Abstract
BackgroundImproving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and health-related research. Many avoidable shortcomings in the health sector that result in poor quality are due to inaccessible data, information, and knowledge. A national health information infrastructure (NHII) offers the connectivity and knowledge management essential to correct these shortcomings. Better health and a better health system are within our reach.DiscussionA national health information infrastructure for the United States should address the needs of personal health management, health care delivery, public health, and research. It should also address relevant global dimensions (e.g., standards for sharing data and knowledge across national boundaries). The public and private sectors will need to collaborate to build a robust national health information infrastructure, essentially a 'paperless' health care system, for the United States. The federal government should assume leadership for assuring a national health information infrastructure as recommended by the National Committee on Vital and Health Statistics and the President's Information Technology Advisory Committee. Progress is needed in the areas of funding, incentives, standards, and continued refinement of a privacy (i.e., confidentiality and security) framework to facilitate personal identification for health purposes. Particular attention should be paid to NHII leadership and change management challenges.SummaryA national health information infrastructure is a necessary step for improved health in the U.S. It will require a concerted, collaborative effort by both public and private sectors.If you cannot measure it, you cannot improve it. Lord Kelvin
Highlights
Improving health in our nation requires strengthening four major domains of the health care system: personal health management, health care delivery, public health, and healthrelated research
A national health information infrastructure (NHII) is the means by which we can improve the quality of health data, information, and knowledge used to support decisions at all levels and in all domains of the health sector
Using a framework based on the four major domains of personal health management, health care delivery, public health, and research, this article describes the information and communications technology (ICT) infrastructure that is needed to bring the health sector from a memory-based non-system to a computer-assisted integrated care system
Summary
Defining the NHII An information and communications infrastructure exists to connect users – to each other, to information, and to analytical tools – and to enable management and generation of knowledge. Health care organizations will be well served if they collaborate with vendors to design and implement information and knowledge management systems that meet the needs of patients, clinicians, public health professionals, and researchers. IDX Systems Corporation is collaborating with Apelon, Inc., Intermountain Health Care (IHC) Health Services, Inc., Mayo Clinic Rochester, Stanford University, and the University of Nebraska Medical Center to "develop advanced software tools and technologies to enable the widespread creation, distribution, and application of electronic clinical practice guidelines."[62] Another active grant is supporting the development of an extensive, homogeneous infrastructure for distributed bioinformatics resources.[63] While the ATP program may have some detractors, it does represent a working collaborative model. Revenue-neutral strategies can be adopted that pay a premium for computer-based billings or offer incentives for ITC capital investments
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