"This report describes what can be gained and what is required to achieve an
interoperable system of electronic healthcare information. This goal can be
reached, and its benefits are worth the effort that will be required."
"The evidence cited in this report compels action to achieve an interoperable
health information technology system in the United States."
"Americans need a connected system of electronic healthcare information available
to all doctors and patients whenever and wherever necessary.
In 2000, the Institute of Medicine (IoM) estimated that between 44,000 and
98,000 Americans die each year from preventable medical errors. Subsequent
studies have estimated that the number may be twice as high. Medical errors
are killing more people per year, in America, than breast cancer, AIDS, or motor
vehicle accidents. This pain and suffering is compounded by the knowledge that
many of these errors could have been avoided.
"The lack of immediate access to patient healthcare information is the source of
one-fifth of these errors.
"One of every seven primary care visits is affected by missing medical information.
In a recent study, 80 percent of errors were initiated by miscommunication,
including missed communication between physicians, misinformation in medical
records, mishandling of patient requests and messages, inaccessible records, mislabeled
specimens, misfiled or missing charts, and inadequate reminder systems.6
Under the current paper-based system, patients and their doctors lack instant,
constant access to medical information. As a result, when a patient sees more
than one doctor, no doctor knows exactly what another doctor is doing, or even
that another doctor is involved. The consequences range from inconvenient to
critical or even fatal. Each time an individual encounters a new healthcare provider, that patient must retell his or her medical history. Not only is this
redundant, it can introduce error and imprecision, ensuring that no two copies
of a personal medical record will be exactly alike. In an emergency, delay and a
lack of information can be deadly.
"In the age of the Internet, this shortcoming is unacceptable.
Many other problems stem from the lack of connectivity. Since doctors often
work independently, the lack of shared knowledge can cause duplicate tests to
be ordered, resulting in unnecessary expense and, occasionally, risk, and pain.
The same problem exists for prescriptions, which can conflict with one another
to create life-threatening drug interactions.
"Security and confidentiality are limited by the difficulty of tracking access to
paper-based records. The paper-based system necessitates consultations via telephone
calls, faxes, and e-mails without the benefit of complete medical records. Patients
who want follow-up information on their conditions must schedule time with
doctors, nurses, or staff, or conduct research independently—there is no
networked access to supporting information.
"Handwritten records—most notoriously, prescriptions—are easily misread,
causing potentially life-threatening mistakes. Similarly, analysis of large numbers
of paper records is impossible, denying the public the benefits of early warnings
of dangerous trends in disease or bioterrorism, and other research-driven efforts."