As introduced in Chapter 1, however, health database organizations (HDOs) hold considerable promise as a reasonably comprehensive source of the information needed to: In practice, no one system will suit every need or produce information appropriate for every question. In principle, this information can be acquired through numerous avenues, such as surveys, electronic financial transactions for health insurance claims, computer-based patient records (CPRs), and disease registries.
When this is so, they can say little, with confidence, about the value of the investment in health care for population subgroups, regions, or the nation as a whole. They may not be able to determine with confidence the outcomes, quality, effectiveness, appropriateness, and costs of care for different segments of the population, for different settings, services, and providers, and for different mechanisms of health care delivery and reimbursement. Policymakers, researchers, health professionals, purchasers, patients, and others continue to be frustrated in their attempts to acquire health information.
The needs are quite broad: health care reform evaluation of clinical care and health care delivery administration of health plans, groups, and facilities and public health planning. 1 Beyond debate, however, is the need for much more and much better information on use of health care services and on the outcomes of that care. No one engaged in any part of health care delivery or planning today can fail to sense the immense changes on the horizon, even if the silhouettes of those changes, let alone the details, are in dispute.
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