Special article Information technology for quality health care: a summary of United Kingdom and United States experiences

Introduction The explicit use of health information technology (HIT) to enable threshold improvements in the delivery of health care services is beginning to emerge as a serious objective for health care organisations and systems. Many readers who are very knowledgeable of quality measurement are relatively uninformed about health informatics and the converse is also true. It is for these readers that this paper is written. Specifically, the objective of this review of HIT in the UK and USA will focus upon salient features, deployment, and related policy issues. Particular attention will be given to areas in which threshold improvements in quality now exist or are likely to be forthcoming. Comments are organised to relate at the level of the individual, teams or microsystems, organisations, and larger systems, including national information infrastructures. Health care information technology is a broader phenomenon than it is deep. Over the past 30 years the information technology revolution developed slowly from roots in Turing’s military intelligence machines of World War II to DARPA and the present day Internet when the pace picked up. While the telephone took 40 years to reach 10 million people, it only took 4–5 years for the Internet to reach 100 million. Despite successes being clouded by hype and hope, the Internet consumer health market is projected to reach $1.7 billion by 2003. Randomised trials now confirm the early evidence that health care quality can be significantly improved through health informatics. Evidence of improved access and cost eVectiveness should soon follow. Over the next two decades e-health could deliver patient, provider, and planner/manager interactions for all aspects of health care. A positive impact on quality, access, and cost eVectiveness is likely and this should lead to better evaluation of health status and outcomes. The focus for action can change from detection of errors and problems to information systems whose processes prevent many adverse outcomes. National diVerences in the health care systems of the USA and UK have resulted in complementary strengths with respect to HIT. Most early major deployments of information technology in health care were for financial accounting of medical transactions. Only now is HIT being regarded as an essential investment for enhancing quality, and the UK is currently leading the way. Despite being at the onset of a phenomenon, so many examples of computer-based quality orientated eVorts now exist that this paper can list only a few as illustrations. The UK and the Netherlands have oVered world leadership in primary care HIT deployment and privacy policy, while the USA has strengths in information systems for hospitals and health systems. Correspondingly, joint leadership in standards and terminology have complemented these priorities. Australia and Canada may well have the best records for combining national strategies with deployment. Both the UK and the USA have policy documents and legislation that favour the deployment of HIT for simplification of patient care and administration. Clearly, the most dramatic is England’s Information for Health strategy that was developed in 1998 and runs to 2005. 13 It has the following objectives: lifelong electronic health records for everybody in the country; round the clock online access to patient records and information about best clinical practice for all NHS clinicians; genuinely seamless care for patients through GPs, hospitals, and community services sharing information across the NHS information highway; and fast and convenient public access to information and care through online information services and telemedicine. It was announced as a £1 billion initiative but, to date, less than £100 million has been allocated for local implementation. This agenda fits within the broad policies emphasising “modernisation”, e-government, and the National Information Partnership. This has been confirmed in The NHS Plan of July 2000 with its £200 million investment over the next Quality in Health Care 2000;9:181–189 181