In 1999, I had a cellphone, but it definitely was not smart. My laptop weighed 12 pounds. My desktop computer was reliably unreliable and took up most of the desk. (Although, I think my cats still remember it fondly as a toasty perch and mourn its demise.) The basement was a graveyard for big clunky printers and scanners that no longer worked. And wires, wires, everywhere there were wires.

If you have racked up 15 years of health care experience, you can probably come up with a similar quaint-sounding list. When the Most Wired Survey began, information technology was most commonly talked about in terms of myriad back-office functions with some forays into supply chain management, as the vaunted battle between bricks and clicks was just beginning. But everything would change — and quickly.

In 1999, H&HN's Most Wired Survey and Benchmarking Study launched as a national inventory on hospital use of information technology to improve operations and patient care. Hospitals and health systems wanted to know how they stacked up against other organizations nationwide. Each participating organization — not just Most Wired designees — receives a customized report detailing its individual strengths and weaknesses compared with the field. All entrants also receive a national trends report framing the big-picture IT issues. This year, a new high of 659 hospitals and systems completed the survey, representing 1,713 hospitals, roughly 30 percent of all U.S. hospitals.

Coincidentally, this is also the 15th anniversary of the patient safety movement. In 1999, the Institute of Medicine published "To Err is Human: Building a Safer Health System" with the goal of reducing preventable medical errors. And a whole new and long-overdue public discussion began about what was frequently treated as a hush-hush boardroom topic or a forum for legal wrangling.

The explosion of IT systems and the patient safety movement may have been two theoretical ships passing in the night, but each felt the other's wake. It was soon apparent that technology could boost human performance with advances in automated medication order entry systems and computerized physician order entry. IT now plays a prominent role in patient documentation, clinical decision support and evidence-based protocols with more to come.

IT is so important to the delivery system that it is now the fulcrum point for the clinical, operational and strategic directions of health care. Hospitals will not be able to connect the continuum of care, align physicians and other providers, push evidence-based practices, and improve efficiency without the development of truly integrated information systems.

Delivery system transformation and a successful transition to value-based care and all of the data and information needed to make accountable care, the continuum of care and population health efforts possible rests within the capabilities of information technology.

IT has come a long way from supporting the back office to being at the center of clinical decision-making, quality improvement, and possibly the future shape of the system itself.

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