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IOM Urges Adoption of Data Standards as Core of Revamped Health Care System

Kate Traynor

Creating a seamless flow of electronic patient care information among all segments of the health care system is an essential component of improving patient safety, according to a new report from the Institute of Medicine (IOM).

The report, Patient Safety: Achieving a New Standard for Care, is part of IOM's Information for Health Initiative, a project designed to aid in the development of data standards for collecting, coding, and classifying patient safety information, including adverse-event and error-reporting data.

In the report, IOM calls for the current health care delivery system to be replaced by one that is built on a national health information infrastructure (NHII)—a standardized system for the efficient interchange of patient safety and health data, health care terminology, and the growing medical knowledge base. This integrated system would be designed to prevent most errors from happening and learn from them when they do occur. According to the report, the data management system would be built on "Internet protocols, common standards, timely knowledge transfer, and transparent government processes."

A central component of the NHII is the widespread adoption of electronic medical records by health care providers in all patient care settings. Other electronic components of the infrastructure would include clinical decision-support systems, reminder systems to improve adherence to evidence-based care practices, and computerized laboratory and radiology test results.

Once the NHII is in place, standardized data would flow between clinical laboratories and health care facilities, between pharmacies and prescribers, and between health care organizations and entities that pay for patient care. The report envisions that patient safety information would be culled from a variety of sources, including computerized prescriber order-entry systems, admissions and discharge data, disease registries, coroners' data sets, and malpractice data.

Kasey K. Thompson, director of Patient Safety for ASHP, said that the Society strongly supports the concept of using information technology to capture knowledge about medical and medication errors to improve patient safety. "The lack of continuity of care throughout the U.S. health care system represents a significant source of many of the problems associated with safety and quality," he said.

The IOM report states that the benefits of the NHII would extend beyond patient care, enhancing the provision of public health services and homeland security.

IOM acknowledged in the report that developing the NHII is an "enormous undertaking with sizable costs in terms of human, organizational, financial, and governmental resources" and stated that estimating the costs of the initiative was outside the scope of the report. The institute envisions the creation of a public–private partnership to develop the NHII, with the private sector shouldering much of the cost, aided by the federal government.

On the federal side, the report recommends that Congress mandate the "enabling authority" and financial support to allow several government agencies to assume "major new responsibilities." Chief among these federal entities are the Agency for Healthcare Research and Quality (AHRQ)—which requested and funded the IOM report—and the National Library of Medicine.

The report was prepared by IOM's Committee on Data Standards for Health Safety and follows the committee's July 2003 report, Key Capabilities of an Electronic Health Record System. These reports build on two previous publications from IOM's Committee on Quality of Health Care in America: To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century.

AHRQ has received $165 million in congressional appropriations since 2001 to support the agency's patient safety leadership role, with an additional $60 million requested for this purpose in 2004. According to IOM, the next phase of the Information for Health Initiative is to map out NHII's scope, obstacles to the program's implementation, and funding issues.

AHRQ Director Carolyn M. Clancy said in a statement that her organization commends IOM for issuing the report and plans to carefully review its recommendations. 

ASHP's Thompson said that, in his opinion, "a standards-based national health information technology infrastructure will be good for patients and providers." But he cautioned that technology alone is not the answer to improving patient care. 

"It is important to remember," he said, that "people—not computers—care for people."