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Introduction Harvey Fineberg The topic of tonight's lecture is "Fostering Rapid Advances in Health Care, Learning from System Demonstrations." This is the title of the re- cently released report by the Institute of Medicine (IOM), which many of you have in your hands and which is depicted here on the slide. This project started innocently enough over dinner. It was a dinner hosted here at the Academies by my predecessor Ken Shine, by Bruce Alberts, president of the National Academy of Sciences, and by Bill Wulf, president of the National Academy of Engineering. The dinner also in- cluded a number of experts and members of the Academies, drawn for the occasion to meet with Secretary Tommy Thompson and discuss his concerns. That evening, the secretary expressed an interest in identifying and implementing demonstration projects that would deal with critical prob- lems facing our health care system. In response to this conversation, the IOM took up the challenge and initiated what we call a "fast-track project." Gail Warden of the Henry Ford Health System agreed to serve as the committee chair and we were very pleased that 14 other distinguished individuals also agreed to give of their time and expertise on a short and very intensive assignment. Their names are listed at the outset of the report. All of us, of course, share awareness and concern about the health care delivery system. It is confronting many serious problems, including rising costs, a rising number of uninsured, racial and ethnic disparities in care, shortages in the work force, and increasing liability costs. The need 1

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2 FOSTERING RAPID ADVANCES IN HEALTH CARE for us to take action at many levels to solve these problems grows ever more acute with each passing day. The committee that prepared this report has done an outstanding job in identifying a set of demonstration possibilities, each of which has po- tential to lead to broader health system reform. I am very pleased to welcome tonight's panelists and to welcome this distinguished audience. The panelists, each of whom served on the com- mittee, will offer their perspective on various aspects of the report. Our moderator this evening, Gail Warden, chaired the committee. Gail is the president and chief executive officer of the Henry Ford Health Sys- tem in Detroit. He chairs the National Forum on Health Care Quality Mea- surement and Reporting, the Health Care Research and Development In- stitute, and also the newly created National Center for Health Care Leadership. He is a member of the board of the Robert Wood Johnson Foundation and is also on the Institute for Health Care Improvement Board and the RAND Health Board of Advisors. Seated next to him is William L. Roper, who is dean of the School of Public Health at the University of North Carolina, Chapel Hill. Before joining UNC in 1997, Dr. Roper was senior vice president and chief medi- cal officer at Prudential Healthcare. Prior to that position, Dr. Roper was director of the Centers for Disease Control and Prevention, served on the senior White House staff, and also as administrator of the Health Care Financing Administration, now called the Centers for Medicare and Med- . . ~ . calc ~ Services. Seated next to Dr. Roper is Arthur Carson, fr. He is currently the vice president and dean of the University of Virginia School of Medicine, and, until tune of 2002, served as the senior vice president and academic dean for operations at Baylor College of Medicine in Houston, Texas. Dr. Carson received his M.D. from Duke University and an M.P.H. from the University of Texas, Houston. He is the past president of the American College of Cardiology. To his right is Edward H. Shortliffe. Dr. Shortliffe is professor and chair of the Department of Medical Informatics at the Columbia College of Physicians and Surgeons in New York City. From 1988 to 1995, he served as the chief of internal medicine at Stanford University. Dr. Shortliffe is a fellow of the American College of Medical Informatics, the American Association for Artificial Intelligence, and the American Col- lege of Physicians. He is editor-in-chief of the Journal of Biomedical Informatics. Currently, he sits on the National Committee for Vital and Health Statistics and served on the Computer Science and Telecommuni- cations Board of the National Research Council from 1990 to 1996. To his right is Karen Davis. She is the president of the Commonwealth Fund, a national philanthropy engaged in independent research on health

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INTRODUCTION 3 and social policy issues. She assumed the presidency of this foundation in 1995. Dr. Davis is a nationally recognized economist with a distinguished career in public policy and research. Prior to joining the Fund, she served as chair of the Department of Health Policy and Management at the Johns Hopkins (Bloomberg) School of Public Health, where she also held an appointment as a professor of economics. On the end of the table, to her right is William M. Sage. He is a profes- sor of law at Columbia University, where he teaches health law and regu- latory theory and the professions. Professor Sage's areas of expertise are managed care, health care information, antitrust, medical malpractice, in- surance coverage determinations, and the regulation of health care pro- fessionals. He currently serves as the principal investigator for the Project on Medical Liability in Pennsylvania, which is a two-year study funded by The Pew Charitable Trusts. I know we will all gain a great deal from the discussion this evening with this distinguished audience, and I look forward to the time that we've set aside for open discussion and conversation amongst ourselves. It is my pleasure to turn the program over to our moderator, Gail Warden.