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Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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BUILDING A BETTER DELIVERY SYSTEM

A New Engineering/Health Care Partnership

Proctor P. Reid, W. Dale Compton, Jerome H. Grossman, and Gary Fanjiang, Editors


NATIONAL ACADEMY OF ENGINEERING AND INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
×

THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Science, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

Support for this project was provided by the National Science Foundation (Award No. DMI-0222041), the Robert Wood Johnson Foundation (Grant No. 044640), and the National Institutes of Health (Contract No. N01-OD-4-2139, Task Order No. 111). Any opinions, findings, and conclusions or recommendations expressed in this report are those of the National Academy of Engineering/Institute of Medicine Committee on Engineering and the Health Care System and do not necessarily reflect the views of the funding organizations, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

International Standard Book Number 0-309-09643-X

Copies of this report are available from the
National Academies Press,
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Copyright 2005 by the National Academies. All rights reserved.

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Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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COMMITTEE ON ENGINEERING AND THE HEALTH CARE SYSTEM

W. DALE COMPTON (NAE), co-chair,

Purdue University, West Lafayette, Indiana

JEROME H. GROSSMAN (IOM), co-chair,

John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts

REBECCA M. BERGMAN,

Medtronic Inc., Minneapolis, Minnesota

JOHN R. BIRGE,

University of Chicago, Chicago, Illinois

DENIS CORTESE,

Mayo Clinic, Rochester, Minnesota

ROBERT S. DITTUS,

Vanderbilt University and Veterans Administration Tennessee Valley Healthcare System, Nashville, Tennessee

G. SCOTT GAZELLE,

MGH Institute for Technology Assessment, Boston, Massachusetts

CAROL HARADEN,

Institute for Healthcare Improvement, Cambridge, Massachusetts

RICHARD MIGLIORI,

United Resource Networks, Golden Valley, Minnesota

WOODROW MYERS (IOM),

WellPoint, Thousand Oaks, California

WILLIAM P. PIERSKALLA,

Anderson Graduate School of Management, University of California, Los Angeles

STEPHEN M. SHORTELL (IOM),

School of Public Health and Haas School of Business, University of California, Berkeley

KENSALL D. WISE (NAE),

University of Michigan, Ann Arbor

DAVID D. WOODS,

Ohio State University, Columbus

Project Staff

PROCTOR P. REID, Study Director and Director, Program Office,

National Academy of Engineering

JANET M. CORRIGAN, Senior Board Director for Health Services,

Institute of Medicine

CAROL R. ARENBERG, Editor,

National Academy of Engineering

PHILIP ASPDEN, Senior Program Officer, Board on Health Services,

Institute of Medicine

GARY FANJIANG, Fellow,

National Academy of Engineering

PENELOPE J. GIBBS, Program Associate, Program Office,

National Academy of Engineering

JAMES PHIMISTER, J. Herbert Hollomon Fellow,

National Academy of Engineering

AMANDA SARATA,

Intern, National Academy of Engineering

Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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Preface

In 2000 and 2001, the Institute of Medicine (IOM) issued two reports, To Err Is Human and Crossing the Quality Chasm, documenting a glaring divergence between the rush of progress in medical science and the deterioration of health care delivery. The first report included an estimate that systems failures in health care delivery (i.e., poorly designed or “broken” care processes) were responsible for at least 98,000 deaths each year. The second report revealed a wide “chasm” between the quality of care the health system should be capable of delivering today, given the astounding advances in medical science and technology in the past half-century, and the quality of care most Americans receive. Documenting deep crises related to the safety, efficacy, efficiency, and patient-centeredness of health care in America, Crossing the Quality Chasm set forth a vision for a transformed health care system and challenged system stakeholders to take bold actions to bring about that transformation.

In response to this challenge, the National Academy of Engineering (NAE) and IOM, with support from the National Science Foundation, Robert Wood Johnson Foundation, National Institutes of Health, and the NAE Fund, initiated a project in 2002 to (1) identify engineering applications that could contribute significantly to improvements in health care delivery in the short, medium, and long terms; (2) assess factors that would facilitate or impede the deployment of these applications; and (3) identify areas of research in engineering and other fields that could contribute to rapid improvements in performance. This report, Building a Better Delivery System, is the culmination of the joint NAE/IOM study.

The report builds on a growing realization within the health care community of the critical role information/ communications technologies, systems engineering tools, and related organizational innovations must play in addressing the interrelated quality and productivity crises facing the health care system. The report provides a framework for change and an action plan for a systems approach to health care delivery based on a partnership between engineers, health care professionals, and health care managers. The goal of the plan is to transform the U.S. health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers, etc.) into a high-performance “system” in which participating units recognize their interdependence and the implications and repercussions of their actions on the system as a whole. The report describes opportunities and challenges to using systems engineering, information technologies, and other tools to advance a twenty-first century system capable of delivering safe, effective, timely, patient-centered, efficient, equitable health care—a system that embodies the six “quality aims” envisioned in Crossing the Quality Chasm.

The committee co-chairs are grateful to the members of the committee, not only for their knowledge, expertise, and commitment to change, but also for their participation in wide-ranging discussions on various aspects of this complex topic. Their collegiality and openness to ideas from many directions enabled the committee as a whole to overcome some of the very communications and cultural barriers described in the report and reach consensus on key recommendations. We also thank the outside experts who contributed their time and efforts to the success of this project, and the NAE and IOM staff for their research, editorial, and administrative support.

W. Dale Compton, co-chair

Committee on Engineering and the Health Care System

Jerome H. Grossman, co-chair

Committee on Engineering and the Health Care System

Page viii Cite
Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
×

Acknowledgment of Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for reviewing this report:

David E. Daniel, University of Texas

Paul Griner, Emeritus, University of Rochester School of Medicine and Dentistry

John D. Halamka, CareGroup Health System

Angela Barron McBride, Indiana University School of Nursing

James C. McGroddy, IBM Corporation (ret.)

John M. Mulvey, Princeton University

Robert M. Nerem, Georgia Institute of Technology

Don M. Nielsen, American Hospital Association

Vinod K. Sahney, Henry Ford Health System

Edward J. Sondik, National Center for Health Statistics

Paul C. Tang, Palo Alto Medical Foundation

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Don E. Detmer, American Medical Informatics Association, and Charles E. Phelps, University of Rochester, appointed by the National Research Council Report Review Committee, who was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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4

 

INFORMATION AND COMMUNICATIONS SYSTEMS: THE BACKBONE OF THE HEALTH CARE DELIVERY SYSTEM

 

63

   

 The Centrality of Information to Health Care Delivery,

 

63

   

 From Electronic Medical Records to a National Health Information Infrastructure,

 

64

   

 Foundations of a National Health Information Infrastructure,

 

67

   

 Communications Technologies,

 

72

   

 Microelectronic Systems and Emerging Modes of Communication,

 

75

   

 Conclusion,

 

78

   

 References,

 

79

5

 

A STRATEGY TO ACCELERATE CHANGE

 

83

   

 Educational Barriers to Change,

 

83

   

 A Platform for Interdisciplinary Research, Education, and Outreach,

 

84

   

 Call to Action,

 

89

   

 References,

 

89

PART II:   WORKSHOP PRESENTATIONS

 

 

 

 

FRAMING THE HEALTH CARE CHALLENGE

 

 

 

 

Crossing the Quality Chasm,
Janet Corrigan

 

95

 

 

Bridging the Quality Chasm,
David Lawrence

 

99

 

 

Envisioning the Future,
Jeff Goldsmith

 

103

 

 

Improving Health and Health Care,
Lewis G. Sandy

 

105

 

 

Engineering and the Health Care System,
Richard J. Coffey

 

107

 

 

Engineering and the Health Care Organization,
Vinod K. Sahney

 

113

 

 

EQUIPPING THE PATIENT AND THE CARE TEAM

 

 

 

 

Evidence-Based Medicine,
Brian Haynes

 

117

 

 

The Context of Care and the Patient Care Team: The Safety Attitudes Questionnaire,
J. Bryan Sexton, Eric J. Thomas, and Peter Pronovost

 

119

 

 

Engineering the Patient and Family into the Patient Care Team,
David Gustafson

 

125

 

 

Connecting Patients, Providers, and Payers,
John D. Halamka

 

129

 

 

New Paradigms for Working and Learning,
Richard Bohmer

 

133

 

 

Designing Caregiver- and Patient-Centered Health Care Systems,
H. Kent Bowen

 

135

 

 

ENGINEERING TOOLS AND PROCEDURES FOR MEETING THE CHALLENGES

 

 

 

 

Systems Engineering: Opportunities for Health Care,
Jennifer K. Ryan

 

141

 

 

Supply-Chain Management and Health Care Delivery: Pursuing a System-Level Understanding,
Reha Uzsoy

 

143

 

 

The Human Factor in Health Care Systems Design,
Kim J. Vicente

 

147

Page xiii Cite
Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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Changing Health Care Delivery Enterprises,
Seth Bonder

 

149

 

 

Transforming Current Hospital Design: Engineering Concepts Applied to the Patient Care Team and Hospital Design,
Ann Hendrich

 

153

 

 

Discrete-Event Simulation Modeling of the Content, Processes, and Structures of Health Care,
Robert S. Dittus

 

157

 

 

Measuring and Reporting on Health Care Quality,
Dana Gelb Safran

 

163

 

 

Archimedes: An Analytical Tool for Improving the Quality and Efficiency of Health Care,
David M. Eddy and Leonard Schlessinger

 

167

 

 

Applying Financial Engineering to the Health Services Industry,
John M. Mulvey

 

173

 

 

Engineering Tools and Methods in the Delivery of Cancer Care Services,
Molla S. Donaldson

 

177

 

 

Patient Trajectory Risk Management,
Charles Denham

 

183

 

 

Deploying Resources for an Idealized Office Practice: Access, Interactions, Reliability, and Vitality,
Thomas W. Nolan

 

187

 

 

INFORMATION TECHNOLOGY FOR CLINICAL APPLICATIONS AND MICROSYSTEMS

 

 

 

 

Engineering and the System Environment,
Paul C. Tang

 

191

 

 

Challenges in Informatics,
William W. Stead

 

193

 

 

A National Standard for Medication Use,
David Classen

 

195

 

 

Obstacles to the Implementation and Acceptance of Electronic Medical Record Systems,
Paul D. Clayton

 

199

 

 

Automation of the Clinical Practice: Cost-Effective and Efficient Health Care,
Prince K. Zachariah

 

205

 

 

The eICU® Solution: A Technology-Enabled Care Paradigm for ICU Performance,
Michael J. Breslow

 

209

 

 

Wireless Biomonitoring for Health Care,
Thomas F. Budinger

 

215

 

 

Rehabilitation Redefined,
Mindy L. Aisen

 

221

 

 

Evaluating the Potential of New Technologies,
Carolyn M. Clancy

 

223

 

 

BARRIERS AND INCENTIVES TO CHANGE

 

 

 

 

Political Barriers to Change,
Nancy-Ann DeParle

 

227

 

 

Lessons from Financial Services,
Ralph Kimball

 

231

 

 

Can Purchasers Leverage Engineering Principles to Improve Health Care?,
Arnold Milstein

 

233

 

 

Shibboleths in Modeling Public Policy,
Richard P. O’Neill

 

235

 

 

Matching and Allocation in Medicine and Health Care,
Alvin E. Roth

 

237

Suggested Citation:"Front Matter." National Academy of Engineering and Institute of Medicine. 2005. Building a Better Delivery System: A New Engineering/Health Care Partnership. Washington, DC: The National Academies Press. doi: 10.17226/11378.
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In a joint effort between the National Academy of Engineering and the Institute of Medicine, this books attempts to bridge the knowledge/awareness divide separating health care professionals from their potential partners in systems engineering and related disciplines. The goal of this partnership is to transform the U.S. health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers et. al.) into a high performance "system" in which every participating unit recognizes its dependence and influence on every other unit. By providing both a framework and action plan for a systems approach to health care delivery based on a partnership between engineers and health care professionals, Building a Better Delivery System describes opportunities and challenges to harness the power of systems-engineering tools, information technologies and complementary knowledge in social sciences, cognitive sciences and business/management to advance the U.S. health care system.

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