The Institute of Medicine (“IOM”) issued its newest report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (the “Report”), on September 6, 2012. The Report follows the IOM’s previous publications, including To Err is Human: Building a Safer Health System and Crossing the Quality Chasm, which address improving the quality of health care in the United States. The newest Report is the product of the IOM’s Committee on the Learning Health Care System in America, a committee focused on exploring the central challenges to health care and recommending ways to create a learning health care system.
The IOM developed the idea of the learning health care system through its Roundtable on Value & Science-Driven Health Care. A learning health care system 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. As the Roundtable noted, a health care system that gains from continuous learning is a system that can provide Americans with superior care at lower cost.
Mark D. Smith, the Committee Chair noted, “Our health care system lags in its ability to adapt, affordably meet patients’ needs, and consistently achieve better outcomes. But we have the know-how and technology to make substantial improvement on costs and quality. Our report offers the vision and road map to create a learning health care system that will provide higher quality and greater value.” The Committee believes that care that is based on the best available evidence, takes appropriate account of individual preferences, and is delivered reliably and efficient, is possible today. It is also generally less expensive than the less effective, less efficient care that is now too commonly provided. However, achieving higher quality care at a lower cost will require an across-the-board commitment to transform the U.S. health system into a “learning” system that systematically captures and broadly disseminates lessons from every care experience and new research discovery.
The Report contained several recommendations and discussed various strategies to cultivate the idea of the learning health care system. The Committee first noted that the foundation for a learning health care system is continuous knowledge development, improvement and application. In order to establish this foundation, the Committee recommended improving the digital infrastructure to capture clinical, care delivery process and financial data for better care, system improvement and generation of new knowledge. The Committee recommended increasing involvement at the patient level, the organizational level and the agency level as a strategy to build the digital infrastructure. Regulatory agencies were called to improve regulations concerning the collection and use of clinical data to protect patient privacy and the seamless use of clinical data for better care coordination and management, improved care, and knowledge enhancement.
The Report also emphasized that engaged patients are central to an effective, efficient and continuously learning system. Patients and families should be fully engaged participants at all levels, including individual care decisions, health system learning and improvement activities and community-based interventions to promote health. One of the strategies recommended by the Committee was for clinicians to employ high-quality, reliable tools and skills for informed shared decision making with patients and families, tailored to clinical needs, patient goals, social circumstances, and the degree of control patients prefer.
The Committee also recommended that health care delivery organizations develop organizational cultures that support and encourage continuous improvement, the use of best practices, transparency, open communication, staff empowerment, coordination, teamwork, and mutual respect and align rewards accordingly.
The previous IOM reports have sparked numerous discussions on efforts to improve health care practices in the United States. The Best Care at Lower Cost will likely also bring attention to the idea of a learning health care system in order to provide higher quality and greater value.
This article was originally published in the September 2012 issue of Atlanta Hospital News.