, Volume 21, Issue 2 Supplement, pp S50-S57

Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice

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The U.S. health care system is one of the world’s most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.

The authors appreciate comments on the draft white paper from Denise Hynes, RN, PhD, and discussion of the issues surrounding it by experts at the Veterans Health Administration (VHA) State-of-The-Art Conference: “Attributes of an Ideal Integrated Informatics System that Supports Implementation of Evidence,” VHA State of the Art Conference (SOTA) VII, Implementing the Evidence: Transforming Practices, Systems, and Organizations, Washington, DC, August 2004. Responsibility for the positions outlined in the manuscript reside with the authors.