Best Care at Lower Cost: The Path to Continuously Learning Health Care in America
Health care in America has experienced an explosion in knowledge, innovation,
and capacity to manage previously fatal conditions. Yet, paradoxically,
it falls short on such fundamentals as quality, outcomes, cost, and equity.
Each action that could improve quality—developing knowledge, translating
new information into medical evidence, applying the new evidence to patient
care—is marred by significant shortcomings and inefficiencies that result in
missed opportunities, waste, and harm to patients.
The full extent of these shortcomings is visible when considering how
other industries routinely operate compared with many aspects of health care.
Builders rely on blueprints to coordinate the work of carpenters, electricians,
and plumbers. Banks offer customers financial records that are updated in real
time. Automobile manufacturers produce thousands of vehicles that are standardized
at their core, while tailored at the margins. While health care must
accommodate many competing priorities and human factors unlike those in
other industries, the health care system could learn from these industries how
to better meet specific needs, expand choices, and shave costs. Americans
would be better served by a more nimble health care system that is consistently
reliable and that constantly, systematically, and seamlessly improves. In
short, the country needs health care that learns by avoiding past mistakes and
adopting newfound successes.
In response to widespread demand for an improved health care system,
the Institute of Medicine (IOM) convened a committee to explore health care
challenges and to recommend ways to create a continuously learning health
care system. Its work was supported by the Robert Wood Johnson Foundation,
the Blue Shield of California Foundation, and the Charina Endowment Fund,
and it builds on landmark IOM reports published in the past two decades,
including To Err Is Human: Building a Safer Health System, Crossing the Quality Chasm: A New Health System for the 21st century,
and Unequal Treatment: Confronting Racial
and Ethnic Disparities in Health Care. The IOM
offers its recommendations in Best Care at Lower
Cost: The Path to Continuously Learning Health
Care in America.
Building an Adaptive System
Because health care is complex and constantly
changing, the committee set out to chart a transition
to a system that learns, in real time and
with new tools, how to better manage problems.
Indeed, such opportunities now exist that were
not available just a decade ago. Vast computational
power is increasingly affordable, and connectivity
allows information to be accessed in real
time. Human and organizational capabilities offer
expanded ways to improve the reliability and efficiency
of health care. And health care organizations
and providers recognize that effective care
must be delivered by collaborative teams of clinicians,
each member playing a vital role. Yet simply
acknowledging such opportunities does not necessarily
result in putting them to good use.
The responsibility for building a continuously
learning health care system rests on many
shoulders because the stakes are high. As the IOM
committee reports, every missed opportunity for
improving health care results in unnecessary suffering.
By one estimate, almost 75,000 needless
deaths could have been averted in 2005 if every
state had delivered care on par with the best performing
state. Current waste diverts resources;
the committee estimates $750 billion in unnecessary
health spending in 2009 alone.
Data generated in health care delivery—
whether clinical, delivery process, or financial—
should be collected in digital formats, compiled,
and protected as resources for managing care,
capturing results, improving processes, strengthening
public health, and generating knowledge.
The Department of Health and Human Services
(HHS) can encourage not only this digital
capacity, but also the development of distributed
data research networks and expanded access
to health data resources to improve care, lower
costs, and enhance public health. Payers and
medical product companies also should contribute
more data to research groups to generate new
insights. Patients should participate in developing
robust data utility; use new tools, such as personal
portals, to better manage their own care; and
be involved in building new knowledge, such as
through patient-reported outcomes.