From the field

Abstract

Widespread adoption of information technology is now regarded as a pathway to improving health care and achieving the Institute of Medicine’s highly regarded six aims for redesigning care. Achieving these aims requires fresh approaches to health system design, including continuous healing relationships between physicians and patients and provision of tools to help patients be more active participants in their own care. Personal health records (PHRs) might allow patients and providers to develop new ways of collaborating and provide the basis for broader transformation of the health care system. Federal policies can be key catalysts in accelerating PHR development and adoption. F our years have pas sed s ince the Institute of Medicine (IOM) issued its six aims for redesigning health care for the twenty-first century: providing safe, effective, patient-centered, timely, efficient, and equitable health care.1 The current enthusiasm for adoption of electronic health records (EHRs) and broad connectivity across the health care system reflects the belief that information technology (IT) can hasten the nation’s ability to achieve these six aims. Less often mentioned are the IOM’s ten design rules: care based on continuous healing relationships; customization based on patients’ needs and values; the patient as the source of control; shared knowledge and the free flow of information; evidence-based decision making; safety as a system property; the need for transparency; anticipation of needs; continuous decrease in waste; and cooperation among clinicians. The first four of these rules imply that the IOM’s worthy aims will not be achieved unless we build a system in which patients share information and control with professionals. The mere installation of EHRs—even with comprehensive interoperability—will not sufficiently engage patients in the health system. Patients As ‘Copilots’ In Their Care Patients have little access to information and knowledge that can help them participate in, let alone guide, their own care. The IOM design rules propose that patients have shared knowledge and free flow of information. At a minimum, they need access to information from their providers’ EHRs—their own diagnoses, medications, allergies, lab test results, visit summaries, and other findings over time. A continuous healing relationship is a twoway interaction (whether electronic or faceto-face) between patients and their providers. 1 2 9 0 S e p t e m b e r / O c t o b e r 2 0 0 5 H e a l t h T r a c k i n g DOI 10.1377/hlthaff.24.5.1290 ©2005 Project HOPE–The People-to-People Health Foundation, Inc. Paul Tang (tang@smi.stanford.edu) is the chief medical information officer at the Palo Alto Medical Foundation in Palo Alto, California. David Lansky is director of the Health Program at the Markle Foundation in New York