| | Statement of Janet Marchibroda, Chief Executive Officer, eHealth Initiative Testimony Before the Subcommittee on Health
of the House Committee on Ways and Means June 17, 2004 Madame Chairwoman Johnson, Congressman Stark, distinguished
members of the Subcommittee, I am honored to be here today to testify before
you on the role of information technology in improving quality, safety and
efficiency in healthcare. My name is Janet Marchibroda. I am testifying today
on behalf of the eHealth Initiative and serve as its Chief Executive Officer. I
am also Executive Director of the Foundation for eHealth Initiative. Both are Washington, D.C.-based national non-profit
organizations whose missions are the same: to improve the quality, safety and
efficiency of health and healthcare through information and information
technology. The eHealth Initiative’s membership includes clinicians, employers,
health plans, healthcare IT suppliers, hospitals and other healthcare
providers, consumer groups, pharmaceutical and medical device manufacturers,
public health organizations, standards bodies, and academic institutions that have
interests in improving healthcare through information technology. I also serve
as the Executive Director of Connecting for Health, a public-private sector
collaborative established by the Markle Foundation which receives additional
funding and support from the Robert Wood Johnson Foundation that is designed to
address the barriers to development of an interconnected health information
infrastructure.
In my remarks today, I will share some information and
observations about what we believe are the key challenges to improving
healthcare in America, information technology’s role in addressing those
challenges, the current state of the healthcare system as it relates to
information technology adoption, the key barriers the system is facing in
achieving progress, and strategies that both the public and private sectors can
employ to promote the usage of information technology to support better health
and healthcare.
Challenges Within the U.S. Healthcare
System
There is a looming healthcare crisis in our country. As
Americans we are faced with an aging population, healthcare cost increases,
dissatisfied clinicians abandoning the practice of medicine, a shortage of
nurses, access problems created by lack of health insurance coverage, and baby
boomers demanding greater accountability.
By 2030, one in five Americans will be over 65 years of age,
consuming a larger portion of our healthcare resources. And with rising
healthcare costs continuing to drive up health insurance premiums (2002 premium
increases averaged 12.7 percent), healthcare purchasers are finding themselves
choosing between wage increases or higher subsidies for health insurance. The
rate of healthcare inflation is at an all-time 12-year high, at eight times the
general inflation rate.
Clinicians also are facing rising insurance premiums, but of
another sort: malpractice rates. Many are leaving medical practice due to
escalating premiums and the increasing challenges of an overly complicated
healthcare system. And clinicians are not the only ones in the healthcare
sector facing challenges. Nurses are becoming scarcer, with a current shortfall
of approximately 400,000 nurses nationwide. Thirty states had a shortage of
registered nurses in 2000, and 44 states and the District of Columbia are
expected to have a shortage in 2020.
Access problems are further complicated by those lacking
appropriate healthcare coverage. Today, 15.8 percent of the U.S. population is
not covered by health insurance. This leaves close to 44 million Americans
without financial coverage for major medical emergencies and access to needed
medical care on an ongoing basis.
The Institute of Medicine (IOM) and other highly regarded
organizations have published a great deal of information regarding the patient
safety challenges currently experienced in our healthcare system. According to
the IOM, medical errors in hospitals kill an estimated 44,000 to 98,000 people
per year — more than those that die in motor vehicle accidents (43,458), or
from breast cancer (42,297). Adverse events occur in up to 3.7 percent of
hospitalizations, with up to 13.6 percent of them leading to death.[1]
Studies show that adverse drug events occur in 5 to 18 percent of ambulatory
patients[2].
In a 2001 Robert Wood Johnson survey, 95 percent of doctors, 89 percent of
nurses and 82 percent of healthcare executives said that they have witnessed
serious medical errors. Forty-seven percent of patients surveyed in 2000 by
AHRQ and the Kaiser Family Foundation say they are concerned about experiencing
a medical error. In many cases, physicians do not know what drugs a patient is
currently taking because of the lack of information technology and
connectivity.
There are also opportunities for
improvement in the quality of care that is delivered. A June 26, 2003 report in the
New England Journal of Medicine documents the appropriateness of
treatment for 7,528 adults. Their research revealed that American adults, on
average, receive only a little more than half (54.9 percent) of the healthcare
measures recommended for their conditions — and the lead author pointed to the
need for "a major overhaul of our current health information
systems" as a key step to fix the problem.[3]
Finally, in addition to challenges in the healthcare
delivery system, the U.S. is experiencing challenges in the public health
system. Recent threats including those related to SARS and West Nile Virus, as
well as the terrorist acts of September 11, 2001 underscore the vital
significance of disease surveillance in protecting the public from natural and
unnatural outbreaks.
As Americans we are at a place where there is a real social,
political and economic crisis requiring a new kind of thinking about how we
should manage and deliver healthcare. The evidence is clear and compelling that
the way we delivered care before will not fit the way the world is now. We have
to become more efficient and effective, and information technology can play a
critical role in addressing these challenges.
The Role of Information Technology in Addressing
Healthcare Challenges
According to the IOM’s report—Crossing the Quality Chasm,
“If we want safer, higher quality care, we will need to have redesigned systems
of care, including the use of information technology to support clinical and
administrative processes…the current care systems cannot do the job. Trying
harder will not work. Changing systems of care will.”
The U.S. healthcare system,
representing approximately $1.4 trillion or 14 percent of the nation’s gross
domestic product, is highly fragmented, with information stored in a variety of
formats (often paper-based) which in most cases are not connected. Each
healthcare entity, public and private —clinicians, hospitals, insurers,
researchers—gathers and holds its own information, most often in paper form. In
an electronic information age when vital data can be transferred electronically
at the speed of light, only a fraction of healthcare data is accessed and
transferred digitally. More than 90 percent of the estimated 30 billion
healthcare transactions in the United States each year are still conducted by phone, fax or mail.[4]
As a result, the information
that is needed to support the care of patients is not available when it is
needed and where it is needed to support both clinical decision-making and
patients as they navigate our complicated healthcare system. The absence of
readily available, comprehensive, patient-centric health information and ready
access to clinical knowledge negatively affects healthcare at every level.
Clinicians sometimes are forced
to approach patient care with incomplete information about a patient and
without point-of-care access to the multitude of clinical decision support
guidelines that are available to guide them. The volume and complexity of these
guidelines is growing so fast that they cannot be accessed effectively without
the use of information technology. As a result, clinicians may unnecessarily
repeat tests, call for unnecessary hospital stays, or advise ineffective (or sometimes
dangerous) treatments. Research shows that physicians spend and
estimated 20% to 30% of their time searching and organizing information. And in fact, today, 10 to 81 percent of the time,
physicians do not find patient information they need in a paper-based medical
record.[5]
This can lead to duplication of lab tests and other medical services, delays in
treatment, and the increased risk of medication errors.
In addition, researchers and
public health officials do not have ready access to aggregate data to track
diseases or measure the effectiveness of treatments. Patients cannot easily
view their own health records or transfer their own health information from
clinician to clinician. Businesses cannot measure the effectiveness of
clinicians or health systems in delivering safe, quality care.
There is now clear and compelling evidence that information
technology will indeed help to improve the quality, safety and efficiency of
our Nation’s healthcare system.
A recent study from the Center for Information Technology
Leadership indicates that we can achieve $44 billion in savings annually in
reduced medication, radiology, laboratory, and hospitalization expenditures
from 100 percent adoption of Computerized Provider Order Entry (CPOE) in the
ambulatory care environment. A more recent study indicates that standardized
healthcare information exchange among healthcare IT systems would deliver national
savings of $86.8 billion annually after full implementation and would result in
significant direct financial benefits for providers and other stakeholders.
According to the CITL CPOE data, more than two million
adverse drug events and 190,000 hospitalizations per year could be prevented
using IT.[6]
Further, evidence from Brigham & Women’s Hospital concluded that through
use of CPOE, error rates were reduced by 55 percent, from 10.7 to 4.9 per 1,000
patient days.[7]
A recent study of intensive care patients by Kaiser Permanente found that when
physicians used a CPOE system, incidents of allergic drug reactions and
excessive drug dosages dropped by 75 percent, and the average time spent in the
intensive care unit dropped from 4.9 days to 2.7 days, reducing costs by 25
percent.[8]
Current Levels of Information Technology Adoption
Despite evidence of the quality, safety and efficiency
improvements that can be achieved through the use of information technology,
adoption rates continue to be low. More than 90 percent of the estimated 30
billion health transactions each year are conducted by phone, fax or mail.[9]
Forty percent of surveyed healthcare organizations planned to spend 1.5 percent
or less of their total operating budgets last year on IT, and 36 percent set
spending at 2 to 4 percent.[10]
This compares to an average IT investment of 8.5 percent in other industries.[11]
It appears that the organizations and individuals who are
taking the lead in the adoption of information technology are the ones who truly
believe that healthcare information technology can save money and improve
healthcare quality, safety and efficiency as well as those who have been able
to offset those investments through grant programs. Those who have been the
slowest adopters are those who have had limited access to capital, and those
who have not had ongoing financial incentives to support their adoption.
On the individual practitioner level, only 5 to 10 percent
of physicians use electronic medical records in their practices. And in the electronic
prescribing area —some research shows that less than 5 percent of U.S.
physicians currently “write” prescriptions electronically.[12]
At the facility level, while 13 to 15 percent of hospitals
have implemented some form of computerized medication order entry, physicians
in these organizations enter less than 25 percent of their orders using the
system.[13]
Demand is Emerging from Clinicians and Consumers
It is clear that demand for information technology adoption is
now emerging from clinicians and consumers. Recent activities related to
information technology by groups such as the American Academy of Family
Physicians, the American College of Physicians, and the American Medical
Association serve as a signal of this increased interest. In fact, a recent
Medical Group Management Association (MGMA) study indicates that 22.8 percent
of respondents thought that use of the electronic medical record (EMR) would
result in decreased costs, and 31 percent believed it would increase patient
satisfaction.
There is also increasing consumer demand for electronic
tools that will support navigation of the healthcare system. A study by
Jupiter Media Metrix showed that 54 percent of consumers were willing to
“switch” to a physician who would use e-mail to schedule appointments, renew
prescriptions, answer treatment questions and check lab reports. A 2003
Foundation for Accountability (FACCT) survey conducted as part of Connecting
for Health found that over 70 percent of consumers surveyed believed a personal
health record would improve quality of care. When respondents were asked about
having health information online, 71 percent said it would clarify doctor
instructions, 65 percent said it would prevent medical mistakes, 60 percent
said it would change the way they manage their health and 54 percent said it
would improve quality of care.[14]
Barriers to Information Technology Adoption
In discussions with stakeholders across the healthcare
system, including clinicians, hospitals, health plans, employers and healthcare
information technology suppliers—the following have emerged as the key barriers
to adoption:
- Lack of Standards and Interoperable Systems. The
lack of interoperable systems and data standards has often been cited as a
key barrier to adoption. According to a 2002 survey conducted by the
Medical Records Institute, clinicians across a variety of settings
identified “difficulty in finding an electronic medical record solution
that is not fragmented over several vendors or IT platforms” as a top
barrier.[15]
While some gains could be achieved through the adoption of electronic
health records across the healthcare system, the real value—particularly
within clinician offices--expressed in terms of quality, safety, and
efficiency will only be achieved if such systems are interoperable and
electronic connectivity is achieved, so that clinicians have key
information--such as that related to laboratory tests and
prescriptions—when and where it is needed—at the point of care.
- Lack of Upfront Funding and Misalignment of Incentives.
Practicing clinicians, hospitals and other healthcare providers often cite the
lack of upfront funding and business models to support ongoing usage as key
barriers to adoption. In addition, emerging research indicates that there is a
misalignment between those who pay for the implementation and ongoing usage of
information technology and those who benefit from its usage. Under the current
healthcare system, benefits related to the gains in quality, safety, and
efficiency are spread across all stakeholders while the real costs are borne by
only a few. Incentives must be realigned to facilitate the exchange and
sharing of data and information across and between organization, institutions,
providers, and payers. In a survey of provider CEOs, 25 percent cited lack of
financial support as a barrier, while 17 percent cited the need to provide
quantifiable benefits or return on investment as the greatest barrier.[16]
A recent survey of 5,000 family physicians conducted by the American Academy of
Family Physicians found that 60.5 percent cited affordability as a barrier to
adopting electronic medical records.
- Organizational Change Issues. A recent survey of
5,000 family physicians conducted by the American Academy of Family
Physicians found that 54.2 percent cited worries about slower workflow or
lower productivity.[17]
This has been confirmed through several meetings and discussions with
practicing clinicians across the country.
- Need for Leadership. In order to drive
transformational change, leadership is needed from both the public
sector—both at the federal and state level--and every segment of the
private sector--including clinicians, hospitals, laboratories, payers,
employers and other healthcare purchasers, manufacturers of pharmaceutical
and medical devices, public health agencies, and those who build and
implement information technology.
Public and Private Sector Strategies for Addressing
Barriers
There is a great deal of work going on in both the public
and private sectors to overcome the barriers identified above to drive
improvements in the quality, safety and efficiency through the use of
information technology but clearly more work still needs to be done.
The eHealth Initiative and its Foundation and key
initiatives such as Connecting for Health, have taken an active role in
advancing the development and implementation of policies and practical
strategies by key stakeholders across the healthcare system to promote a
healthcare system that mobilizes information to support patients through
electronic connectivity and the use of standards-based, interoperable
information systems. The following summarizes key steps taken by our
organization, the public sector and several other private sector organizations
that are moving us towards an interoperable, electronic healthcare system.
Standards and Interoperable Systems
Many influential groups have made great strides in both the
development and adoption of standards to support a higher quality, safer and
more efficient healthcare system enabled by information technology. Within
government, the Consolidated Health Informatics Initiative has played an
integral role in gaining consensus on the data standards that the Federal
government will use in its own operations. The National Committee on Vital and
Health Statistics has played a critical role by providing ongoing advice and
counsel to the Secretary of the Department of Health and Human Services
regarding the standards that should be adopted to promote an interoperable,
electronic healthcare system.
Through Connecting for Health, a public-private sector
collaborative in which the Foundation for eHealth Initiative is involved,
leaders across every sector of healthcare achieved consensus on a first set of
data standards that should be adopted by our healthcare system, which played a
considerable role in moving this work forward. Connecting for Health is
extending this work further in its second phase, through the development of
recommendations which address technical architecture, applications and
standards to support electronic connectivity and IT adoption.
The eHealth Initiative and its Foundation have played an
integral role in promoting standards adoption. Through our Public-Private
Sector Collaborative for Public Health, we developed strategies and practices
for transmitting data electronically—using standards—to support public health
surveillance processes. Our Connecting Communities for Better Health Program,
conducted in cooperation with with the U.S. Health Resources and Services
Administration (HRSA) is providing seed funding to nine multi-stakeholder
collaboratives within communities across the country who are using IT and
mobilizing information across institutions to support quality, safety,
efficiency and public health goals within their regions. One of the key
criteria for selection was the usage of standards in electronic data
transmission conducted as part of the project. These projects will be
announced to the public over the next month.
The Medicare Prescription Drug, Improvement and Modernization
Act of 2003 (MMA) provides critical provisions that will promote the
adoption of data standards, including the standards requirements included in
both the electronic prescription program and the “Medicare Care Management
Performance Demonstration” as well as the creation of the Commission on System
Interoperability which will develop a comprehensive strategy, timelines and
priorities for the adoption and implementation of healthcare information
technology standards. In addition to the MMA, H.R. 2915, the National Health
Information Infrastructure Act of 2003 also provides critical provisions that
will facilitate the adoption of standards to promote interoperability. The
eHealth Initiative supports this bill and commends Chairwoman Johnson for her leadership.
In order to build upon the current momentum for standards
development and more importantly—adoption of existing standards, activity
should continue on the current trajectory. The Federal Government should
continue to play a strong role in the development and adoption of standards
within its own programs. It should provide incentives to the private sector to
promote the usage of such standards, and it should work closely with the
private sector in establishing consensus on the standards that should be
adopted.
To accelerate the adoption of information technology
adoption and an interoperable healthcare system, demonstration projects should
be conducted—ideally through public-private sector partnerships—to test and
evaluate standards and specifications related to data, technical architecture,
applications and security—so that lessons learned and various tools and
resources can be shared with other communities across the country who are
adopting information technology and engaging in health information exchange
activities.
Lack of Upfront Funding and Misalignment of Incentives
Progress on addressing the second key barrier—financing—has
lagged behind the significant work around data standards and interoperable
systems, despite the demand from both healthcare communities and stakeholders
across the country.
The Agency for Healthcare Research and Quality’s $50 million
Health Information Technology grant program received an unprecedented amount of
interest from hundreds and hundreds of providers and other healthcare
stakeholders interested in grant funding to support both planning and
implementation of information technology-related projects. In response to a
request for proposal sent out by the Foundation for eHealth Initiative as part
of its Connecting Communities for Better Health program conducted in
cooperation with HRSA, proposals came in from 134 communities representing 42
states plus the District of Columbia, who were interested in implementing
information technology and sharing clinical data electronically across at least
three stakeholder groups, and who had secured matched funding to support this
work. The response from both of these programs indicates that communities
across America, and the healthcare leaders who reside within them, are ready to
move towards an interoperable, electronic healthcare system, but will need help
in getting there. Our dialogue with several of these communities indicates
that, while the creation of these programs has stimulated a great deal of
interest and in many cases, has created the impetus for a multi-stakeholder
consortium of leaders to take this work forward—that efforts will be hampered
by the lack of capital required to get this work off the ground.
A small number of pilot projects are emerging that are
driven by both employer-purchasers and health plans that provide incentives to
clinicians, hospitals and other healthcare providers who are using information
technology to deliver higher quality healthcare. The Bridges to Excellence
Program is one example of an initiative that is developing and evaluating
reimbursement models that encourage the recognition of healthcare providers who
demonstrate that they have implemented comprehensive solutions in the
management of patients and deliver safe, timely, effective, efficient,
equitable and patient-centered care which is based on adherence to quality
guidelines and outcomes achievement. Adoption of health information
technology, with special emphasis on fully functional electronic medical record
systems, equipped with electronic prescribing modules and robust clinical
decision support, is being targeted for rewards. Physician practices will be
able to earn up to $20,000 per physician per practice for adopting these
systems.
In addition, the MMA provisions related to a “Medicare Care
Management Performance Demonstration” in Section 649, offer a valuable set of
learning laboratories for testing and evaluating the impact of providing
information technology to physicians on quality, safety and efficiency.
It is imperative that these demonstrations be closely coordinated with private
sector initiatives such as Bridges to Excellence, where possible, to coordinate
market experiments.
Finally, the chronic care provisions included in the MMA offer
an excellent opportunity to support movement towards an electronic healthcare
system by rewarding those applications that leverage integrative information
infrastructures, new applications of information and communication
technologies, expert clinical systems that incorporate evidence-based
guidelines for multiple conditions, and predictive modeling capabilities to
support their operations.
In order to continue to move towards an electronic health
information infrastructure and the adoption of health information technology,
it is critical that policy options that both align incentives and provide
federal investment be developed and implemented. These activities will not only
accelerate movement, they will also serve to stimulate private sector
innovation and investment in these activities. Current and emerging Federal
programs should be leveraged to test and evaluate these policy options.
Organizational Change
A number of initiatives have emerged--primarily in the
private sector—to address organizational change issues and facilitate the
migration towards an interoperable, electronic healthcare system. Successful
adoption of electronic application depends upon the ease and speed with which
the clinician can use it, as much as the value that it provides for quality,
safety, and cost. It is affected by a number of factors including how well the
system supports the specific workflows present within a clinician’s office, and
the specific features that the system provides to improve speed and efficiency.
While the effective implementation of information technology ultimately
improves outcomes and results in efficiency gains, migrating to a new system
takes time and resources, and achieving full return on investment takes time. Because
of the changes in care delivery and clinical care processes that are necessary
in order to migrate towards the use of electronic systems, the provision of
financial and other incentives designed to promote their usage are critical.
To provide support to providers who are undergoing this
transition, organizations such as AMIA and HIMSS are developing resources and educational
materials that will help clinicians, hospitals and other healthcare providers
effectively implement information systems. In addition, the eHealth Initiative
and its Foundation have contributed to the field in two key areas. Through our
Electronic Prescribing Initiative, the eHealth Initiative engaged more than 70
national experts and key stakeholders across every sector of healthcare and the
prescribing chain to develop design, implementation and incentives
recommendations that will facilitate the effective and rapid adoption of
electronic prescribing in the ambulatory environment. Representatives from
hospitals, clinician groups, healthcare IT suppliers, patient and consumer organizations,
federal and state agencies, pharmaceutical manufacturing organizations,
pharmacy benefits management organizations, health plans, pharmacies, and
connectivity providers reached consensus on a set of recommendations related to
the levels of electronic prescribing and the benefits that accrue at each level
as well as detailed recommendations related usability, clinical decision
support, communication, standards and vocabularies, implementation, and incentives.
Through the Connecting Communities for Better Health
Program the Foundation for eHealth Initiative is obtaining critical input
from experts, “on-the-ground” implementers, and other key stakeholders to
develop resources and tools related to technical, financial, organizational,
and clinical challenge areas related to health information technology adoption
and the mobilization of information across organizations. These resources and
tools are being disseminated through our Community Learning Network and
Resource Center and meetings such as the June 2004 Connecting
Communities Learning Forum and Resource Exhibition, both of which provide
both a learning network and a resource to enable communities and healthcare
stakeholders to learn from national experts and each other, strategies for
addressing the challenges related to implementation of IT and a health
information infrastructure.
Private sector organizations will and should continue to
emerge to assist healthcare stakeholders as they migrate towards an electronic
healthcare system. The Federal government can play a critical role by
leveraging the work being conducted by private sector organizations and
collaborations in this area. This is also an area that would benefit from
public-private sector collaboration.
Leadership
A number of key actions taken by both the public and private
sectors have signaled a significant increase in the level of leadership around
healthcare information technology issues.
President Bush’s recent executive order, which establishes
the National Health Information Technology Coordinator position and calls on
Federal leaders—within ninety days—to provide options to provide incentives to
promote adoption of interoperable health information technology will play a
critical role in helping to spur adoption of information technology within the
healthcare system. The work of Dr. David Brailer—the new National Health
Information Technology Coordinator—including that which is related to
developing and implementing a strategic plan; advancing standards through
collaboration with the private sector and evaluating benefits and costs of
IT—will also be very important to stimulate cooperation within the public
sector and collaboration related to these issues across both the public and
private sectors.
Connecting for Health, a public-private sector collaborative
has also taken several steps to move us towards an interoperable healthcare
system, including gaining consensus among diverse stakeholders across both the
public and private sectors on an initial set of “adoption-ready” data
standards; developing a high-level value proposition for interoperability and a
framework for migration; and identifying the high-level characteristics of the
personal health record and survey on consumer attitudes. Over the next month,
an incremental Roadmap for achieving electronic connectivity will be released
by Connecting for Health which is designed to articulate the near-term actions
that should be undertaken by both the public and private sectors to get to an
electronic health information infrastructure. In addition, over the next few
months, several recommendations which have been vetted by both the public and
private sectors, which address a wide range of issues related to adoption of
interoperable information systems will be released.
Conclusion
In conclusion, healthcare information technology holds great
promise for helping our Nation address its healthcare challenges. Evidence has
shown that the effective implementation of information technology and the
mobilization of information across organizations can result in significant
improvements in healthcare quality, safety and efficiency and can also serve to
protect and improve public health.
But there are many barriers to the adoption of information
technology and electronic connectivity, including those related to leadership,
financing, standards and organizational change. It is imperative that we build
upon the work being conducted by both the public and private sectors and the
public-private sector partnerships that have emerged—to continue to drive the
change that it necessary to help us achieve our vision of an electronic
healthcare system that will lead to better health and healthcare for all Americans.
Madame Chairwoman Johnson, Congressman Stark, distinguished
members of the Subcommittee, thank you again for inviting me to discuss our
perspectives on the role of information technology in addressing our healthcare
challenges, the barriers that impede its adoption, and the strategies that can
be employed to overcome these barriers. We at the eHealth Initiative are
committed to working with both the public and private sectors to make our
vision of an improved healthcare system enabled by information technology and
electronic connectivity a reality. We commend you and your Committee for the
work that you have done to improve the quality, safety and efficiency of
healthcare for patients through information technology. Your introduction of
H.R. 2915, to accelerate the creation of a National Health Information
Infrastructure, along with the inclusion of several important information
technology provisions in the Medicare Prescription Drug, Improvement and
Modernization Act of 2003 (MMA), and of course this hearing today all serve
to improve our nation’s healthcare system through information technology.
Again, thank you for this opportunity and I look forward to answering any
questions you may have.
[1]To Err Is Human: Building a
Safer Health System, Institute of Medicine, 2000
[2]
Leape LL, Bates DW, Cullen DJ, Cooper J, Demonaco HJ, Gallivan T, et al.
Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA.
1995;274: 35-43.
[3] From a June 26,
2003 report in USA Today, “50/50 chance
of proper health care,” by Rita Rubin.
[4]
Michael Menduno, “apothecary.now,” Hospitals and Health Networks, July 1999,
35-36
[5]Clinical Information:
Achieving the Vision, 2002; Kaiser Permanente
[6]
The Value of Computerized Provider Order Entry
in Ambulatory Settings, Center for Information Technology Leadership, 2003
[7] Bates et al., JAMA, October 1998
[8] Clinical Information: Achieving the Vision, 2002;
Kaiser Permanente
[9] Michael Menduno, “apothecary.now,” Hospitals and
Health Networks, July 1999, 35-36
[10] An info-tech disconnect, Modern Healthcare, February 10, 2003
[11] InformationWeek Research's Evolving IT Priorities
2002 and 2003
[12] “A call to Action: Eliminate Handwritten
Prescriptions Within 3 Years!” Institute for Safe Medical Practices.
http://www.ismp.org/msaarticles/whitepaper.html.
[13] American Society of Health-System Pharmacists Study.
[14] Connecting for Health. The Personal Health Working
Group Final Report: July 2003, p. 5.
[15] The Medical Records Institute and SNOMED. Fourth
Annual MRI Survey of Electronic Health Record Trends and Usage. 2002.
[16] Healthcare Information and Management Systems Society
and Superior Consultant Company, 14th Annual HIMSS Leadership Survey. 2003.
[17] Ibid. | |
