ABSTRACT
The U.S. healthcare system is immensely complex and fragmented with multiple providers, multiple sources of funding, and multiple locations of care. There are more than 360,000 care delivery sites in the United States, and often there is little or no communication between them. It has been estimated that in as many as 80% of outpatient encounters, the provider lacks potentially important information about the patient that is hidden away in the ˆles of other providers. What is communicated is often incomplete, inaccurate (wrong or out of date), or unclear (i.e., illegible, nonsensical notes). Clinical decisions based on invalid or out-of-date information can have disastrous consequences and result in much inefˆciency, including duplication of tests, delays in care delivery, and inappropriate or unnecessary care. All of this can ultimately raise the cost of care and lead to patient harm.
