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Employing health information technology in the real world to transform delivery.

OBJECTIVES
Strong leadership and a supportive culture are critical to effective organizational transformation, but organizations pursuing change also need the infrastructure and tools to do so effectively. As policy makers seek to transform healthcare systems-specifically the delivery of care-we explore the real-world connection between health information technology (HIT) and the transformation of care delivery.


STUDY DESIGN AND METHODS
This study is based on interviews with diverse federal and health system leaders and federal officials. The work was funded by the Office of the National Coordinator for Health Information Technology as part of a global assessment of the Health Information Technology for Economic and Clinical Health Act.


RESULTS
The functionalities supported by HIT are integral to creating the information flow required for innovations such as medical homes, accountable care organizations, and bundled payment. However, such functionalities require much more than the presence of electronic health records; the data must also be liquid, integrated into the work flow, and used for analysis. Even in advanced systems, it takes years to create HIT infrastructure. Building this infrastructure and transforming delivery simultaneously is difficult, although probably unavoidable, for most providers. Progress will likely be slow and will require creative strategies that take into account the real-world environment of organizations and communities.


CONCLUSIONS
While the rapid transformation of delivery and infrastructure is appealing, both types of change will take time and will progress unevenly across the nation. Policy makers serious about transforming the delivery of healthcare can benefit by recognizing these realities and developing practical strategies to deal with them over a relatively long period of time.