The U.S. healthcare system is widely regarded as the best in the world, but preventable medical errors still account for between 44,000 and 98,000 deaths each year, according to the Institute of Medicine. Using the more conservative figure, medical errors rank as the eighth-leading cause of death, killing more Americans each year than motor vehicle accidents, breast cancer or AIDS.
In its landmark 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century, the IOM urged providers and payers to re-engineer the nation's healthcare system by adopting advanced information technology to support their clinical services, and by encouraging physicians and staff to improve their quality-management practices.
Since that report, hospitals throughout the nation have raced to deploy a wide range of clinical IT solutions, including computerized physician order-entry software, decision support and electronic medical-record systems, bar-coded medication management technology, personal digital assistants, wireless communications and more. Spending on clinical IT systems is projected to continue growing rapidly, from $15.4 billion today to $25 billion by 2009, a 64% increase in only five years, according to Kalorama Information, a market research firm.
The race to deploy IT
The race to deploy life-saving technology is laudable, but rapid change involving complex systems can create problems. Already, healthcare IT departments are encountering difficulties in meeting the demands being placed upon them. In its 16th Annual Leadership Survey of chief information officers at more than 500 leading hospitals, the Healthcare Information and Management Systems Society, found 10 barriers to implementing effective IT solutions, with staffing shortages, poorly designed software, lack of clinical leadership and the absence of a strategic IT plan being the four that have grown worse during the past year. Left unresolved, the next crisis in healthcare could well erupt in overburdened hospital IT departments that must deploy and manage so many new clinical-care systems.
Realizing the potential for dangerous mishaps, some hospitals, payers and other providers have begun to adopt quality-management practices not just for their doctors and nurses, but for their IT professionals as well. One approach that is gaining adherents among healthcare providers and payers is known as the Information Technology Infrastructure Library, or ITIL, a quality-management framework that was originally developed by Great Britain's Office of Government Commerce. ITIL's best-practice approach to IT management and service delivery has been continuously improved by thousands of practitioners around the world since it debuted in 1989. The framework is flexible enough that it can accommodate the special requirements imposed on regulated industries such as healthcare, which must conform to the Health Insurance Portability and Accountability Act, as well as drug safety, control and labeling regulations promulgated by the Food and Drug Administration. In addition, public hospitals must also comply with the Sarbanes-Oxley Act of 2004. ITIL has played a major role in successful compliance activities since Sarbanes-Oxley was enacted.
ITIL framework gains support
In recent years, the ITIL framework has caught on strongly in the U.S. Today, more than 3,000 individual practitioners at 300 companies participate in the IT Service Management Forum USA, or itSMF USA, the national body that promotes the adoption of ITIL and other quality frameworks and systems -- including ISO 20,000 and Six Sigma -- through seminars and conferences. More than 30 local interest groups have sprung up across the nation where members meet monthly to present case studies and participate in discussions about quality improvement in IT.
Today, scores of IT vendors -- including IBM Corp., Hewlett Packard Co., BMC Software and Computer Associates -- are designing software applications based on or conforming to ITIL. As these solutions mature and become more widely adopted, ITIL may usher in a golden age of higher quality software and IT services.
Everyone knows the frustration that comes from using poorly designed and managed IT systems -- whether it's a sluggish e-mail system, a crashing Web site or business software that fails to perform as expected. But in healthcare, quality problems in the IT department can have life-threatening consequences. As healthcare providers deploy automated systems to help reduce medical errors and improve patient outcomes, let's not forget that the IT departments supporting these medical marvels need a quality-management framework that we can all depend on. Perhaps ITIL is just what the doctor should order?
James Prunty is executive director of the itSMF USA and works from its Los Angeles office. itSMF USA is a trademark of the IT Service Management Forum USA.
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