commentary FRONTIERS RICHARD SKINNER AND Alden Solovy and Chaiken and Barry Chaiken have wrestled with one of toughest questions in healthcare. For sheer complexity, attempting to measure value of information technology (IT)-and to satisfy anxieties of chief executive officers, other executive team members, and boards of trustees when they are contemplating major in IT-ranks somewhere just below decoding human genome. Serving as a member of Institute of Medicine's (10M) Committee on Quality of Healthcare in America (the committee that published To Err is Human in 2000 and Crossing Quality Chasm in 2001), I was frustrated to find that so little had been done to establish methods and compile measurements of value of IT in healthcare. The 10M committee concluded that two most important strategies for improving quality of healthcare in United States will be to make massive increases in IT and to revamp reimbursement for care. We wrote (10M 2001): The committee believes information technology must play a central role in redesign of health care system if a substantial improvement in quality is to be achieved over coming decade. Automation of clinical, financial, and administrative transactions is essential to improving quality, preventing errors, enhancing consumer confidence in health system, and improving efficiency. We recognized that new funding for IT would be necessary to accomplish national goals for connectivity and quality improvement, and we recommended federal funding to supplement existing health delivery system IT spending. In response to a request by Secretary Tommy Thompson of Department of Health and Human Services last year, ioM has just released a further report that calls for federal dollars to support regional demonstrations of key advances in IT infrastructure and connectivity (10M 2002). All of these recommendations were made because, as a practical matter, no traction will be gained on quality improvement and efficiency without significant advances in healthcare IT. However, in all of our discussions with health system leaders and our review of literature, we found no clear answer to two very basic questions: 1. What types of in IT will produce most value for health delivery systems? 2. Are these same that will produce value for patients, consumers, and nation? National policy shares much same problem that executive teams and boards of trustees face at individual delivery system level. Skinner and Solovy and Chaiken have provided valuable assistance by suggesting two fundamental and reasonably complementary approaches to these questions. Both begin with observation that return on investment (ROI) analyses for IT are undergoing a revolution in every sector of economy. In healthcare, as in other sectors, this turmoil is exacerbated by painful experiences of previous investments. From perspective of healthcare cEos, according to Solovy and Chaiken, the past two decades have been littered with broken promises and increasing costs. As Skinner notes, IT that have greatest potential yield are those that go to heart of business, improving core functions and directly affecting consumers and physicians in front-office systems, with goals of increasing market share or offering new products. Instead of automating old work processes, they disrupt these processes and make new solutions possible. However, these are also riskiest investments, as Skinner sees in many examples of catastrophic failures in ERP and CRM investments in other industries. Ultimately, Skinner points out, the ... measures of IT's contribution to business value are same metrics used to measure business in general. An investment must: 1. build productivity, 2. …
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