Using information systems to measure and improve quality

Information systems (IS) are increasingly important for measuring and impro ving quality. In this paper, we describe our integrated delivery system's p lan for and experiences with measuring and improving quality using IS. Our belief is that for quality measurement to be practical, it must be integrat ed with the routine provision of care and whenever possible should be done using IS. Thus, at one hospital, we now perform almost all quality measurem ent using IS. We are also building a clinical data warehouse, which will se rve as a repository for quality information across the network. However, IS are not only useful for measuring care; but also represent powerful tools for improving care using decision support. Specific areas in which we have already seen significant benefit include reducing the unnecessary use of la boratory testing, reporting important abnormalities to key providers rapidl y, prevention and detection of adverse drug events, initiatives to change p rescribing patterns to reduce drug costs and making critical pathways avail able to providers. Our next major effort will be introduce computerized gui delines on a more widespread basis, which will be challenging. However, the advent of managed care in the US has produced strong incentives to provide high quality care at low cost and our perspective is that only with better IS than exist today will this be possible without compromising quality. Su ch systems make feasible implementation of quality measurement, care improv ement and cost reduction initiatives on a scale which could not previously be considered. (C) 1999 Elsevier Science Ireland Ltd. All rights reserved.