Dr. Farzad Mostashari | November 8, 2011
New Institute of Medicine Report: Health IT and Patient Safety
The U.S. Department of Health & Human Services (HHS) appreciates the thoughtful work of the Institute of Medicine (IOM) in its new report, Health IT and Patient Safety: Building Safer Systems for Better Care. The reportwas commissioned by the HHS Office of the National Coordinator for Health Information Technology (ONC), as
part of our long-term strategy to make safety efforts a top priority in our support of electronic health record (EHR) adoption.
Findings on Health IT and Patient Safety
This report reaffirms years of studies dating back to the seminal IOM reports To Err is Human and Crossing the Quality Chasm that underscored the tremendous potential of health IT to improve patient care and safety. While the IOM report today recognizes the early safety
successes of EHRs, including how computerized drug prescribing has significantly reduced the number of patients receiving incorrect medications, it also highlights how some of the complexities associated with EHRs have introduced new risks into the system. The report also highlights the importance of health IT to continuously improving health care quality and safety by rapidly and reliably flagging potential patient safety risks and preventing adverse events in the clinical setting.
HITECH Act, Health IT, and Patient Safety
HHS has already initiated several activities under the HITECH Act to ensure that any safety issues that arise in the national adoption of EHRs are shared and addressed. The Secretary has appointed a technical expert panel focused on improving safety that regularly meets and reports its findings. We have also funded a health care workforce training curriculum that strongly emphasizes safety and usability issues for the health IT workers
who are responsible for installing and maintaining EHR systems.
HHS agrees with IOM that more can and should be done to capture safety issues unique to EHRs when and if they arise. ONC will lead an HHS planning initiative to develop a comprehensive EHR safety action and surveillance plan well within the 12-month period recommended by IOM. In formulating this plan, ONC will work with the FDA, AHRQ, NIH, and CMS as well as the broader health care community and industry.
Regulators, payers, health care providers, and patients each have a role in ensuring that patients are not harmed. The safety of health IT is one critical element in a larger and longstanding patient safety discussion that includes medical errors, hospital acquired conditions, readmissions, and a host of other issues. HHS is working to address these risks through several Affordable Care Act initiatives including the Partnership for Patients and accountable care organizations. Health IT will help make these patient safety programs and others like it work by providing health care professionals and patients with the real-time information they need to avoid injury and death.
We are hopeful that today’s report will serve to strengthen health IT systems and enable EHRs to make their full contribution toward safer, better quality care for Americans.
A handful of analytic frameworks for quality assessment have guided measure development initiatives in the public and private sectors. One of the most influential is the framework put forth by the Institute of Medicine (IOM), which includes the following six aims for the health care
system.[1] Existing measures address some domains more extensively than others. The vast majority of measures address effectiveness and safety, a smaller number examine timeliness and patient-centeredness, and very few assess the efficiency or equity of care.[2] Frameworks like the
IOM domains also make it easier for consumers to grasp the meaning and relevance of quality measures. Studies have shown that providing consumers with a framework for understanding quality helps them value a broader range of quality indicators. For example, when consumers are given a brief, understandable explanation of safe, effective, and patient-centered care, they view all three categories as important. Further, when measures are grouped into user-friendly versions of those three IOM
domains, consumers can see the meaning of the measures more clearly and understand how they relate to their own concerns about their care.[3] To learn more about grouping measures into categories, go to Organizing Measures To Reduce Information Overload.
To learn more about selecting and reporting measures within categories that consumers understand, refer to:
- Hibbard J. Engaging Consumers in Quality Issues: While the road to engaging consumers is steep, it is fairly well marked. Washington, DC: National Institute for Health Care Management Foundation; October 2005. Available at //www.nihcm.org/pdf/ExpertV9.pdf.
- Hibbard JH, Pawlson LG. Why Not Give Consumers a Framework for Understanding Quality? Joint Commission Journal on Quality Improvement 2004 June. 30(6); 347-351.
- Pillittere D, Bigley MB, Hibbard J, et al. Exploring Consumer Perspectives on Good Physician Care: A Summary of Focus Group Results. New York: The Commonwealth Fund; January 2003. Available at //www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2003_jan_exploring_consumer_perspectives_on_good_physician_care__a_summary_of_focus_group_results_pillittere_consumerperspectives_578_pdf.pdf
[1] Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for
the 21st Century. Washington, D.C: National Academy Press; 2001.
[2] Institute of Medicine (IOM). Performance Measurement: Accelerating Improvement. Washington, D.C: National Academy Press; 2005.
[3] Hibbard JH, Pawlson
LG. Why Not Give Consumers a Framework for Understanding Quality? Joint Commission Journal on Quality Improvement 2004 June. 30(6); 347-351.
Also in "Select Measures to Report"
- The Six Domains of Health Care Quality
- Types of Measures You Can Report
- Understanding Data Sources
- Selecting the Right Measures for Your Report
- Measures of Quality for Different Health Care Settings
- Quality Measurement Resources
Page last reviewed November 2018
Page originally created February 2015
Internet Citation: Six Domains of Health Care Quality. Content last reviewed November 2018. Agency for Healthcare Research and Quality, Rockville, MD.
//www.ahrq.gov/talkingquality/measures/six-domains.html