This is a pre-publication copy of the latest Institute of Medicine report “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America”. This is an excerpt from the Preface of the report
The committee that authored this report observes challenges to the overly complex US healthcare system: learning and adoption that are maddeningly slow coexisting with overly rapid adoption of some new techniques, devices, and drugs, with harmful results. The committee also believes that opportunities exist for attacking these problems—opportunities that did not exist even a decade ago.
- Vast computational power (with associated sophistication of information technology) has become affordable and widely available. This capability makes it possible to harvest useful information from actual patient care (as opposed to one-time studies), something that previously was impossible.
- Connectivity allows that power to be accessed in real time virtually anywhere by professionals and patients, permitting unprecedented diffusion of information cheaply, quickly, and on demand.
- Progress in human and organizational capabilities and management science can improve the reliability and efficiency of care, permitting more scientific deployment of human and technical resources to match the complexity of systems and institutions.
- Increasing empowerment of patients unleashes the potential for their participation, in concert with clinicians, in the prevention and treatment of disease—tasks that increasingly depend on personal behavior change.
The committee recognizes that individual physicians, nurses, technicians, pharmacists,and others involved in patient care work diligently to provide high-quality, compassionate care to their patients. The problem is not that they are not working hard enough; it is that the system does not adequately support them in their work. The system lags in adjusting to new discoveries, disseminating data in real time, organizing and coordinating the enormous volume of research and recommendations, and providing incentives for choosing the smartest route to health, not just the newest, shiniest—and often most expensive—tool. These broader issues prevent clinicians from providing the best care to their patients and limit their ability to continuously learn and improve.