APPENDIX A
Workshop Agenda

The Roles of Academic Health Centers in the 21st Century

Thursday, January 24

8:30-8:40

Welcome, opening remarks

John Edward Porter

8:40-9:00

Introductions around the table

 

Section I: Changing Needs and Trends in Health Care

9:00-9:20

How AHCs Can Meet the Future of Health Care

Uwe E. Reinhardt, Ph.D., Professor of Economics and Public Affairs, Woodrow Wilson School of Public and International Affairs, Princeton University

9:20-9:40

Future Trends and Directions in Health Care

Jeff Goldsmith, Ph.D., President, Health Futures, Inc. and Associate Professor of Medical Education, University of Virginia

9:40-10:00

Brief Questions for Drs. Reinhardt and Goldsmith

10:00-10:30

Changing Expectations for AHCs from Various Constituencies

The Needs of Patients: Ellen Stovall, Executive Director, National Coalition for Cancer Survivorship

The Needs of Low Income Populations: Sara Rosenbaum, J.D., Harold and Jane Hirsh Professor of Law and Policy, George Washington University School of Public Health and Health Services

The Needs of Health Plans: Charles Cutler, M.D., Chief Medical Officer, American Association of Health Plans

10:30-11:10

Q&A for all morning presenters

Do different constituencies have conflicting expectations for AHCs?

Which trends and expectations are likely to have a particularly significant impact on the roles performed by AHCs?

11:10-11:20

Break



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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary APPENDIX A Workshop Agenda The Roles of Academic Health Centers in the 21st Century Thursday, January 24 8:30-8:40 Welcome, opening remarks John Edward Porter 8:40-9:00 Introductions around the table   Section I: Changing Needs and Trends in Health Care 9:00-9:20 How AHCs Can Meet the Future of Health Care Uwe E. Reinhardt, Ph.D., Professor of Economics and Public Affairs, Woodrow Wilson School of Public and International Affairs, Princeton University 9:20-9:40 Future Trends and Directions in Health Care Jeff Goldsmith, Ph.D., President, Health Futures, Inc. and Associate Professor of Medical Education, University of Virginia 9:40-10:00 Brief Questions for Drs. Reinhardt and Goldsmith 10:00-10:30 Changing Expectations for AHCs from Various Constituencies The Needs of Patients: Ellen Stovall, Executive Director, National Coalition for Cancer Survivorship The Needs of Low Income Populations: Sara Rosenbaum, J.D., Harold and Jane Hirsh Professor of Law and Policy, George Washington University School of Public Health and Health Services The Needs of Health Plans: Charles Cutler, M.D., Chief Medical Officer, American Association of Health Plans 10:30-11:10 Q&A for all morning presenters Do different constituencies have conflicting expectations for AHCs? Which trends and expectations are likely to have a particularly significant impact on the roles performed by AHCs? 11:10-11:20 Break

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary   Section II: Creating a Vision for the Future   Panel on the Clinical Service Role 11:20-11:35 Peter Kohler, M.D., President, Oregon Health and Science University 11:35-11:50 Ezra Davidson, M.D., Associate Dean, Charles R. Drew University of Medicine and Science 11:50-12:30 Questions for panelists and general discussion As competition in clinical services grows and more sources of care are available, where does the AHC fit into the delivery system? To what extent is the academic relationship a differentiating factor in the marketplace? Do AHCs have a role in developing efficient and effective models of care for the populations dependent upon them? 12:30-1:15 Lunch/Break   Panel on the Education and Training Role 1:15-1:30 A Perspective from Medicine—Edward Hundert, M.D., Dean, University of Rochester School of Medicine and Dentistry 1:30-1:45 A Perspective from Nursing—Colleen Conway-Welch, Ph.D., R.N. Dean and Professor, School of Nursing, Vanderbilt University 1:45-2:00 A Perspective from Public Health—James W. Curran, M.D., M.P.H., Dean and Professor of Epidemiology, The Rollins School of Public Health, Emory University 2:00-2:45 Questions for panelists and general discussion How will training programs in medicine, nursing and public health relate to each other to effectively train health professionals in the future? Can linkages be created between medical, behavioral and social sciences to improve health? Will education become more expensive in the future? Why? To what extent will changes in the education and training role impact the clinical service and/or research roles, or are the future changes in this role independent of other roles? 2:45-3:00 Break   Panel on the Research Role 3:00-3:15 Biomedical Research—Gerald Fischbach, M.D., Executive Vice President for Health and Biomedical Sciences; Dean, Faculty of Health Sciences; Dean, Faculty of Medicine, Columbia University College of Physicians and Surgeons 3:15-3:30 Clinical Research—Ralph Snyderman, M.D., Chancellor for Health Affairs; Executive Dean, School of Medicine; President and CEO, Duke University Health System 3:30-3:45 Perspectives from Private Industry—Samuel Broder, M.D., Executive Vice President, Celera Genomics 3:45-4:00 Health Services Research—Ralph I. Horwitz, M.D., Yale University School of Medicine

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary 4:00-4:45 Questions for panelists and general discussion Are research relationships between AHCs and private industry likely to increase or decrease in the future? What are the potential benefits and concerns that arise in research relationships between AHCs and private industry? How do AHCs set research priorities? Who has input in defining priorities? How important are concerns surrounding technology transfer? What is the role of the university in technology transfer? 4:45-5:00 Thanks to those leaving, Committee’s next steps; Adjourn Friday, January 25 8:30-8:45 Call to Order, announcements, new introductions John Edward Porter, Chair   Section III: Creating an Environment to Support Needed Changes 8:45-9:10 Critical Issues to Confront In Studying Academic Health Centers David Blumenthal, M.D., Executive Director, Commonwealth Task Force on Academic Health Centers; Director, Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, Inc. 9:10-9:40 Questions and Discussion 9:40-10:00 Financial Issues Affecting the Future of Academic Health Centers Bruce Vladeck, Ph.D., Senior Vice President for Policy, Mount Sinai/NYU Health 10:00-10:20 Questions and Discussion 10:20-10:30 Break 10:30-10:50 An AHC’s View on Cross-Subsidies and the Implications for Shifting Priorities Darrell G. Kirch, M.D., Senior Vice President for Health Affairs; Dean, College of Medicine; and CEO, Penn State Milton S. Hershey Medical Center, Pennsylvania State University 10:50-11:10 Questions and Discussion 11:10-11:30 Variation In the Roles Pursued by Academic Health Center Gerard F. Anderson, Ph.D., Professor and Director, Center for Hospital Finance and Management, The Johns Hopkins University Bloomberg School of Public Health 11:30-11:50 Questions and Discussion 11:50-12:15 General Discussion Are all AHCs affected equally be the changing trends? Are all AHCs equally prepared to meet changing community needs? To what extent can AHCs make changes desired by both themselves and their communities within current financing methods (e.g., if more ambulatory and multidisciplinary education is desired, can it be done)?

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary   What are the non-financially related needs of AHC to adapt to a changing health system? 12:15 Committee’s next steps, Thanks, Adjourn John Edward Porter, Chair

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary Participants Linda Aiken, Ph.D., R.N., FAAN, FRCN Center for Health Outcomes and Policy Research University of Pennsylvania Philadelphia, PA Gerard Anderson, Ph.D. Johns Hopkins University Baltimore, MD J. Claude Bennett, M.D. BioCryst Pharmaceuticals, Inc. Birmingham, AL Brian Biles, M.D., M.P.H. George Washington University Washington, DC Joseph D. Bloom, M.D. Oregon Health and Science University Portland, OR David Blumenthal, M.D., M.P.P. Institute for Health Policy Boston, MA Samuel Broder, M.D. Celera Genomics Rockville, MD Jordan Cohen, M.D. Association of American Medical Colleges Washington, DC Colleen Conway-Welch, Ph.D., CNM, FAAN Vanderbilt University School of Nursing Nashville, TN James W. Curran. M.D., M.P.H. Rollins School of Public Health Emory University Atlanta, GA Charles Cutler, M.D., M.S. American Association of Health Plans Washington, DC Ezra Davidson, M.D., FACOG Charles R. Drew University of Medicine Los Angeles, CA Nancy-Ann Min DeParle, J.D. Adjunct Professor of Health Care Management, Wharton School, University of Pennsylvania Senior Advisor, JP Morgan Partners New York, NY Robert Dickler Association of American Medical Colleges Washington, DC Gerald Fischbach, M.D. Columbia University College of Physicians and Surgeons New York, NY Jeff Goldsmith, Ph.D. Health Futures, Inc. Charlottesville, VA Edward Holmes, M.D. University of California San Diego La Jolla, CA Ralph Horwitz, M.D. Yale University School of Medicine New Haven, CT Edward Hundert, M.D. School of Medicine and Dentistry University of Rochester Rochester, NY Darrell Kirch, M.D. Penn State Milton S. Hershey Medical Center Hershey, PA Lawrence Lewin, M.B.A. Executive Consultant Washington, D.C. Nicole Lurie, M.D. The RAND Corporation Washington, DC

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary John Edward Porter, J.D. Hogan and Hartson, L.L.P. Washington, D.C. Paul G. Ramsey, M.D. University of Washington School of Medicine Seattle, WA Uwe E. Reinhardt, Ph.D. Princeton University Princeton, NJ Robert Reischauer, Ph.D. The Urban Institute Washington, D.C. Sara Rosenbaum, J.D. The George Washington University Washington, DC John W. Rowe, M.D. Aetna Inc. Hartford, CT Elaine Rubin, Ph.D. Association of Academic Health Centers Washington, DC Marla Salmon, ScD, RN, FAAN Nell Hodgson Woodruff School of Nursing Emory University Atlanta, GA Christine Seidman, M.D. Brigham and Women’s Hospital Harvard Medical School Boston, MA Ralph Snyderman, M.D. Duke University Health System Durham, NC Bruce C. Vladeck, Ph.D. Mount Sinai School of Medicine New York, NY M. Roy Wilson, M.D. Creighton University School of Medicine Omaha, NE IOM Staff Linda T. Kohn, Ph.D., Study Director Ronné Wingate, Project Assistant Janet Corrigan, Ph.D., Director, Division of Health Care Services

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary APPENDIX B Remarks Prepared by Ellen Stovall for Presentation at IOM Conference on Academic Health Centers Good morning, I am Ellen Stovall, a 30-year survivor of Hodgkin’s disease. I am also the Executive Director of the National Coalition for Cancer Survivorship, an organization that serves individuals with all kinds of cancer. I am pleased to be here today to talk about the partnership between individuals with cancer and academic health centers. In my remarks, I will focus primarily on the experience of individuals with cancer, an experience I can discuss with significant knowledge, but many of my comments are relevant to the situation of those with other serious and life-threatening illnesses. Over the course of the last twenty years, cancer care has shifted significantly from cancer centers, most of which are part of academic health centers, to the community. Most individuals with cancer currently receive their care from a community oncologist. Even though the care of cancer patients has shifted to a community setting, we remain heavily dependent on academic health centers. The quality of our cancer care is contingent in large part on how well the academic health centers accomplish their core missions. The delivery of quality cancer care hinges on the availability of specialists who receive their training at academic health centers. Cancer patients realize that they are able to receive outstanding care in the community because of the solid training that their oncologists receive at academic health centers. And many of us with rare cancers or those with limited treatment options may find that the best of limited treatment options are provided at academic health centers. For the cancer patient, the most critical role for the academic health center is its research mission. Cancer care has changed slowly and incrementally, with improvements in care coming through clinical research that is conducted in the academic health center and in the community setting. For a few cancers, the improvements in treatment have been significant and the boost in survival rates have been impressive. For many more cancers, the enhancements in treatment have been modest and the challenges to additional clinical advances are substantial. Although progress in cancer clinical research has not been as rapid as we all wish, cancer survivors remain steadfast and aggressive advocates for clinical research. We believe that a healthy clinical research enterprise is literally our lifeline, and we understand that the health of academic health centers is an essential part of this equation. I said at the beginning of my remarks that cancer survivors consider themselves the partners of academic health centers. To us, that partnership has meant fighting for federal dollars to support biomedical research, improving third-party reimbursement for care provided in clinical trials, and enrolling willingly in clinical trials. We realize that, despite our efforts and those of many more advocates to boost federal research funding, these dollars account for a shrinking proportion of the academic health center budget. We also

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary understand that academic health centers are forging new relationships with biotechnology and pharmaceutical sponsors to support their research programs. These are relationships that we endorse, because we wish to see promising research findings translated as rapidly as possible into new treatments. However, there are risks associated with the strong partnership between academic health centers and industry. One of the greatest risks is the potential for conflicts of interest if individual researchers or institutions have a financial interest in the commercialization of their research. Even the appearance of a conflict is a possible problem if it undermines the confidence of the public in the research system. We urge the community of academic health centers to approach this matter seriously and to act aggressively to reassure their most important research partners – clinical trial participants – that potential conflicts of interest are being evaluated carefully and disclosed or managed appropriately. The two recent reports on conflicts of interest in research suggest different solutions to the issue, and the cancer community is not yet prepared to recommend specific reforms at this time. It is clear that balance in the monitoring of possible conflicts of interest much be achieved so institutions are not overwhelmed by new regulatory responsibilities at the same time many are reforming their institutional review boards and implementing medical records privacy standards. This is a matter of trust between academic health centers and a very important constituency, the group of willing and enthusiastic clinical trial participants. Aggressive action regarding conflict of interest issues is critical to a continued strong partnership between academic health centers and cancer survivors.

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary Appendix C Academic Health Centers: Challenges and Opportunities The Oregon Perspective Remarks Prepared by Peter Kohler, M.D., President, Oregon Health and Science University My topic today is Academic Medical Centers: Challenges and Opportunities, The Oregon Perspective. We’ve heard quite a bit this morning about changing needs and emerging trends in health care, and the role that AHCs might play in this ever-evolving landscape. These developments include such things as: 1) the shift to chronic care; 2) the increasing importance of information technology; 3) the emergence of genomics; and 4) cost pressures. These factors will increasingly come to define the environment in which AHCs operate. My task today is to talk a little bit about how these trends and others have impacted my institution, the Oregon Health & Science University, or OHSU, and how we’ve attempted to deal with them. I believe, as the title of my talk indicates, that within these environmental challenges lie opportunities for the academic health center. Cost Pressures and the Marketplace Environment We all know about the rapid marketplace evolution that came our way in the course of the 1990s with the advent of managed care. Oregon has one of the highest managed care penetration rates in the country, and OHSU found itself at a disadvantage in a hyper-competitive marketplace. Our revenues were not sufficient to allow needed investments. One of our greatest problems was a deteriorating physical plant. At one point, we calculated that we were behind about $400 million in deferred maintenance. That left us with a bi-modal distribution of services: 1) cutting edge medicine and 2) indigent care. We were often perceived as the hospital you went to if you were too sick or too poor to go anywhere else. In that environment, we tried to become competitive. We were able to identify and implement some improvements in quality and efficiency, but we were in large part constrained by our governance system. As a state agency, we lacked autonomy in strategic decision-making. We were unable to adjust to a rapidly changing marketplace. We approached the Governor and the State Legislature with the idea that something needed to change. There were really only three options: 1) remain a state agency; 2) become a private, 501(c) (3) corporation; or 3) become a public corporation, a public-private hybrid. We felt that remaining a state agency was unworkable. We were wary of becoming a wholly private corporation, because we had linkages to the state such as a retirement plan that would be difficult to close. Both the state and the institution itself preferred to keep OHSU as a public entity. We quickly settled on becoming a public corporation. This was approved by the legislature in 1995 and signed into law by the Governor. The practical effect is that OHSU now has a Board of Directors appointed by the Governor of Oregon and confirmed by our Senate. Under this new structure, OHSU and the Board gained a great deal of decision-making autonomy while maintaining our public missions. The results have been dramatic. We have saved millions by streamlining operations and brought in millions more through prudent business decisions. We brought our facilities closer to community standards with the proceeds of $250 million in bond financing – we would not have had access to the bond market as a state agency. We improved our research standing substantially. In terms of economic impact in our community, we have

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary grown our overall university budget by over $500 million annually, and increased jobs by 4500 to our current total of over 11,000. We are today the largest employer in Portland. Catching the Biotechnology Wave To further bolster our education and research capabilities, OHSU has (since becoming a public corporation) undertaken three separate mergers: first with the Oregon Regional Primate Research Center, then with the Neurological Sciences Institute, and most recently, with Oregon Graduate Institute of Science and Technology (OGI). The OGI merger, in particular, represents a key element in our efforts to capitalize on the genomic revolution. It is also fair to say that it represents a philosophical shift from the traditional focus of an academic health center. As part of the merger, which was completed in the summer of 2001, we modified our mission statement to include engineering and high technology. During the course of a two-year strategic planning process, it became more and more obvious that medicine was moving towards engineering and computer science. As Lou Gerstner, the CEO of IBM, said recently: “There is a market now emerging around the marriage of information technology with life sciences research and genetics, and I personally believe this represents the next major revolution – not only in this industry, but for society at large.” By putting the OGI School of Science and Engineering alongside Schools of Dentistry, Nursing and Medicine, we believe we have created a unique university. This will distinguish us academically, but it can also distinguish us clinically – by translating research from bench to bedside. Collaborative Care That brings me to OHSU’s clinical care. We are working to organize our clinical operations to meet areas of strong demand while emphasizing those areas where academic health centers have a natural advantage. Fortunately, we believe there is a good deal of overleap between high-volume care areas and those lines of service that favor AHCs. I mentioned our two-year strategic planning process. The original impetus behind that process was a concern for empty beds and clinics. We began to look at how to improve our competitiveness, and to do so we looked at the future direction of health care. The principal trend that influenced our strategic planning was the move away from predominantly acute, episodic care to long-term care for chronic conditions. Since nearly half of those with chronic illnesses have more than one such condition, the best option for treatment is a collaborative, multi-disciplinary process that incorporates long-range goals and planning. At OHSU, we believe that academic health centers are in the best position to deliver the wide range of services necessary to treat chronic conditions. The synergy between education, research and clinical care gives AHCs a competitive advantage when it comes to building inter-disciplinary centers of excellence. During our planning we decided to re-organize our clinical operations towards the building of centers of excellence. This is a difficult management problem when you look at the differences between centers and institutes and the traditional departmental approach to medicine. One significant achievement was the formation of a unified group faculty practice, representing a transition from approximately 35 different departmentally based organizational models – including partnerships and corporations, both for profit and not-for-profit – to a single 501 (c) (3) corporation with all practice areas and disciplines included. This change to the

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary group practice model has been in the works for several years, and was finally fully implemented on January 1, 2002. We have had some success during the course of this transition, however, particularly if you look at the Oregon Cancer Institute. Dr. Brian Druker, the OHSU researcher who developed the anti-cancer agent Gleevec, is a good example of the bench to bedside clinician/researcher we want to develop. Dr. Druker’s work brought attention to the Institute and to OHSU while also providing early access to treatment for leukemia patients in Oregon and elsewhere. OHSU has moved forward in inter-disciplinary care by developing a Center for Women’s Health and a Center for Healthy Aging. We have also moved towards comprehensive, inter-disciplinary services in the increasingly important areas of cancer and heart disease. We have made excellent progress with pediatric cardiovascular, but have not yet made similar progress in adult cardiovascular disease. In sum, I would say that we are growing and achieving some degree of success in creating strong clinical programs while lagging in others. As we attempt to move forward, we are confronted with the problem of shortages in key personnel areas such as nursing. New Challenges Like most of the rest of the country, Oregon faces an immediate nursing shortage. We have retained an adequate staff of dedicated nurses who receive a competitive wage but an extremely generous benefits package. Recently, the AFL-CIO merged with our local bargaining unit and promised the nurses very large salary increases. As we entered into negotiations late last year, the nurses insisted on a 29% raise over two years. Naturally, we couldn’t accommodate that. In December, our nurses went on strike. We believe that the AFL-CIO sees us as a national test case, given the pro-union political climate in the Portland area in combination with the national nursing shortage. We’ve made a fair offer that would make our nurses the highest-paid in the metropolitan area in terms of wages and benefits. Unfortunately, our offers of a 6% raise per year have been rejected. We have deployed contract nurses as a means to keep our revenue from falling, but this is costly. All this occurs against the backdrop of the highest unemployment rate in the country so the union does not have as much sympathy as they might otherwise. As we speak here today, the strike goes on, in its fifth week. This could signal a national trend for the AFL-CIO in nursing. In addition, our success seems to have made us a recurring target for the Oregon legislature. In September 2001, we projected a $32 million operating margin for our hospital. In the court of public opinion, word spread rapidly that OHSU had achieved a $32 million profit – which is of course misleading given that the university and other sectors of our operation are operated at a loss. In January, our legislature began to seek ways to make up an $800 million shortfall. It would appear that one of the first places they decided to look is at the OHSU Hospital – this despite the fact that OHSU receives less than 5% of our budget from the state and just underwent a $10 million cut in the 2001 session. In a throwback to the state agency days, we were told that the state would consider a $32 million cut to OHSU and direct us to maintain programs. Needless to say, we believe that such a short sighted action would threaten to undermine all the good things we’ve done as a public corporation and all the good things to come. Nevertheless, we are vulnerable to this kind of state grab-back simply because of our success.

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary Finally, I would point out that, like most of you, OHSU is operating in an environment of ever-increasing regulatory scrutiny. Our costs associated with HIPAA, PATH audits, clinical and research compliance, personnel law, and various types of insurance, to name just a few, have increased dramatically over the past five years. This trend, unfortunately, shows no signs of abating. Quality Management In the midst of these new challenges, OHSU is nevertheless moving forward to improve our clinical operations. Another trend that we think favors AHCs is the move towards improving quality performance. We know that the complexity of what we do is one reason health care has lagged behind other industries in producing error-free performance. Nevertheless, we believe that quality can be a competitive advantage for OHSU and other AHCs. In an IOM report entitled To Err is Human, investigators suggest that one of the primary contributing factors in medical errors is the fragmented and decentralized nature of the health care delivery system. I quote: “Even within hospitals and large medical groups, there are rigidly-defined areas of specialization and influence. For example, when patients see multiple providers in different settings, none of whom have access to complete information, it is easier for something to go wrong than when care is better coordinated. At the same time, the provision of care to patients by loosely affiliated organizations and providers makes it difficult to implement improved clinical information systems capable of providing timely access to complete patient information. Unsafe care is one of the prices we pay for not having organized systems of care with clear lines of accountability.” At OHSU, we’re working to implement a multifaceted quality initiative aimed at moving us closer to error-free performance. Specifically, we want to implement the six aims outlined in the IOM report Crossing the Quality Chasm. Health care should be: 1) safe, 2) effective, 3) patient-centered, 4) timely, 5) efficient, and 6) equitable. In other words, we will strive to: 1) avoid injuries to patients from care that is intended to help them; 2) provide services based on scientific knowledge to all who could benefit and refrain from providing services to those not likely to benefit; 3) provide care that is respectful and responsive to individual patient preferences, needs and values and ensure that patient values guide all clinical decisions; 4) reduce waits and sometimes harmful delays for both those who receive and those who give care; 5) avoid waste, including waste of equipment, supplies, ideas and energy; and 6) provide care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, or socioeconomic status. From these six aims, we have devised five principles that we will use to train and evaluate personnel. Each health care provider will be measured against their ability to: 1) improve the patient experience for all patients, 2) make the hospitals and clinics safe in the delivery of health care; 3) monitor and improve clinical outcomes; 4) design better systems to assure timeliness and efficiency; and 5) assure quality while maintaining fiscal responsibility. To achieve these aims, we at OHSU are working to utilize the latest information technology. The IOM report suggests that “health care delivery has been relatively untouched by the revolution in information technology that has been transforming nearly every other aspect of society.” We think patient-practitioner relations can be enhanced by new technologies. According to the IOM report, “only a small fraction of physicians offer e-mail interactions.” We are working to encourage this practice – consistent with the new HIPAA regulations, of course. We are also working to augment communication between and among clinicians.

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The Roles of Academic Health Centers in the 21st Century: A Workshop Summary It used to be, for example, that when an x-ray was taken, the x-ray itself had to be routed among the various clinicians. It could take days to cross the desk of every concerned practitioner. Today, all interested parties can access the image in a computer file simultaneously. That is a big jump forward in efficiency and quality performance. Another area of opportunity to improve quality is in the area of training – where academic health centers, again, have a natural advantage. The benefits of coordinated care are becoming more and more apparent, yet the training of health care providers is typically isolated by discipline. This is perfectly appropriate – up to a point. We must prepare the next generation of health care professionals for the kind of collaborative, inter-disciplinary care-giving environment they are increasingly likely to find after leaving school. Related to that, we must also manage the growing knowledge base and ensure that all those in the health care workforce have access to the skills and continuing education they need. If we do these things – utilize the latest information technology and implement lifetime training with respect to quality performance – we can reach the six aims. We can make health care: 1) safe, 2) effective, 3) patient-centered, 4) timely, 5) efficient, and 6) equitable. Conclusion In closing, it seems evident to me that academic health centers are well positioned to capitalize on some key health care trends like genomics, collaborative care, and quality performance. The view from Oregon is, if anything, even brighter. OHSU has, in just six years, gone from the “too sick or too poor to go anywhere else hospital” to Portland’s #1 hospital in customer satisfaction and overall reputation. We’re looking forward to a bright future as Portland’s leading hospital and an economic engine for all of Oregon.