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PROLOGUEThe Promises And Pitfalls Of Health Information TechnologySuccessful innovators leave no doubt that health information technology (IT) can have a dramatic impact on care, despite the challenges of implementation and adoption. The papers in the sections that follow describe efforts all along the continuum from large health care organizations to small independent physician practices. Catherine Chen and colleagues document how adoption in Hawaii of Kaiser Permanente’s new comprehensive electronic health record (EHR) system—complete with secure e-mail messaging and "e-visits" between physicians and patients—has reduced enrollees’ old-fashioned office visits for primary care by more than 25 percent in four years. Next, Anna-Lisa Silvestre and colleagues report survey results describing how Kaiser’s patients value the convenience of online appointment scheduling, e-mail contact with their doctors, and instant access to lab test results. Stephen Parente and colleagues report on EHRs’ impact on patient safety and find some evidence of positive effects. Farzad Mostashari and associates then describe state-backed efforts to implement health IT among independent physician practices in Massachusetts and New York City. Carleen Hawn’s Report from the Field on social media in health care focuses on how various organizations, physician practices, and patients are making growing use of these tools. Personal health records (PHRs)—either stand-alone or as patient-oriented complements to EHRs—have important potential in such areas as promoting better self-management for patients with chronic conditions. However, as James Kahn and colleagues report, PHRs are unlikely to fulfill their promise without improved health literacy and computer competency for many patients. Joy Grossman and colleagues describe how health insurers are developing and promoting PHRs but are also encountering lack of trust and privacy concerns among patients, providers, and payers. Medicare’s apparently sure-fire strategy of promoting electronic prescribing with payment incentives has hit snags as well, Maria Friedman and colleagues report. A comparison by Jos Aarts and Ross Koppel of efforts under way in the United States and six other industrialized countries to implement computerized physician order entry (CPOE) systems shows advantages—even though adoption is slow, systems are often poorly integrated, they’re producing new and different types of errors, and users are frequently frustrated.
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