Granting Wishes

But such projects are expensive, and most nearby hospitals don't have the IT staff to support any such technology. To help offset costs, Powers' IT organization serves as an outsourcing agent for some of the smaller hospitals in the region, sending staff to work at these facilities as needed. "Given that they have no experience implementing technology, it's important to have a partner that can assist with acquisition, installation, and the process and culture changes that are happening," Powers says.

Ball Memorial also offers distance-learning classes and has set up videoconferencing capabilities in remote hospitals to be used for continuing education. In some cases, Powers has included small hospitals when negotiating agreements with large vendors. It's not worth it for vendors to sell to small hospitals directly, so Ball Memorial included in the language of its contracts that it will extend its same technology to smaller facilities. The vendors are happy because they get a little more revenue without using resources on smaller facilities. In the end, collaboration improves the health and well-being of the entire region.

That mirrors the goals of the AHRQ grants. But the $50 million will barely scratch the surface when it comes to meeting the needs of smaller and rural communities. "America would get a huge dividend from quadrupling AHRQ's budget," says Dr. Arnold Milstein, a principal and consultant at consulting firm William M. Mercer and a strategic adviser to many health-care related agencies, including AHRQ. One of the most powerful remedies to medical errors is real-time clinical information systems that continually draw on common information about a patient, Milstein says. If such technology existed across the country, that information would be invaluable. "We'd be able to perfect America's ability to quantitatively compare performances of doctors and hospitals and treatment options," he says. "AHRQ is the most valuable and underinvested public agency on the face of the earth."

But there's hope. Just as AHRQ has gotten attention from the federal government for this grant program, politicians are beginning to look at health-care quality across the board. Skeptics say that's only because it's an election year, and health care is a hot issue. But Berkshire's Podesta says the fact that the issue was included in President Bush's State of the Union address this year is a sign that it's taking top priority.

And there are things that can be done that don't require money, Susquehanna's Wirth says. The health-care industry needs to get organized. It needs to set implementation standards and best practices to help all physicians get electronic medical-record capabilities in their offices. Common medical definitions need to be published. The industry needs to move forward on what it has already learned about integrating health enterprises to support secure patient information systems.

Perhaps most importantly, someone needs to take the lead. Several health-care groups have specific areas of HIT expertise, but no one's coordinating the groups and organizing the areas of knowledge and agendas. And there's no time to waste. "This is an election year," Wirth says, "so let's use that interest and desire to decrease patient errors and eventually have an impact on the cost of health care. Now that we have that, let's take advantage and run."

Illustration by Luba Lukova

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