Errors in medicine: problems and solutions for managed care.

Extrapolating data from 2 large retrospective studies, the IOM report provides an estimate of errors in health care. While these estimates have been taken from inpatient experience and not from ambulatory care (the site of most HIV/AIDS care today), these estimates have stimulated discussion and action on the part of the Federal government and health care organizations to improve patient safety. HIV/AIDS care lends itself to electronic solutions as suggested in the IOM report. Providers are under increasing pressure to do more clinical work and documentation in an era of shrinking resources. Managing the care of patients with HIV/AIDS requires frequent visits and necessitates documentation of both clinical and nonclinical information and considerable coordination and tracking of care activities by all members of the care team, with the goals of good outcomes and cost-effectiveness. Recent studies suggest that the current standard of HIV care is effective and cost-effective. Today's electronic technologies can help sustain these good outcomes by helping to manage large volumes of critical health information more efficiently. Electronic management of health information requires a change in work patterns and a significant capital investment for health organizations. Federal standards for management of electronic health information are in early implementation stages. To start the process, managed care organizations and HIV/AIDS providers should become familiar with the capabilities of electronic health information systems, begin the planning and needs assessment processes, and begin to lay the infrastructure needed for such systems.