Over the past several years information systems (IS) and health care experts alike have reflected on the relatively slow pace of adoption of information technology in the health care industry compared to many other industries. Although specific sectors within health care, such as the hospital supply and pharmaceutical industry, have been using advanced electronic information management and data interchange for decades, other segments of the health care marketplace, physicians in particular, have been cautious about introducing even basic information management technologies such as email or networked computers. Recent estimates indicate that the health care organizations make approximately one fifth of the investment in information technology (as a percentage of their overall operating budget) compared to industries with similar information needs. Another trend of note is the lack of commonly accepted and utilized standards for health information management and transfer. Such standards would facilitate the important goal of efficient and secure exchange of electronic health data among providers and between providers and other entities. This is a particular challenge in light of HIPAA data standards and privacy requirements.
There are, however, important exceptions to the overall trend of relative underutilization of information technology and systems by providers. Key among these is the increasing prevalence of electronic submission of claims to Medicare and other large health care purchasers, although these submissions are largely mediated by third-party clearinghouses that take data produced through hospital and or physician office systems and convert it to meet purchaser standards. In addition, there are examples of larger public and private providers such as Kaiser Permanente, Partners Healthcare System and the U.S. Veterans Administration that have successfully used information system technology to implement electronic medical records, enhanced communication with patients, greater access to medical knowledge resources, electronic order entry and clinical decision support tools. Because the recent focus of health centers in this area has been to implement tools related to more efficient administrative management of center activities and, in some cases, employment of electronic systems for electronic capture of clinically relevant information, we focused our environmental scan around these two broad issues. In the sections that follow we discuss concepts and tools involved in enhanced practice management and use of EMR or electronic health records.