespread use of HIT is a unique means of improving quality and reducing costs at the same time. HIT is also critical to transforming how health care is delivered. It could allow a real market to develop that would reward innovations in care delivery, make the health care system more responsive to consumers, and involve consumers much more actively in their own health and health care.