THE NEED FOR A CONTINUOUSLY LEARNING HEALTH CARE SYSTEM

Decades of rapid innovation and technological improvement have created a health care system that is extraordinarily complex. The discovery of penicillin, which could treat many previously incurable bacterial diseases quickly and completely, heralded the advent of widespread antibiotic treatments for many communicable diseases. The development of insulin therapy has allowed diabetics to control their blood sugar and manage their condition effectively. Imaging systems, from computed tomography (CT) scans to magnetic resonance imaging (MRI), have allowed clinicians to view the inside of the body in extraordinary detail. These and other innovations have benefited millions of patients, but they also have introduced new challenges for both clinicians and patients in treating and managing health conditions.

Today in health care, there is more to know, more to manage, and more to do than ever before. The rate at which new scientific knowledge is being produced outstrips the cognitive capacity of even the most adroit clinician to monitor and evaluate effectively. Physicians specialize and subspecialize to manage the growing stores of health care knowledge, and patients now visit multiple providers for most conditions. New developments promise to accelerate this trend and further challenge the ability of clinicians to remain current on the state of the field. New research in genetics, epigenetics, proteomics, and related molecular biology topics, for example, is adding myriad factors to what clinicians may have to consider when helping patients choose the most appropriate treatment for their circumstances.

Most physicians, nurses, and other health care professionals work diligently to care for their patients, but they often are contending with the challenges of a system that is poorly configured for the current complexity of treatments, technologies, and clinical science. These difficulties are exacerbated by administrative and organizational complexity that requires time that could be spent with patients.

The growing complexity of health care challenges not only providers but also patients. Increasing specialization has made it difficult for patients to navigate the system and find the right care for their conditions. Furthermore, as patients move among providers and settings, they often encounter communication and coordination problems that can result in treatment errors, duplicative services, and fragmented care. Improving the quality of care, patient health outcomes, and the value of care is possible, but will require broad changes in the culture, incentives, administration, and information supports that govern the current health care environment.

Absent such change, the very solvency of the system is threatened, because the cost of health care continues to rise relentlessly. In 2012, the United States will spend an estimated $2.8 trillion on the health care



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