Health and the National Information Infrastructure

Only information technology offers society the opportunity to reinvent health care into a more value-driven, knowledge-based, cost-effective industry. The author urges the health informatics community to assume greater leadership for defining and securing a robust health information infrastructure (HII). A blueprint for the future tied to a coalition of advocates pushing for change would enable the step-interval improvements in health care needed by the nation. Our nation and its people are fortunate. We are blessed with a system of government that offers ordinary citizens the opportunity to shape the future, leadership that seeks to anticipate and create a better society, and at present a robust economy. Moreover, like many other countries, we are benefiting from astounding advances in medical knowledge and technologies. Finally, the increasing power and affordability of information technology is transforming the work of many industries and incrementally changing the lives of many citizens. At the same time this is true, there is much about which to be concerned with respect to health care. Tens of millions lack financial access to care; quality is very uneven and not receiving serious attention from health professionals; and costs are once again rising. Our people are unhappy with their care; providers are unhappy with the system; payers will soon become more unhappy about costs; and government reacts by enacting regulations that will fail to create substantial change. There will never be sufficient funds to do all we would like to do. Better knowledge and treatments will come from biomedical research, but the progress will be gradual and likely offset by increased demand by an aging society. While improved health care system management will result from health services research, only the information technology revolution and better policy offer promise of dramatic help. Yet there is little evidence of movement to harness this opportunity. One of the great challenges for our generation is to assure that the astonishing capabilities of information technology benefit human health to the fullest extent possible in the future. This paper seeks to stir debate, discussion, and action. It identifies and discusses some of the likely elements of our nation's emerging information infrastructure that can revolutionize health care to the betterment of our society. Further, it advises on ways to move this strategic agenda forward. This paper relates to the formal position of the American Medical Informatics Association on a national health information infrastructure and other policy documents on advancing health information technology in the hope that continued discussion will stimulate further refinement and action.