Appendix A


Workshop Agenda

ENGINEERING A LEARNING HEALTHCARE SYSTEM:
A LOOK AT THE FUTURE

A LEARNING HEALTHCARE SYSTEM WORKSHOP
ROUNDTABLE ON EVIDENCE-BASED MEDICINE
THE INSTITUTE OF MEDICINE (IOM)
in cooperation with
THE NATIONAL ACADEMY OF ENGINEERING (NAE)

APRIL 29–30, 2008
THE KECK CENTER OF THE NATIONAL ACADEMIES
WASHINGTON, DC 20001

Issues Motivating the Discussion

  1. Health care is substantially underperforming on most dimensions: effectiveness, appropriateness, safety, cost, efficiency, and value.
  2. Increasing complexity in health care is likely to accentuate current problems unless reform efforts go beyond financing to foster significant changes in the culture, practice, and delivery of health care.
  3. Extensive administrative and clinical data collected in healthcare settings are largely unused for new insights on the effectiveness of healthcare interventions and systems of care.
  4. If the effectiveness of health care is to keep pace with the opportunity of diagnostic and treatment innovation, system design and information technology must be structured to ensure application of the best evidence, continuous learning, and research insights generated as a natural by-product of the care process.
  5. Engineering principles are at the core of a learning healthcare system—one structured to keep the patient constantly in focus, while continuously improving quality, safety, knowledge, and value in health care.


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Appendix A Workshop Agenda EnginEEring a LEarning HEaLtHcarE SyStEm: a Look at tHE FuturE A Learning Healthcare System Workshop Roundtable on Evidence-Based Medicine The Institute of Medicine (IOM) … in cooperation with … the National Academy of Engineering (NAE) April 29–30, 2008 The Keck Center of The National Academies Washington, DC 20001 Issues Motivating the Discussion 1. Health care is substantially underperforming on most dimensions: effectiveness, appropriateness, safety, cost, efficiency, and value. 2. Increasing complexity in health care is likely to accentuate current problems unless reform efforts go beyond financing to foster significant changes in the culture, practice, and delivery of health care. 3. Extensive administrative and clinical data collected in healthcare settings are largely unused for new insights on the effectiveness of healthcare interventions and systems of care. 4. If the effectiveness of health care is to keep pace with the opportunity of diagnostic and treatment innovation, system design and information technology must be structured to ensure application of the best evidence, continuous learning, and research insights generated as a natural by-product of the care process. 5. Engineering principles are at the core of a learning healthcare system—one structured to keep the patient constantly in focus, while continuously improving quality, safety, knowledge, and value in health care. 28

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28 ENGINEERING A LEARNING HEALTHCARE SYSTEM 6. Impressive transformations have occurred through systems and process engineering in service and manufacturing sectors—e.g., banking, airline safety, automobile manufacturing. 7. Despite the obvious differences that exist in the dynamics of mechanical vs. biological and social systems, the current challenges in health care necessitate an entirely fresh view of the organization, structure, and function of the delivery and monitoring processes in health care. 8. Taking on the challenges in health care offers the engineering sciences an opportunity to test, learn, and refine approaches to understanding and improving innovation in complex adaptive systems. DAY ONE 8:30 WELcomE and introductionS Denis A. Cortese, Mayo Clinic and Roundtable on Eidence-Based Medicine (IOM) William B. Rouse, Georgia Institute of Technology and Planning Committee Chair (NAE) 8:45 kEynotES: 1. LEarning opportunitiES For HEaLtH carE 2. tEacHing opportunitiES From EnginEEring Opening keynote speakers will address some of the key systemic shortfalls and challenges in health care today, reflecting on the changes needed and how systems engineering might help foster a healthcare system that delivers the care we know works and that learns from the care delivered. Brent C. James, Intermountain Healthcare (IOM) W. Dale Compton, Purdue Uniersity (NAE) 9:45 SESSion 1: Engaging compLEx SyStEmS tHrougH EnginEEring concEptS How do the various engineering disciplines (e.g., systems engineering, industrial engineering, operations research, human factors engineering, financial engineering, risk analysis) engage system complexity, and how might this perspective inform and improve health care? What can we learn from the contrasts? Chair: Paul H. O’Neill, Value Capture, LLC Systems engineering perspectives ÿ William B. Rouse, Georgia Institute of Technology (NAE) Engineering systems analysis tools ÿ Richard C. Larson, Massachusetts Institute of Technology (NAE)

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28 APPENDIX A [10:35–10:55 BrEak] Engineering systems design tools ÿ James M. Tien, Uniersity of Miami (NAE) Engineering systems control tools ÿ Harold W. Sorenson, Uniersity of California, San Diego Panel discussion to follow 12:00 LuncH 1:00 SESSion 2: HEaLtHcarE SyStEm compLExitiES, impEdimEntS, and FaiLurES What are the multiple healthcare system components and processes that affect the generation and application of evidence, and which inefficiencies, impediments, structural barriers, and failures are most acutely in need of attention and correction? How might systems engineering address these issues? Chair and Introduction: Cato T. Laurencin, Uniersity of Virginia Health Systems (IOM) Healthcare culture ÿ William W. Stead, Vanderbilt Uniersity Medical Center (IOM) Diagnostic and treatment technologies ÿ Rita F. Redberg, Uniersity of California, San Francisco Clinical data systems and clinical decision support ÿ Michael D. Chase, Kaiser Permanente Colorado Care coordination and linkage ÿ Amy L. Deutschendorf, Johns Hopkins Hospital and Health System Administrative and business systems ÿ Ralph W. Muller, Uniersity of Pennsylania Health System Information and knowledge development ÿ Eugene C. Nelson, Dartmouth–Hitchcock Medical Center Panel discussion to follow [3:15–3:30 BrEak] 3:30 SESSion 3: caSE StudiES in tranSFormation tHrougH SyStEmS EnginEEring How has systems engineering been successfully used in certain industries and sectors? Which key lessons best apply in the

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288 ENGINEERING A LEARNING HEALTHCARE SYSTEM transformation of a sociologically and technologically complex healthcare arena? Are there examples of successful applications to health care? What are some key lessons from other sectors and service industries in managing complexity? Chair: Carmen Hooker Odom, Milbank Memorial Fund Airline safety ÿ John J. Nance, formerly of National Patient Safety Foundation Alcoa reorientation ÿ Earnest J. Edwards, formerly of Alcoa Veterans Health Affairs ÿ Kenneth W. Kizer, Medsphere Systems Corporation (IOM) Ascension Health ÿ Daid B. Pryor, Ascension Health Panel discussion to follow 5:15 day’S Summary and FramEWork diScuSSion What framework might illustrate ways in which lessons from engineering could map onto healthcare systems? Paul H. O’Neill, Value Capture, LLC, and William B. Rouse, Georgia Institute of Technology (NAE) 5:30 rEcEption DAY TWO 8:00 WELcomE and rEcap oF tHE FirSt day W illiam B. Rouse, Georgia Institute of Technology and Planning Committee Chair (NAE) 8:15 SESSion 4: FoStEring SyStEmS cHangE to drivE continuouS LEarning in HEaLtH carE The IOM Learning Healthcare System workshop publication identified several common characteristics of a learning healthcare organization, including culture that emphasizes transparency and learning through continuous feedback loops, care as a seamless team process, best practices that are embedded in system design, information systems that reliably deliver evidence and capture results, and results that are bundled to improve the level of practice and the state of the science. What do feedback and

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289 APPENDIX A performance improvement look like for each topic below, and how can impediments be turned into enablers? Chair: Richard C. Larson, Massachusetts Institute of Technology (NAE) Learning-, team-, and patient-oriented culture ÿ Steen J. Spear, Massachusetts Institute of Technology Knowledge development, access, and use ÿ Donald E. Detmer, American Medical Informatics Association (IOM) Technologies management ÿ Stephen J. Swensen, Mayo Clinic Information systems organization and management ÿ Daid C. Classen, Computer Sciences Corporation Panel discussion to follow [10:00–10:30 Break] 10:30 BrEakout SESSion: Capturing morE vaLuE in HEaLtH carE Five groups to meet and discuss three questions: ÿ t a macro level, what’s your best guess on how much more A value (health returned for money invested) could be obtained through application of systems engineering principles in health care? ÿ you had to identify one area in which the greatest value If could be returned, what would that be? ÿ hat are the actions, taken by whom, that could do the most W to facilitate the needed changes? Breakout Chairs Kenneth Boff, Room 205 ÿ Richard C. Larson, Room 206 ÿ William B. Rouse, Room 204 ÿ Harold W. Sorenson, Room 208 ÿ James M. Tien, Room 213 ÿ 11:45 LuncH avaiLaBLE (outSidE 100) room 1:00 BrEakout SESSion rEportS 1:45 SESSion 5: oBSErvationS on initiating SyStEmS cHangE in HEaLtH carE Donald M. Berwick, Institute for Healthcare Improement (IOM)

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290 ENGINEERING A LEARNING HEALTHCARE SYSTEM 2:15 SESSion 6: nExt StEpS: aLigning poLiciES WitH LEadErSHip opportunitiES What are the key policy priorities if the best and most applicable lessons from the engineering sciences are to be applied in bringing about the necessary transformational changes? A panel of leaders from key settings will offer brief (5-minute) reflections on the policy and related culture changes necessary, followed by an interactive discussion. Chair: Donald M. Berwick, Institute for Healthcare Improement (IOM) Academic medical centers ÿ Denis A. Cortese, Mayo Clinic (IOM) Community hospital settings ÿ Paul F. Conlon, Trinity Health Integrated healthcare delivery organizations ÿ Louise L. Liang, Kaiser Permanente Small ambulatory care settings ÿ Douglas W. Lowery-North, Emory Uniersity Skilled nursing facilities ÿ Mary Jane Koren, The Commonwealth Fund Panel discussion to follow 4:30 concLuding Summary rEmarkS and adjournmEnt Denis A. Cortese, Mayo Clinic and Roundtable on Eidence-Based Medicine (IOM) J. Michael McGinnis, IOM Planning Committee: William B. Rouse. Ph.D., M.S. (Chair), Georgia Institute of Technology Jerome H. Grossman, M.D., Harvard University Brent C. James, M.D., M.Stat., Intermountain Healthcare, Inc. Helen S. Kim, M.B.A., Gordon and Betty Moore Foundation Cato T. Laurencin, M.D., Ph.D., University of Virginia The Honorable Paul H. O’Neill, Value Capture, LLC