While clinical and biomedical research production is rapidly growing, delivery to practitioners remains unacceptably slow. Numerous studies document significant delay, loss, and waste in the production and dissemination of evidence from research. To improve health care quality and to make the best scientific achievements part of usual practices, clinicians have to be informed. Better information systems and services are needed to support health care practices in absorbing and efficiently introducing the constantly growing amount of information. There is a need for a more systematic analysis of practical relevance and better overall efficiency in the process of transferring clinical evidence from research to practice.

The purpose of this book is to provide insight into the new and innovative uses of computers and other digital information technologies from European and American leaders in the fields of communication and health information sciences. Information technologies are impacting organizations, communities and societies and redefining systems for education, work, health services and almost every other aspect of life. Throughout the book the issues of how information technologies can facilitate health care quality improvement by transferring research evidence to practitioners is explored through emerging information technologies, better information for quality health care, and international collaboration. The book is divided into three sections, with several chapters in each section.

The first section describes the information infrastructure for transferring research. New scientific information is being discovered at a rapid rate. Putting research into practice should be the ultimate goal of emerging information technologies. The chapter by Donald A.B. Lindberg, M.D. of the National Library of Medicine addresses the transfer of research through high performance computing. Literature-based and fact-based services that help deliver modern scientific information at the time and place that it is most useful are discussed. Otto Rienhoff, M.D. of the Georg August University in Gottingen, Germany provides an overview of how the training and delivery of medical care needs to be reengineered. Medical training is not keeping up with modern realities. Doctors need to be trained to deal with more informed patients and information technologies. Physician practices need retooling to deal with the isolation many physicians feel in their everyday practices. A high degree of specialization, massive information flow, and better-informed patients create a desire among physicians to link to other physicians. Ilias Iakovidis, Ph.D. of the European Commission on Telecommunications in Brussels, Belgium highlights European initiatives in the emerging health information infrastructure and citizen-centered shared care. The health information infrastructure is an enabling mechanism for continuity of care. Reed M . Gardner, Ph.D. of the University of Utah in Salt Lake City, Utah focuses on methods of gathering and using clinical data for clinical research and patient care. The examples in this chapter are based on the HELP hospital computer system at LDS Hospital in Salt Lake City.

The second section includes three chapters that describe aspects of how knowledge can be structured for practical application. Alexa T. McCray, Ph.D. of the Lister Hill National Center for Biomedical Communications which is part of the National Library of Medicine in Bethesda, Maryland provides an introduction to the digital libraries initiative funded by the U.S. federal government, a discussion of the Unified Medical Language System, and issues in creating Web-accessible resources for health care consumers. Nancy M. Lorenzi, Ph.D. of the University of Cincinnati and Robert T. Riley, Ph.D. of Riley Associates in Cincinnati, Ohio discuss knowledge and change in health care organizations by focusing on the reality that managing change is crucial to the success of an information system. Users must be involved in systems development from the beginning to feel ownership in the system and look upon it as “our” system, not “their” system or “my” system. A successful project depends 80% on the social and political interaction skills of the developer and only 20% on implementation of the hardware and software. The developer must have organizational savvy, and be aware of who in the organization has the ability to make things happen, i.e., be “positively political.” Jean Roberts, B.Sc. M.B.C.S., M.H.S.M., C.Eng. of First Consulting Group in Macclesfield, United Kingdom addresses how to incorporate knowledge into commercially available systems. This chapter focuses on attitudes to the transfer of knowledge, funding mechanisms and how to protect an investment in knowledge.

The third section deals with practical solutions to obtain better information for improved health care quality. Janet Corrigan, Ph.D., M.B.A. of the Institute of Medicine at the National Academy of Sciences in Washington, D.C. discusses the current state of health care quality and describes some of the factors that are hindering efforts to move toward evidence-based practice. The efforts of the President’s Advisory Commission on Consumer Protection and Quality are also described. Kenneth D. Bopp, Ph.D. of University of Missouri in Columbia, Missouri highlights the multiple roles patients play in the health care process. Patients are both consumers and co-producers of services. Patients provide information that is critical to their diagnosis and treatment. They need to receive instructions on exactly what they are to do to carry out their treatment. Patients are banding together in self-help groups for their conditions, and giving input as to how they wish health professionals to deal with them. Mary Jane Richman, R.N., M.N., P.N.P. and Jeffrey S. Poltawsky, M.S., C.H.E. of Egleston Scottish Rite Children’s Healthcare System in Atlanta, Georgia provide an example of how evidence-based disease management can be applied to a population of pediatric asthma patients to improve quality and access while decreasing total health care costs.

As mentioned earlier, international collaboration appears to be vital to move forward with efforts to prepare for modern practice and improve health care quality. However, various issues must be addressed between Europe and the United States in order to move forward with collaborations. The main challenges in transferring research to practice are user acceptance, cultural differences, national and regional strategies, legal and ethical issues, and standardization of technologies. We need to shift our attention to these enabling mechanisms for good implementation.

The degree of difference between the definitions of health professions in the various countries is quite dramatic. The same words are used, but they represent different legal concepts, professional roles, and self-understanding. For international collaboration to be successful, we need to recognize that we deal with hundreds of different professional types and not just with three or four. In countries that are in dire need of health professionals, differently educated health professionals may help fill that need. A major stumbling block to future international collaboration is agreement on protection of medical data. The Council of Europe recommendations, issued in February 1997, do not carry the weight of law, but do highlight the need for serious dialogue between the European Union and United States. Information ethics research is needed to address medical ethics aspects of the use of databases.

This book comes out of the conference “Transferring Research to Practice in the Information Age” held at the University of Missouri, November 12 and 13, 1998. This two-day conference also coincided with the opening of the European Union Center at (he University of Missouri.

E. Andrew Balas, M.D., Ph.D.

Suzanne Austin Boren, M.H.A.

Gordon D.Brown, Ph.D.