title: Outside the box: will information technology be a viable intervention to improve the quality of cancer care?
abstract: The use of health information technology (IT) to resolve the crisis in communication inherent within the fragmented service environment of medical care in the United States is a strategic priority for the Department of Health and Human Services. Yet the deployment of health IT alone is not sufficient to improve quality in health service delivery; what is needed is a human factors approach designed to optimize the balance between health-care users, health-care providers, policies, procedures, and technologies. An evaluation of interface issues between primary and specialist care related to cancer reveals opportunities for human factors improvement along the cancer care continuum. Applications that emphasize cognitive support for prevention recommendations and that encourage patient engagement can help create a coordinated health-care environment conducive to cancer prevention and early detection. An emphasis on reliability, transparency, and accountability can help improve the coordination of activities among multiple service providers during diagnosis and treatment. A switch in emphasis from a transaction-based approach to one emphasizing long-term support for healing relationships should help improve patient outcomes during cancer survivorship and end-of-life care. Across the entire continuum of care, an emphasis on "meaningful use" of health IT-rather than on IT as an endpoint-should help put cancer on a path toward substantive continuous quality improvement. The accompanying research questions will focus on reducing the variance between the social and technical subsystems as IT is used to improve patient outcomes across the interfaces of care.
authors.affiliation: National Cancer Institute, 6130 Executive Blvd, MSC 7365, Bethesda, MD 20892-7365, USA. hesseb@mail.nih.gov
authors.forename: Bradford W
authors.initials: BW
authors.lastname: Hesse
authors.forename: Christopher
authors.initials: C
authors.lastname: Hanna
authors.forename: Holly A
authors.initials: HA
authors.lastname: Massett
authors.forename: Nicola K
authors.initials: NK
authors.lastname: Hesse
mesh_terms: D022126:Access to Information; D055088:Early Detection of Cancer; D005103:Expert Systems; D005260:Female; D005544:Forecasting; D006040:Goals; D006292:Health Priorities; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D033183:Interdisciplinary Communication; D020407:Internet; D008490:Medical Informatics / Q000191:economics / Q000639:trends*; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care / Q000639:trends; D014481:United States; D014584:User-Computer Interface
references.citation: J Med Internet Res. 2005 Jul 01;7(3):e30
references.pmid: 15998621
references.citation: J Am Med Inform Assoc. 2001 Jul-Aug;8(4):324-43
references.pmid: 11418539
references.citation: N Engl J Med. 2007 Jun 14;356(24):2527-34
references.pmid: 17568035
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):w282-93
references.pmid: 19174390
references.citation: J Natl Cancer Inst Monogr. 2010;2010(40):25-30
references.pmid: 20386051
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1281-9
references.pmid: 16162574
references.citation: J Oncol Pract. 2009 May;5(3):110-2
references.pmid: 20856747
references.citation: N Engl J Med. 2009 Apr 16;360(16):1628-38
references.pmid: 19321858
references.citation: J Am Med Inform Assoc. 2006 Jan-Feb;13(1):106-12
references.pmid: 16221936
references.citation: Ann Intern Med. 2005 Aug 2;143(3):165-73
references.pmid: 16061914
references.citation: Health Expect. 2007 Mar;10(1):75-91
references.pmid: 17324196
references.citation: N Engl J Med. 2008 Jul 3;359(1):50-60
references.pmid: 18565855
references.citation: J Med Internet Res. 2006 Mar 31;8(1):e4
references.pmid: 16585029
references.citation: N Engl J Med. 2008 Sep 18;359(12):1200-2
references.pmid: 18799555
references.citation: J Am Med Inform Assoc. 1994 Jan-Feb;1(1):8-27
references.pmid: 7719792
references.citation: Cancer. 2008 Jun 1;112(11 Suppl):2529-40
references.pmid: 18428201
references.citation: J Biomed Inform. 2005 Aug;38(4):270-80
references.pmid: 16084470
references.citation: JAMA. 2007 Jan 24;297(4):403-6
references.pmid: 17244837
references.citation: AMIA Annu Symp Proc. 2005;:939
references.pmid: 16779226
references.citation: J Gen Intern Med. 2009 Feb;24(2):252-5
references.pmid: 19089501
references.citation: J Natl Cancer Inst Monogr. 2010;2010(40):31-7
references.pmid: 20386052
references.citation: Arch Intern Med. 2000 Feb 14;160(3):301-8
references.pmid: 10668831
references.citation: Arch Intern Med. 2009 Feb 23;169(4):364-71
references.pmid: 19237720
references.citation: J Natl Cancer Inst. 2005 May 4;97(9):675-83
references.pmid: 15870438
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):369-76
references.pmid: 19275992
references.citation: J Natl Cancer Inst Monogr. 2010;2010(40):11-7
references.pmid: 20386049
references.citation: Health Aff (Millwood). 2006 May-Jun;25(3):w94-103
references.pmid: 16527825
references.citation: Yearb Med Inform. 2006;:145-58
references.pmid: 17051309
references.citation: BMC Med Inform Decis Mak. 2008 Oct 06;8:45
references.pmid: 18837999
references.citation: JAMA. 1993 Jul 14;270(2):254-5
references.pmid: 8315754
references.citation: Health Aff (Millwood). 2009 May-Jun;28(3):923-4; author reply 924-5
references.pmid: 19414908
references.citation: BMJ. 2004 May 15;328(7449):1197-9
references.pmid: 15142933
references.citation: J Am Med Inform Assoc. 1996 Nov-Dec;3(6):399-409
references.pmid: 8930856
references.citation: N Engl J Med. 2009 Apr 9;360(15):1477-9
references.pmid: 19321856
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):467-77
references.pmid: 19276006
references.citation: Soc Sci Med. 2008 Feb;66(3):790-800
references.pmid: 18037204
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):390-2
references.pmid: 19275994
references.citation: Qual Saf Health Care. 2006 Dec;15 Suppl 1:i76-81
references.pmid: 17142614
references.citation: Health Aff (Millwood). 2009 Mar-Apr;28(2):323-33
references.pmid: 19275987
references.citation: J Natl Cancer Inst Monogr. 2010;2010(40):3-10
references.pmid: 20386048
references.citation: JAMA. 2005 Mar 9;293(10):1261-3
references.pmid: 15755949
references.citation: Stud Health Technol Inform. 2007;129(Pt 2):1169-73
references.pmid: 17911899
references.citation: Int J Med Inform. 2006 Feb;75(2):125-37
references.pmid: 16112893
references.citation: BMJ. 2004 Jan 24;328(7433):177-8
references.pmid: 14739164
references.citation: Am J Prev Med. 2007 May;32(5 Suppl):S97-103
references.pmid: 17466825
references.citation: Med Care. 2003 Jan;41(1 Suppl):I71-9
references.pmid: 12544818
references.citation: J Health Commun. 2006;11 Suppl 1:147-56
references.pmid: 16641080
references.citation: J Med Internet Res. 2001 Apr-Jun;3(2):E20
references.pmid: 11720962
references.citation: Issue Brief George Wash Univ Natl Health Policy Forum. 2009 Aug 25;(834):1-16
references.pmid: 19757538
references.citation: Dis Manag. 2008 Feb;11(1):13-22
references.pmid: 18279110
references.citation: Am J Manag Care. 2004 Apr;10(4):247-8
references.pmid: 15124500
references.citation: J Health Commun. 2005;10 Suppl 1:195-218
references.pmid: 16377608
references.citation: Ann Fam Med. 2005 Jan-Feb;3(1):73-81
references.pmid: 15671195
references.citation: J Med Internet Res. 2007 Jul 12;9(3):e20
references.pmid: 17627929
references.citation: Qual Saf Health Care. 2004 Oct;13 Suppl 1:i85-90
references.pmid: 15465961
references.citation: J Med Internet Res. 2008 Nov 04;10(5):e36
references.pmid: 18984557
references.citation: Stud Health Technol Inform. 2006;122:36-7
references.pmid: 17102213
references.citation: Patient Educ Couns. 2006 Sep;62(3):288-90
references.pmid: 16876378
references.citation: Health Aff (Millwood). 2005 Sep-Oct;24(5):1222-33
references.pmid: 16162567
references.citation: Health Aff (Millwood). 2002 May-Jun;21(3):80-90
references.pmid: 12026006
references.citation: Med Care. 2008 Sep;46(9 Suppl 1):S68-73
references.pmid: 18725836
references.citation: J Natl Cancer Inst Monogr. 2010;2010(40):18-24
references.pmid: 20386050