Pediatric Informatics: Computer Applications in Child Health (Health ...

234 M.G. Leu et al.
Table 17.1 Motivations for and challenges to adoption of health IT
Motivations
Improved quality of care
Reduced cost of care
Administrative efficiencies
Savings from clinical redesign
Increased revenue and productivity
Challenges
Organizational factors
Requires executive leadership, support, and sponsorship
Practice must be receptive to change
Clinical processes must work before they can be automated with health IT
Education, training, and retraining of staff; support infrastructure
Cost
Large capital outlay with significant up front and ongoing costs
Uncertain or slow recovery of initial investment
Practices face risk, but cost savings realized by payors
Expertise
Requires significant technical infrastructure and IT expertise
Vendor evaluation and partnerships
17.2.1 Improving Quality
In the landmark report To Err is Human, 2 the Institute of Medicine (IOM) noted that
“tens of thousands of Americans die each year from errors in their care, and hundreds of
thousands suffer or barely escape from nonfatal injuries.” Subsequent reports revealed
that adults receive only 54.9% of recommended preventive services, and that children
receive only 46.5% of indicated care. 3,4 Other reports demonstrate regional variability
in care, and suggest that there is also variability in ambulatory care settings. 5
Quality care is defined as care that is safe, effective, patient-centered, timely,
efficient, and equitable (Table 17.2). 6,7 Systemic change has been recommended
to improve quality. 7 According to the IOM, this change requires transformation of
microsystems (patient populations, care provider teams, health information systems,
and work processes) using the principles of quality as targets, guided by three
high level philosophies and ten strategies (Table 17.3). 6,7
To implement these strategies, the health care industry has incorporated ideas and
lessons learned from other industries (such as aviation and manufacturing) to create
resilient approaches to planning and process redesign. Included in these approaches
are: focus on proactive and anticipatory problem-solving, creation of learning organizations,
engagement of all levels in process improvement, creating a culture which values
safety, and mitigation of system-based vulnerabilities that induce human error. 8
Health IT can be used to standardize communication and to coordinate information
flow throughout an organization, while simultaneously capturing transaction records.
Information captured and stored in these systems is in itself a valuable resource for
analyzing organizational and individual performance, tracking errors and providing