Information Technology: Benefits Realized for Selected Health Care Functions
United States General Accounting Office, www.gao.gov, 2003, 124 pages

Audience: Healthcare quality professionals

Key Words: Information technology, quality improvement

This is a "must see" government document for anyone in healthcare and healthcare quality improvement. The document discusses results of a survey sent to 19 organizations recognized in the healthcare community for their use of information technology (IT). Data on 14 organizations were obtained and analyzed and then made available to demonstrate cost savings and other benefits. These organizations included 10 private and public healthcare delivery organizations, three healthcare insurers, and one community data network.

The document is presented in a PowerPoint format and is extremely easy to follow, well written, and organized. The objective, scope, and methodology of the study are included, along with a general overview of the participants and benefits of implementing IT. Specific examples of how IT is implemented in each participant's organization is discussed thoroughly with information pertaining to organizational structure, description of the IT environment, reported costs and cost-related benefits, and lessons learned. For example, in one medical center clinical care area, use of bar-coded patient bracelets, medications, nurse IDs, and charts resulted in the prevention of over 3,000 drug errors with an estimated cost savings of over $800,000 in 1 year. There was also a 33% reduction in Medicare disallowance of tests ordered through use of other IT methods. Reduction of administrative costs, improved customer satisfaction and patient safety, improved productivity, and overall financial savings for the organizations were reported by all participants. The sections on "Lessons learned" are invaluable to anyone who wants to avoid the barriers to IT implementation. I would strongly suggest looking over this document to gain insight into the creative options for IT that are being utilized by a variety of healthcare providers to maintain quality of care, competitiveness in the field, and enhanced delivery of services.

Reviewed by Rebecca Cohen, EdD MS MPA RN CPHQ

National Institute of Standards and Technology Information Technology Guide
http://csrc.nist.gov/publications/nistpubs/800-55/sp800-55.pdf

Audience: IT professionals, healthcare quality professionals, senior leaders, decision support personnel

Key Words: Computer security, information systems, indicator monitoring, performance improvement, performance monitoring, policy and procedure, technology

This link contains a 99-page Adobe Acrobat PDF document that is user friendly and well written. The manuscript provides a first-rate, comprehensive guide to effective computer security monitoring processes.

The report covers a wide range of topics such as the need to have leadership support for the allocation of resources to obtain successful outcomes and outlines the roles and responsibilities for several information technology professional positions. Even though the healthcare quality professional's role is not referenced specifically, the association may be made easily. The document describes an implementation cycle that closely resembles the PDCA (i.e., plan, do, check, act) cycle and the metrics referenced are explained fully using sound compilation, analysis tools, and thinking. These metrics can be integrated into existing quality programs at any organizational level.

The explanation and approaches to data collection and measurement are very impressive. An extensive appendix contains sample metrics for topics such as risk management, security controls, system development, life cycle, authorization process, and system security plan.

Another application for the contents of the document is as a valuable resource for meeting the Joint Commission on Accreditation of Healthcare Organization's information management standards for planning, evaluation, and assessment.

A table of contents assists the user in finding desired elements of the report. A list of acronyms aptly defines the terms used in the document and a reference list is provided if additional information is required.

This is an excellent Web site and resource for computer-security metrics and improvement processes.

Reviewed by Carole S. Guinane, MBA RN

Toward a 21st Century Health System
Alain Enthoven and Laura Tollen
Jossey-Bass publisher, www.josseybass.com, 2004, $30, 336 pages, ISBN 0-7879-7309-2

Key Words: Efficiency, healthcare policy, healthcare quality, medical workforce policy and research, national health policy, primary care, quality, technology

Audience: Healthcare quality professionals, senior leaders

Toward a 21st Century Health System, written by a group of 25 healthcare policy experts, including Donald Berwick, MD MPP, president and CEO for the Institute for Healthcare Improvement, is an analysis of the contributions and promise of prepaid group practices (PGP). PGP is defined by editors Alain Enthoven and Laura Tollen as an organized group of primary care clinicians and specialists, including but not limited to physicians, who are paid under a common corporate mechanism for the ongoing care of a defined population of enrolled patients and is guided by the "whole of the care," which also includes finance.

Excerpts and/or interviews from six organization's CEO using the PGP model are presented to the reader for evaluation of the effectiveness of this type of system. Users provide insight into how well the system works and what kinds of problems have been encountered within the system.

In this book the authors present how PGPs perform better than the traditional fee-for-service system in terms of efficiency, quality, and safety. Content and discussion of the PGP system's benefits, risks, limitations, and weaknesses are presented and examined. Discussions are provided for contributions that prepaid group practices have made to healthcare in the areas of national health policy, technology assessment, pharmacy benefit management, medical workforce policy, and research.

Toward a 21st Century Health System is a must read book for anyone desiring to explore the future of healthcare and organized delivery systems. Understanding the effects the systems of the future may have on customers and providers may help develop healthcare policies that will provide a more cost-effective and efficient healthcare system.

Reviewed by Ann Allen, MSN RN CPHQ

To Improve Health and Health Care, Volume VII: The Robert Wood Johnson Foundation Anthology, 2nd Edition
Stephan L. Isaacs and James R. Knickman, Eds.
Jossey-Bass, www.josseybass.com, 2004, $25, 288 pages, ISBN 0-7879-7635-0

Audience: Healthcare quality professionals, public policy makers

Key Words: Healthcare strategies, leadership, research

This text is part of the Robert Wood Johnson Foundation (RWJF) Anthology series that addresses initiatives to improve health and healthcare. Strategies that address important health problems are tested and results of these findings shared with the healthcare community at large through this series. Through the various efforts of RWJF, healthcare professionals are educated and those in the position to affect policy are provided Policy Forums. The publication targets healthcare professionals and public policy makers—groups educated by this text through learning how other entities have addressed healthcare issues. The intent is to share positive and not so successful experiences in public health initiatives, which fits well with the series in general. The Foundation's approach focuses on helping the most vulnerable segments of society and looking for innovative ideas that can improve health and healthcare.

The goals of the RWJF are to (a) ensure that all Americans have access to quality healthcare at a reasonable cost, (b) improve the quality of care and support for people with chronic health conditions, (c) promote healthy communities and lifestyles, and (d) reduce the personal, social, and economic harm caused by substance abuse, tobacco, alcohol, and illicit drugs. RWJF's four priorities for funding include addressing systemic problems in health and healthcare, training leaders to improve healthcare and healthcare workforce through programs, providing services for vulnerable populations, and focusing on new innovative high-risk ideas and approaches.

The text focuses on four Targeted Portfolio Programs including the Fighting Back Program Targeted Portfolio, which includes, four programs of which the first is back pain, the Human Capital Portfolio, the Vulnerable Populations Portfolio and the Pioneering Portfolio. The Fighting Back Program Targeted Portfolio evaluates community coalitions that combat problems of substance abuse. The experiences of two technical support organizations are recounted. It was noted that neither one of the programs was effective in solving the problems they were set up to address. Various community programs focused on affordable healthcare are also featured.

The Human Capital Portfolio addresses the importance of developing leadership capacity in the health sector. This is the Foundation's longest running initiative, often referred to as its flagship program. Since 1972, the RWJF has supported postdoctoral training for young physicians interested in research and leadership careers in healthcare policy. This portfolio explains why a philanthropic organization would be interested in such an expensive, long-term program and how the program has influenced the fields of medicine and healthcare. The section focusing on "increasing minorities in the health professions" is based on the Foundation's interest in minority health practitioners and mechanisms to improve access to and the quality of healthcare for minority patients.

The Vulnerable Populations Portfolio highlights the 1988 RWJF programs focused on reducing injuries to children living in low-income neighborhoods. Initiatives addressed motor vehicle injuries, drowning, fires, bicycle crashes, falls, pedestrian injuries and playground injuries. The initiatives focus on studying where, why, when and how childhood injuries occur and then devise programs and interventions to reduce their incidences. The Homeless Prenatal Program is part of this portfolio and highlights a small nonprofit organization in San Francisco and the work done with the aid of three grants.

The Pioneering Portfolio focuses on the RWJF's response to emergencies. Large scale events such as the September 11 tragedy, natural disasters, and bio-terrorism all require emergency responses. The efforts and activities of the various September 11 grants highlight how a tragedy brings together various organizations to address immediate and postcrisis cooperation and services.

This book is a must have for public policy makers and those involved with public health initiatives. There is much to be learned from the success and failures of entities addressing the complex nature of health and healthcare.

Reviewed by Judith R. Sands, BSN RN LHRM CPHQ CCM ARM CLC

JHQ welcomes the opportunity to review various media that could potentially be of benefit to healthcare quality professionals and the people they serve. Reviews are published in every issue of JHQ.

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