On Sep. 6, the Institute of Medicine (IOM), one of the United States National Academies, and a leading non-governmental organization in the healthcare policy arena, released a report entitled “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” The report was produced by a committee of 18 volunteer healthcare industry leaders, including such luminaries as Helen Darling, president of the National Business Group on Health; George Halvorson, chairman and CEO of Kaiser Permanente, Mark D. Smith (the committee’s chair), president and CEO of the California HealthCare Foundation, and Brent James, chief quality officer at Intermountain Health Care, and supported by nine IOM staff members.
That committee, the Committee on the Learning Health Care System in America, has produced a 382-page report, with 10 core recommendations for action to create what the report’s editors—Mark Smith, Robert Saunders, Leigh Stuckhardt, and J. Michael McGinnis—call a vision of a new healthcare system: “a learning healthcare system that links personal and population data, to researchers and practitioners, dramatically enhancing the knowledge base on effectiveness of interventions and providing real-time guidance for superior care in treating and preventing illness.” The editors added that “A healthcare system that gains from continuous learning is a system that can provide Americans with superior care at lower cost.”
Reflecting on both the gains that have been made in healthcare delivery performance since the publication of the groundbreaking IOM report “To Err Is Human: Building a Safer Health System” in 1999, and its follow-up report “Crossing the Quality Chasm,” published in 2001, as well as the obstacles that remain in improving patient safety, care quality, cost-effectiveness, and efficiency, the report’s authors and the committee offer the following 10 core recommendations:
> The digital infrastructure: Improve the capacity to capture clinical, care delivery process, and financial data for better care, system improvement, and the generation of new knowledge.
> The data utility: Streamline and revise research regulations to improve care, promote the capture of clinical data, and generate knowledge.
> Clinical decision support: Accelerate integration of the best clinical knowledge into care decisions.
> Patient-centered care: Involve patients and families in decisions regarding health and healthcare, tailored to fit their preferences.
> Community links: Promote community-clinical partnerships and services aimed at managing and improving health at the community level.
> Care continuity: improve coordination and communication with and across organizations.
> Optimized operations: Continuously improve healthcare operations to reduce waste, streamline care delivery, and focus on activities that improve patient health.
> Financial incentives: Structure payment to reward continuous learning and improvement in the provision of best care at lower cost.
> Performance transparency: Increase transparency on healthcare system performance.
> Broad leadership: Expand commitment to the goals of a continuously learning healthcare system.
Importantly, the report’s authors and the committee note, “Given the interconnected nature of the problems to be solved, it will be important to take the actions identified above in concert.” For example, they note, “To elevate the quantity of evidence available to inform clinical decisions, for example, it is necessary to increase the supply of evidence by expanding the clinical research base; make the evidence easily accessible by embedding it in clinical technological tools, such as clinical decision support; encourage use of the evidence through appropriate payment, contracting, and regulatory policies and cultural factors; and assess progress toward the goal using reliable metrics and appropriate transparency.” And, they add, “The absence of any one of these factors will substantially limit overall improvement.”
In other words, the committee and the report’s authors agree, a combination of continuous performance improvement, continuously increasing evidence-based care supports, care coordination, continuous improvements in operational efficiency, and the creation of cultures of continuous learning, all supported and facilitated by significant investment in the information systems needed to create this change, will be required.
The implications for healthcare leaders and healthcare IT leaders are obvious, and most importantly, this IOM report acknowledges the interconnectedness of all the issues involved.
To sort through some of those issues, HCI Editor-in-Chief Mark Hagland spoke with Paul Tang, M.D., a committee member, regarding the implications for healthcare IT leaders. Tang is vice president and chief innovation and technology officer at the Palo Alto Medical Foundation, a multispecialty group in Palo Alto, California, that takes care of 800,000 patients in a service area just south of San Francisco. Below are excerpts from that interview.
To begin with, what seems particularly important about this report is that the committee is recommending a broad range of continuous improvements to be tackled in concert, including patient safety and care quality improvement, efficiency improvement and performance improvement, care coordination, provider-community connectedness, and strategic information technology implementation and leveraging. Is that a correct summation of the broadest goals in the report?