Introduction

The explicit use of health information technology (HIT) to enable threshold improvements in the delivery of health care services is beginning to emerge as a serious objective for health care organisations and systems. Many readers who are very knowledgeable of quality measurement are relatively uninformed about health informatics and the converse is also true. It is for these readers that this paper is written. Specifically, the objective of this review of HIT in the UK and USA will focus upon salient features, deployment, and related policy issues. Particular attention will be given to areas in which threshold improvements in quality now exist or are likely to be forthcoming. Comments are organised to relate at the level of the individual, teams or microsystems, organisations, and larger systems, including national information infrastructures.

Health care information technology is a broader phenomenon than it is deep. Over the past 30 years the information technology revolution developed slowly from roots in Turing's military intelligence machines of World War II to DARPA and the present day Internet when the pace picked up. While the telephone took 40 years to reach 10 million people, it only took 4–5 years for the Internet to reach 100 million. Despite successes being clouded by hype and hope, the Internet consumer health market is projected to reach $1.7 billion by 2003.

Randomised trials now confirm the early evidence that health care quality can be significantly improved through health informatics.¹ Evidence of improved access and cost effectiveness should soon follow.² Over the next two decades e-health could deliver patient, provider, and planner/manager interactions for all aspects of health …