The U.S. health care industry has neglected engineering strategies and technologies that have revolutionized quality, productivity, and performance in many other industries, says a new report from the National Academies' National Academy of Engineering and Institute of Medicine. This "collective inattention" has contributed to serious consequences in health care -- nearly 100,000 preventable deaths per year, outdated procedures, about a half-trillion dollars wasted annually through inefficiency, costs rising at roughly three times the rate of inflation, and 43 million people uninsured. Health care professionals and engineers should work more closely together to address these challenges, said the committee that wrote the report, according to a press release.
"The health care sector is deeply mired in crises related to safety, quality, cost, and access that pose serious threats to the health and welfare of many Americans," said Jerome H. Grossman, committee co-chair and senior fellow and director of the Health Care Delivery Policy Program, Harvard University, Cambridge, Mass. "Unfortunately, the health care system has been very slow to embrace engineering tools and clinical information technologies that could transform it from an underperforming conglomerate of independent entities into a high-performance system."
"Systems-engineering tools," developed for the design, analysis, and control of complex systems, have been used by many industries to improve the safety and quality of products and services and to lower production costs. These same tools, in certain circumstances, have been shown to improve the quality and efficiency of health care. If adapted and widely adopted, they could help deliver care that is safe, effective, timely, efficient, equitable, and patient-centered -- the six "quality aims" envisioned in a landmark report by the Institute of Medicine, Crossing the Quality Chasm: A New Health System for the 21st Century -- the report says.
"While medicine has advanced rapidly in recent decades thanks to new diagnostic and therapeutic technologies developed by engineers, the health care industry has virtually ignored a broad spectrum of other technologies that could radically improve the safety and efficiency of health care," said W. Dale Compton, committee co-chair and Lillian M. Gilbreth Distinguished Professor Emeritus of Industrial Engineering, Purdue University, West Lafayette, Ind.
Cultural, organizational, and policy-related barriers have impeded the widespread use of systems-engineering tools and information technology in health care, the report says. Health care professionals often fail to recognize that they are part of a larger system and most engineering professionals have a limited understanding of the complex challenges involved in health care. To encourage health care providers to use systems-engineering tools, organizations that have already adopted or promoted the use of such tools -- such as the Veterans Health Administration, the Institute for Healthcare Improvement, and the Agency for Healthcare Research and Quality -- should increase their outreach efforts to educate the larger health care community.
The health care sector remains woefully underinvested in information and communications technologies, the committee noted. Government and private-sector organizations should accelerate implementation of the National Health Information Infrastructure, a 10-year initiative developed by the U.S. Department of Health and Human Services to improve the overall quality of health care, facilitate the exchange of data among health care organizations, public and private payers, regulatory bodies, and the research community, and enable patients to become more active partners in their own health care, the report says. The health care community should also take advantage of emerging technologies based on wireless communications and microelectronics to improve the lives and care of patients, especially the elderly and patients with chronic illnesses, who require continuous monitoring and care.
The transformation of the health care system will require dramatic changes in the education and training of health care professionals, engineers, and managers and in the way innovation in health care delivery is advanced, the committee said. To hasten this transformation, the federal government, in partnership with the private sector, universities, federal laboratories, and state governments, should establish multidisciplinary centers at institutions of higher learning to bring together researchers, practitioners, educators, and students in engineering, health sciences, management, and the social and behavioral sciences. A lead government agency should be identified to coordinate the activities of these centers and ensure that funding is stable and adequate, the report says.
"If the nation takes up the challenge to transform the health care system now, current crises can be abated -- costs can be cut, the number of uninsured can be reduced, and more Americans can have access to the quality care they deserve and that we are capable of delivering," said Grossman.
The study was sponsored by the National Science Foundation, Robert Wood Johnson Foundation, and the National Institutes of Health. The National Academy of Engineering and Institute of Medicine are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. A committee roster follows.
Copies of Building a Better Delivery System: A New Engineering/Health Care Partnership will be available in the fall from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or order on the Internet at http://www.nap.edu