title: Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice.
abstract: The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.
authors.affiliation: Health Services Research & Development Center of Excellence on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202, USA. bdoebbel@iupui.edu
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
authors.forename: Ann F
authors.initials: AF
authors.lastname: Chou
authors.forename: William M
authors.initials: WM
authors.lastname: Tierney
mesh_terms: D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006284:Health Plan Implementation / Q000379:methods*; D006801:Humans; D008491:Medical Informatics Applications; D018802:Patient-Centered Care / Q000458:organization & administration; D010818:Practice Patterns, Physicians'; D013597:Systems Analysis; D014481:United States; D014493:United States Department of Veterans Affairs