new remote monitoring and connectivity capabilities can help patients like Carolyn and others monitor and manage complex health conditions.

Although the challenges of complexity and value confronting U.S. health care today are formidable, opportunities exist to mold the system into one characterized by continuous learning and improvement. Advances have made vast computational power affordable and widely available, while improvements in connectivity have allowed information to be accessible in real time virtually anywhere. Progress in these areas has the potential to improve health care by increasing the reach of research knowledge, providing access to clinical records when and where needed, and assisting patients and providers in managing chronic diseases. Another area of opportunity lies with the human and organizational capabilities developed by diverse industries to improve safety, quality, reliability, and value; many of these capabilities can be adapted to health care settings to improve performance. Finally, recent changes in health policies present opportunities that can be leveraged to promote the growth of a learning health care system. Together, these opportunities can operate synergistically to enable more transformative change than can be accomplished with any of them individually. The path toward a more effective and efficient health care system will not be an easy one, but recent advances demonstrate the real potential for the necessary transformation.

THE DIGITAL INFRASTRUCTURE: COMPUTING, THE INTERNET, AND MOBILE TECHNOLOGIES

The past several decades have seen remarkable advances in technology, from personal computers, to cellular phones, to portable music players. The first mainframe computer offering a magnetic hard drive, the IBM RAMAC 305, was introduced in 1956, weighed a full ton, cost $250,000-$300,000 a year to lease in today’s dollars, and stored less than 5 megabytes (Lesser and Haanstra, 1957; Levy, 2006). The price and capacity of computer storage have changed dramatically since then: in 2011, one could purchase a 32 gigabyte microSD card for $40,1 which could store almost 7,000 times more information than the IBM RAMAC 305 at almost a thousandth of the price. One could also buy a disk drive capable of storing all of the world’s music for only $600 (Manyika et al., 2011). And computer processing speed has grown by an average rate of 60 percent per year over the past several decades (Hilbert and López, 2011).

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1Based on searches of major vendors.



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