National US health information infrastructure called for

The report outlines a plan to accelerate the development of data standards in three key areas: clinical terminologies, exchange of data among computers, and representation of medical information in computer programs.  It argues that a national set of standards would provide the foundations of a national network for widespread electronic sharing of health information.

"The lack of data standards is a key obstacle to the adoption of both electronic health records and data exchange systems," said committee vice chair Molly Joel Coye, CEO, Health Technology Center, San Francisco.

She added: "Physicians and other providers have hesitated to invest in data systems, reasonably so, knowing that their own medical record system might not be able to exchange important patient information with local pharmacies, hospitals, or even other physicians."

The group behind the IOM report argue that a national infrastructure for standardised data collection and exchange is needed because patients often receive services from many different providers. Routine use of EHRs would give both healthcare providers and patients immediate access to complete patient information as well as tools to guide decision-making and help prevent errors.

To kick start the processes it calls on the government to provide financial incentives to spur public-private sector development of electronic health record systems within the context of a national infrastructure and clear data standards.

While acknowledging that the plan would require ‘sizable investments’ to build the infrastructure, it stresses that the resulting tools and information “could yield significant benefits for other areas as well, including homeland security and public health”.

The key potential benefit identified is significant reductions in the numbers of avoidable medical errors.  “These systems should operate seamlessly as part of a national network of health information that is accessible by all health care organisations and that includes electronic records of patients’ care, secure platforms for the exchange of information among providers and patients, and data standards that will make health information uniform and understandable to all,” said the committee behind the report.

The IOM report, ‘Patient Safety: Achieving a New Standard of Care’ also calls for uniform formats and data standards for reporting medical errors and near-misses.  The report further recommends the development of a government database that collects data in aggregate from health providers about medical errors and near misses.

Recommendations for the US Federal government include investing in parts of the information infrastructure and providing financial incentives to promote private-sector development of EMRs.  Crucially the report says that government health care programs should encourage adoption of national data standards by including them in federal contracts and regulatory contracts.

While the government would set the standards for EMRs and other systems, it would not tell providers what products to buy. 

However, the report notes that adoption of standardised EMRs could rapidly become mandatory in all but name if electronic record keeping and participation in a nationwide information network become a condition of Medicare participation.  US government health care programs currently account for more than 40% of all health care expenditures

The group behind the report recommends that the US Congress authorise the Department of Health and Human Services to lead and fund a public-private partnership to develop and promote data standards.  The IOM estimates that such a program would take 10 years to achieve.

Developments over recent months suggest that the IOM may be pushing at an open door. Under the leadership of Tommy Thompson the US Department of Health and Human Services has already endorsed various data-messaging and other standards to help facilitate the sharing of clinical information within government health related agencies.  The Institute of Medicine report recommends that these existing initiatives should be accelerated.

IOM reports have no legal force but have in the past proved extremely influential.  Four years ago the IOM published “Crossing the Quality Chasm” which estimated that up to 98,0000 US patients annually die or are adversely effected by avoidable medical errors. 

"It is time to shift the emphasis of patient safety programs from a strategy of reporting, focused on injuries after they have occurred, to one of prevention aimed at providing safe and effective care in the first place," concluded Paul Tang, chief medical information officer, Palo Alto Medical Foundation, Palo Alto, California.