Bates David W
Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
BMC Med Inform Decis Mak. 2002 Oct 23;2:7. doi: 10.1186/1472-6947-2-7.
As described in the Institute of Medicine's Crossing the Quality Chasm report, the quality of health care in the U.S. today leaves much to be desired.
One major opportunity for improving quality relates to increasing the use of information technology, or IT. Health care organizations currently invest less in IT than in any other information-intensive industry, and not surprisingly current systems are relatively primitive, compared with industries such as banking or aviation. Nonetheless, a number of organizations have demonstrated that quality can be substantially improved in a variety of ways if IT use is increased in ways that improve care. Specifically, computerization of processes that are error-prone and computerized decision support may substantially improve both efficiency and quality, as well as dramatically facilitate quality measurement. This report discusses the current levels of IT and quality in health care, how quality improvement and management are currently done, the evidence that more IT might be helpful, a vision of the future, and the barriers to getting there.
This report suggests that there are five key policy domains that need to be addressed: standards, incentives, security and confidentiality, professional involvement, and research, with financial incentives representing the single most important lever.
正如医学研究所的《跨越质量鸿沟》报告中所描述的,当今美国医疗保健的质量仍有很大的提升空间。
提高质量的一个主要机会与增加信息技术(IT)的使用有关。目前,医疗保健机构在IT方面的投资比任何其他信息密集型行业都要少,不出所料,与银行或航空等行业相比,当前的系统相对原始。尽管如此,一些机构已经证明,如果以改善医疗的方式增加IT的使用,质量可以通过多种方式得到大幅提高。具体而言,易出错流程的计算机化和计算机化决策支持可以显著提高效率和质量,还能极大地促进质量衡量。本报告讨论了医疗保健领域当前的IT水平和质量、目前质量改进和管理的方式、更多IT可能有益的证据、对未来的展望以及实现这一目标的障碍。
本报告表明,有五个关键政策领域需要解决:标准、激励措施、安全与保密、专业人员参与和研究,其中财务激励是最重要的单一杠杆。