Computer technology
Clinical medicine seems headed inevitably toward electronic medical records. This step could represent a major advance in the care of older people,if the opportunity is properly harnessed. Simply reproducing the current unstructured information set in a more legible and transmissible format will not suffice. Structured information provides the vehicle for assuring a more systematic evaluation and follow-up of cases. By distinguishing between missing and normal values,it can provide the structure to focus clinicians' attention on salient items.
Computer technology can dramatically reduce redundancy. Properly mobilized,computers can provide the structure needed to assure a comprehensive assessment with no duplication of effort. Because they are interactive ,they can carry out much of the desired branching and can even use simple algorithms to clarify areas of ambiguity and retest areas where some unreliability is suspected. Similar algorithms can look for inconsistency to screen for cheating.
Data stored on computers can be aggregated to display performance across patients by provider (eg,physician,nursing home ,or agency). Data on a patient can be traced across time to look at changes in function and ,in turn,can be aggregated.
The next important step in the progression is to move the focus from a single point of care to the linking of related elements of care. In an ideal system,patient information would be linked to permit tracing changes in status for that individual as they move from one treatment modality to another.thus,hospital admis 、、、少、、、care information would be merged into a common computer-linked record,which allows one to trace the patient's movements and status.
Finally,it would be desirable to have data on the process of care as well as the outcomes. This combination would permit analyses of what elements of care made a difference for which patients.
Such an approach to assuring quality is within our grasp if we are prepared to invest in data systems and to commit ourselves to collecting standardized information. It necessitates a shift in some of our fundamental paradigms from thinking about whether we did the right thing to deciding if it made any difference after all.
Two basic changes in thinking are necessary in order to establish an outcome based philosophy,both of which are difficult for clinicians.