Evidence-based medical information technology: the next generation.

US Health care is again in crisis. Our patients are stuck in a quagmire of worsening access to quality care (Fig. 1). The 2000 Institute of Medicine (IOM) report “To Err is Human” identified hospitals to be unsafe environments. Medical errors are rampant. By conservative estimates, these “errors of commission” are responsible for 44,000 to 98,000 deaths per year. In 2001, IOM published a second report entitled “Crossing the Quality Chasm”, which emphasized that despite our professed interest in providing evidence-based care, many patients do not receive proven therapies. A recent study assessed the frequency of these “errors of omission” by documenting 439 indicators of quality care for 30 acute and chronic health conditions in 12 US metropolitan areas and found that only 55% of patients received the appropriate therapies (e.g., -blockers after an acute myocardial infarction). An inherent flaw of our system is that it takes 10 to 15 years for a proven therapy to become standard of care. In addition, this IOM report emphasized that we the providers (i.e., physicians and hospitals) are incapable of fixing these problems. In fact, current methods of reimbursement reward the status quo (e.g., we get paid for taking care of preventable complications). The IOM recommended legislation and regulations to insure that hospitals become safe environments (similar to the Federal Occupational Safety and Health Act). In addition, they recommended that the payers or patients be leveraged into choosing the providers that have a track record of delivering safe and evidence-based care that is customized to the individual patient’s desires. As a result of these two IOM reports, a number of external forces (with increasing recognized acronyms such as AHRQ, IHI, NQF, Leapfrog, SCIP, P4P) are merging their efforts with the intent of radically changing the way health care is practiced. Most physicians are now experiencing how pervasive this influence is on their day to day practices. In June 2006, the IOM published three reports focused on access to emergency and trauma care. The one entitled “Emergency Hospital Based Care: At the Breaking Point” is most pertinent to our practices and nicely outlined the increasing frustration that I experienced during the last several years as Medical Director of a busy Level I Regional Trauma Center in Houston Texas. The basic tenet for reform is that inadequate hospital capacity and inefficient use of inpatient beds are causing an admission gridlock resulting in unacceptable emergency department (ED) overcrowding, diversion and poor care. Similar to the previous IOM reports, these 2006 reports will undoubtedly attract additional external forces that will mandate changes that we as trauma, emergency surgery, and surgical critical care providers will find unnecessarily intrusive. We need to seize the opportunity to Submitted for publication May 10, 2007. Accepted for publication May 15, 2007. Copyright © 2007 by Lippincott Williams & Wilkins From the Department of Surgery, The Methodist Hospital, Houston, Texas. Presented as the Presidential Address at the 37th Annual Meeting of the Western Trauma Association, February 25–March 2, 2007, Steamboat Springs, Colorado. Address for reprints: Frederick A. Moore, MD, Department of Surgery, The Methodist Hospital, 6550 Fannin Street, Smith Tower 1661, Houston, Texas 77030; email: FAMoore@tmh.tmc.edu.