ers who want high service and low out-of-pocket costs, payers who want to select risk and limit cost, and purchasers who want more value at the lowest cost. Looking to a future that will be defined by individualized medicine, Stead suggested that tomorrow’s opportunities may not be fully realized without fundamental changes in the healthcare culture. Education for health professionals is only one area that needs reform. Another requirement will be to move from the business of managing episodes of care to the business of caring for patients and populations. He added that similar fundamental reforms will need to be engineered into the business models of virtually every healthcare stakeholder—in payment mechanisms, and, notably, in the role of the individuals in managing their own care.

Speaking from her perspective as a cardiologist and health policy analyst, Rita F. Redberg, director of Women’s Cardiovascular Services at the University of California, San Francisco, noted that a marked proliferation in new diagnostic and treatment technologies has resulted in a precipitous increase in healthcare costs. Moreover, limited integration in the design of systems for health information technology (HIT) and technologies such as imaging systems has allowed their misuse and overuse, thus impeding their ability to improve healthcare quality. Redberg surveyed the current landscape of diagnostic and treatment technologies available for heart disease and offered suggestions for systemically evaluating and using these technologies in ways that improve care and reduce costs. She proposed that more systematic data collection and the development of more prospective registries would lead to better-informed decisions in health care.

Addressing a concern that was raised throughout the workshop about the need for more robust data collection and mining capacities, Michael D. Chase, associate medical director of quality, Kaiser Permanente Colorado, asserted that the U.S. healthcare system has not fully leveraged clinical data to improve health outcomes. Impediments to full use of the data include limited data access, a problem that is exacerbated by inadequate adoption of electronic health records (EHRs) and lack of data standards. As health care has become more complex, the lag in the sophistication of data applications in evidence generation has become more acute. Engineering principles, Chase suggested, could help those in charge of health care manage various complex processes and increase the use of data for clinical decision support. Chase offered examples and suggestions concerning how key delivery systems could be better integrated into healthcare systems in order to address critical areas in health care. For example, Chase proposed a patient-centered, population health–based view grounded in the principle of getting the right information to the right member of the healthcare team—including the patient—at the right time during the workflow or decision-making process. Chase presented a model that takes a broad look at decision support opportunities across a continuum of patient needs,



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