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PROLOGUEOrganizing, Delivering, And Paying For Health IT SystemsIt’s easy to understand how health information technology (IT) can help individuals; for example, imagine tapping a few keys to access the family personal health record (PHR) for those immunization records required by camps and schools. But the authors of the papers in this section argue that the major benefits will be achieved only when systems become widespread and interlinked and when they capture ever more important data in areas such as quality of care. There are many obstacles in the way, they argue, but also much potential for improvement. Especially important will be investing in the infrastructure that will support and integrate health IT systems, and training the people who will run them. Papers by Carol Diamond, James Walker, and Carolyn Clancy and their colleagues scan the current health IT horizon and see the pronounced need for change. Diamond proposes linking existing health IT systems to gather better data on health at the population level—then feeding those data back to policymakers and care delivery systems that can chart a path toward public health improvement. Walker urges a move away from today’s "task-focused" health IT systems, designed in part to make sure clinicians perform a checklist of interventions for patients. Much better, he says, would be IT systems in which data on a patient’s health status triggered a group effort among clinicians to coordinate care for the patient. Clancy makes a pitch to tie health IT investments to health reform goals—in particular, by compiling data on health care quality and outcomes and by benchmarking improvements. Papers by Julia Adler-Milstein, Lisa Kern, and Robert Miller and their colleagues survey state and regional efforts to build health IT that have produced mixed results. For the most part, the regional health information organizations (RHIOs), encouraged by the federal and some state governments, are struggling to keep going—largely because of concerns surrounding financial sustainability. New York’s State’s major investment in building health IT systems may pay off, but the jury is still out. In California, writes Miller, efforts to pay for clinical information systems have revealed that major public commitments will be needed to get health IT systems into safety-net providers and poorer hospitals. Without an explicit effort to level the playing field, only better-off institutions will be able to afford the investment. That could well exacerbate health care disparities between more affluent populations and the poor and underserved.
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