The IOM report on computer based patient records concluded "computerized clinical data [are] a prerequisite for the safe provision of quality care."38 Similarly, in its report on the quality of long-term care the IOM suggests that the development of computer based record systems is an essential strategy in improving the quality of care.18 Underlying this is the basic understanding that key documentation systems are not separate and removed from persons providing care. This report has illustrated that: (1) current nursing home reporting requirements do not completely reflect the information needed at the point of care to deliver quality of care or to subsequently monitor nursing home quality; and (2) work is needed to extend clinical terminologies so that they reflect the essential data elements required for delivering quality care.
Point of care clinical data captured in an integrated electronic health information system needs to be seen as a business imperative, both as a means of reducing documentation burden and improving accuracy, and, most importantly, as a means of supporting improvements in the quality of care. Although patient medical record information systems are not yet widely implemented in long-term care facilities, the IOM and others have identified the need for such initiatives as a way to substantially contribute to quality of care enhancements across the healthcare continuum. Development of electronic information systems will be slowed without public policy that supports and encourages the adoption of standards for messages, clinical document architecture, and terminologies.
The technology required to support the NHII vision of a distributed health information system is available, representing dramatic developments in the technical infrastructure of health care systems since the MDS was first developed. We can now support through technology assistance a patient and practice-centered approach that was the goal of the MDS efforts in the first place.
However achieving the vision awaits a concerted and coordinated national effort, including public and private efforts to support the adoption of standardized terminology systems, and research and demonstration efforts needed to extend inter-operable electronic clinical information systems into long-term care. In addition, work will be needed to build federal and state payment and quality monitoring policies using a well-developed terminology system that is a part of the NHII.