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Report aims to reboot health care IT.

A NEW REPORT FROM THE NAtional Research Council of the National Academies casts a critical eye on US health care information technology (IT). The report warns that “current efforts aimed at nationwide deployment of health care IT will not be sufficient to achieve the vision of 21st century health care and may even set back the cause if these efforts continue wholly without change from their present course.” The report, Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions (prepublication copy available at http: //www.nlm.nih.gov/pubs/reports /comptech_prepub.pdf), recommends that those implementing health care IT should concentrate not on simply accelerating existing efforts, but rather on using health care IT to improve health care quality. The document is the culmination of 2 years of site visits to academic health centers nationwide and numerous interviews with health care professionals by a committee of computer science and health informatics experts and representatives from the private sector. The report provides recommendations for the government, organizations of health care professionals, researchers, and vendors. William Stead, MD, director of the Informatics Center at Vanderbilt University Medical Center, chaired the committee. Stead said that when the Institute of Medicine (IOM) published two reports on improving the quality and safety of health care (To Err Is Human [1999] and Crossing the Quality Chasm [2001]), many people assumed the problems identified in those reports could be solved by implementing available IT systems. Stead and like-minded colleagues, who thought the situation was more complex than an application problem and involved deeper scientific issues, engaged the computer science community in solving the unique problems of the health care environment. “Our goal was basically to put these experts inside a working [health center] system, to let them see what sort of IT systems were actually deployed and contrast that to what would be needed to achieve the IOM’s vision, and then let them determine what needed to be done in the short term and what were the grand projects for the long term,” he explained. The report includes a number of principles to guide governmental policy on health care IT. Ideas for making progress in the short term include seeking incremental gain from incremental effort. This means that when a site plans to implement a technology, it must make explicit the improvement it expects and how it plans to measure the improvement, said Stead. Another short-term goal is to “rebalance” the portfolio of IT efforts, which have been focused almost solely on automation. This redistribution would shift energy to three other IT domains— connectivity, decision support, and data mining—that receive much less attention, said Stead. But the committee’s major criticism is that current health care IT systems don’t provide cognitive support for clinical decision making. Redressing this lack is the “grand challenge” of the report. What is needed, said Stead, are systems that help clinicians make treatment decisions, as well as tools to help patients and their families better understand disease conditions. “Right now the IT systems we have in use are essentially transactional systems that support actions such as ordering a lab test or documenting the administration of a medication, rather than cognitive support systems that help clinicians sort through data to think more clearly about critical health care decisions,” said Ida Sim, MD, PhD, director of the Center for Clinical and Translational Informatics at the University of California, San Francisco, and the one practicing physician on the committee. Sim also emphasized the need for the academic medical community to recognize the importance of pursuing fundamental research into the development of cognitive support systems for health care. Given President Obama’s pledge to spend $50 billion on health care IT as part of the economic recovery package, Sim noted that she would like to see the perspective put forth in the report— one that she calls an “intellectually