FIGURE 1-1 Schematic of the health care system today.

system, or about 18 percent of gross domestic product (CMS, 2012; Keehan et al., 2011). For 31 of the past 40 years, health care costs have increased at a greater rate than the rest of the economy, and the cumulative increase over that time has been 2.5 times the economy’s growth (BEA, 2011; CMS, 2011). If this level of expenditure produced extraordinary results, it could be justified. On the contrary, however, assessments show that much of this investment is wasted on care activities that do little to improve patients’ health or quality of life.

In sum, as illustrated in Figure 1-1, each stage in the processes that shape the health care received—knowledge development, translation into medical evidence, application of evidence-based care—has prominent shortcomings and inefficiencies that contribute to a large reservoir of missed opportunities, waste, and harm. The threats to the health and economic security of Americans are clear, present, and compelling. What is needed—and possible—to transform care is a system that leverages the growing scientific evidence base, knowledge from other sectors on how to design reliable processes, and advances in information systems to enable continuous improvement in care, consistent implementation of best practices, and the ability to draw on knowledge generated every day through clinical care.


In the face of these realities, the Institute of Medicine (IOM) convened the Committee on the Learning Health Care System in America to explore

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