Building a Better Delivery System: A New Engineering/Health Care Partnership

The report builds on a growing realization within the health care community of the critical role information/ communications technologies, systems engineering tools, and related organizational innovations must play in addressing the interrelated quality and productivity crises facing the health care system. The report provides a framework for change and an action plan for a systems approach to health care delivery based on a partnership between engineers, health care professionals, and health care managers. The goal of the plan is to transform the U.S. health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers, etc.) into a high-performance "system" in which participating units recognize their interdependence and the implications and repercussions of their actions on the system as a whole. The report describes opportunities and challenges to using systems engineering, information technologies, and other tools to advance a twenty-first century system capable of delivering safe, effective, timely, patient-centered, efficient, equitable health care — a system that embodies the six "equality aims" envisioned in Crossing the Quality Chasm.

[1]  J. B. Quinn,et al.  Intelligent Enterprise: A Knowledge and Service Based Paradigm for Industry , 1992 .

[2]  R. Uhlenhake Is patient-focused outpatient cancer care on target? , 1995, The Journal of ambulatory care management.

[3]  David Classen,et al.  Medication safety: moving from illusion to reality. , 2003, JAMA.

[4]  J. Wennberg,et al.  Understanding geographic variations in health care delivery. , 1999, The New England journal of medicine.

[5]  T. Mills Insuring America's health: principles and recommendations. , 2005, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[6]  Cheng-Huei Yang,et al.  Morse code application for wireless environmental control systems for severely disabled individuals , 2003, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[7]  S. Gregorich,et al.  The structure of cockpit management attitudes. , 1990, The Journal of applied psychology.

[8]  J. Donoghue,et al.  Brain–Machine and Brain–Computer Interfaces , 2004, Stroke.

[9]  D H Gustafson,et al.  Computer support for elderly women with breast cancer. , 1998, JAMA.

[10]  M. Rothenberg Current status of second-line therapy for metastatic colorectal cancer. , 2004, Clinical colorectal cancer.

[11]  G. Mensah The global burden of hypertension: good news and bad news. , 2002, Cardiology clinics.

[12]  D. Bates,et al.  Systems analysis of adverse drug events. ADE Prevention Study Group. , 1995, JAMA.

[13]  S. Spear,et al.  Decoding the DNA of the Toyota Production System , 1999 .

[14]  N. Scordis,et al.  Integrated Risk Management: Techniques and Strategies for Reducing Risk , 2000 .

[15]  Joy Christensen,et al.  The Role of the Pediatric Nurse Practitioner in the Comprehensive Management of Pediatric Oncology Patients in the Inpatient Setting , 1999, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[16]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[17]  Dawn M. Taylor,et al.  Direct Cortical Control of 3D Neuroprosthetic Devices , 2002, Science.

[18]  W. Hobbie,et al.  Establishing comprehensive specialty follow-up clinics for long-term survivors of cancer Providing systematic physiological and psychosocial support , 2004, Supportive Care in Cancer.

[19]  James C. Robinson,et al.  External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. , 2003, JAMA.

[20]  D. Safran,et al.  The quality of physician-patient relationships. Patients' experiences 1996-1999. , 2001, The Journal of family practice.

[21]  Ben Gowland,et al.  Redesigning cancer care , 2002, BMJ : British Medical Journal.

[22]  J J Mohr,et al.  Building a Quality Future , 1998, Frontiers of health services management.

[23]  J. Sexton,et al.  Error, stress, and teamwork in medicine and aviation: cross sectional surveys , 2000, BMJ : British Medical Journal.

[24]  J. Sexton A matter of life or death : social psychological and organizational factors related to patient outcomes in the intensive care unit , 2002 .

[25]  Anne F. Kittler,et al.  A cost-benefit analysis of electronic medical records in primary care. , 2003, The American journal of medicine.

[26]  M. Christian,et al.  How sociodemographics, presence of oncology specialists, and hospital cancer programs affect accrual to cancer treatment trials. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[27]  J. Forrester,et al.  Industrial Dynamics , 1997 .

[28]  L. Wolfe A model system. Integration of services for cancer treatment , 1993, Cancer.

[29]  P. Maurette,et al.  [To err is human: building a safer health system]. , 2002, Annales francaises d'anesthesie et de reanimation.

[30]  J. Wyatt,et al.  Evaluating computerised health information systems: hard lessons still to be learnt , 2003, BMJ : British Medical Journal.

[31]  H. R. Warner,et al.  The HELP system , 1982, Journal of Medical Systems.

[32]  J Swanson,et al.  Business Dynamics—Systems Thinking and Modeling for a Complex World , 2002, J. Oper. Res. Soc..

[33]  Thomas Pasko,et al.  Physician Characteristics and Distribution in the Us: 1999 , 1998 .

[34]  G. Young,et al.  Coordination of care for early-stage breast cancer patients , 2001, Journal of general internal medicine.

[35]  D. Bates,et al.  Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. , 1998, JAMA.

[36]  S. Spear,et al.  Ambiguity and Workarounds as Contributors to Medical Error , 2005, Annals of Internal Medicine.

[37]  S. Shortell,et al.  Improving the quality of health care in the United Kingdom and the United States: a framework for change. , 2001, The Milbank quarterly.

[38]  A. Glass,et al.  Delivery of comprehensive cancer care at Kaiser Permanente , 1998, Cancer.

[39]  W. D. Compton,et al.  Wireless Biomonitoring for Health Care , 2005 .

[40]  R. Clive Update from the Commission on Cancer. , 1997, Topics in health information management.

[41]  P. Mahoney,et al.  Choosing a health plan: what information will consumers use? , 1997, Health affairs.

[42]  E. McGlynn,et al.  The quality of health care delivered to adults in the United States. , 2003, The New England journal of medicine.

[43]  Thomas F Budinger,et al.  Biomonitoring with wireless communications. , 2003, Annual review of biomedical engineering.

[44]  Paul D. Clayton,et al.  Using LOINC to link an EMR to the pertinent paragraph in a structured reference knowledge base , 2002, AMIA.

[45]  R. Pearl Health care--past, present, and future. , 1997, Annals of plastic surgery.

[46]  H. Mcguire,et al.  Adverse events. , 2000, Surgery.

[47]  Ross Mullner,et al.  Insuring America's Health: Principles and Recommendations , 2005 .

[48]  R W Gill,et al.  Building the Hospital Without Walls--a CSIRO home telecare initiative. , 2000, Telemedicine journal : the official journal of the American Telemedicine Association.

[49]  D. Safran,et al.  Switching doctors: predictors of voluntary disenrollment from a primary physician's practice. , 2001, The Journal of family practice.

[50]  Gunther Eysenbach,et al.  Consumer health informatics , 2000, BMJ : British Medical Journal.

[51]  G. Bevan,et al.  "Systematic" , 1966, Comput. J..

[52]  Jonathan R Wolpaw,et al.  Control of a two-dimensional movement signal by a noninvasive brain-computer interface in humans. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[53]  Ann E. K. Page Keeping Patients Safe: Transforming the Work Environment of Nurses , 2004 .

[54]  J. L. Frank,et al.  Development of an oncology services performance improvement team. , 1998, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[55]  G O Barnett,et al.  The application of computer-based medical-record systems in ambulatory practice. , 1984, The New England journal of medicine.

[56]  S. Joishy The relationship between surgery and medicine in palliative care. , 2001, Surgical oncology clinics of North America.

[57]  N. Feistritzer,et al.  Perioperative supply chain management. , 2000, Seminars for nurse managers.

[58]  A. Greiner,et al.  Health Professions Education: A Bridge to Quality , 2003 .

[59]  J. Marc Overhage,et al.  Research Paper: A Randomized Trial of "Corollary Orders" to Prevent Errors of Omission , 1997, J. Am. Medical Informatics Assoc..

[60]  Robert P. Hawkins,et al.  CHESS: 10 years of research and development in consumer health informatics for broad populations, including the underserved , 2002, Int. J. Medical Informatics.

[61]  Anita L. Tucker,et al.  When Problem Solving Prevents Organizational Learning , 2002 .

[62]  R. Sagebiel The multidisciplinary melanoma center. , 1996, The Surgical clinics of North America.

[63]  J Bryan Sexton,et al.  Discrepant attitudes about teamwork among critical care nurses and physicians* , 2003, Critical care medicine.

[64]  R. McQuellon,et al.  Psychosocial care of the patient with cancer. A model for organizing services. , 1996, Cancer practice.

[65]  T. Schacker,et al.  Clinical and Epidemiologic Features of Primary HIV Infection , 1996, Annals of Internal Medicine.

[66]  D. Classen Patient safety, thy name is quality. , 2000, Trustee : the journal for hospital governing boards.

[67]  Ann M Holmes,et al.  Cost-utility of one-time colonoscopic screening for colorectal cancer at various ages , 2000, American Journal of Gastroenterology.

[68]  K. Vella,et al.  Use of consensus development to establish national research priorities in critical care , 2000, BMJ : British Medical Journal.

[69]  W. K. Klein Haneveld,et al.  Asset and Liability Management Tools , 2003 .

[70]  William A Yasnoff,et al.  Building the National Health Information Infrastructure. , 2004, Journal of AHIMA.

[71]  P. Aspden Patient Safety: Achieving a New Standard for Care , 2004 .

[72]  C B Parker,et al.  Intra-oral remote control. An access device for the severely disabled , 1990, British Dental Journal.

[73]  L. Donaldson,et al.  An organisation with a memory. , 2002, Clinical medicine.

[74]  P. Shekelle,et al.  Validity of the Agency for Healthcare Research and Quality clinical practice guidelines: how quickly do guidelines become outdated? , 2001, JAMA.

[75]  B. McCarthy,et al.  The Henry Ford Health System , 1998, Cancer.

[76]  Elliott S Fisher,et al.  Geography and the debate over Medicare reform. , 2002, Health affairs.

[77]  Erin Graydon-Baker,et al.  Patient Safety Leadership WalkRounds. , 2003, Joint Commission journal on quality and safety.

[78]  P. A. Lembcke Measuring the quality of medical care through vital statistics based on hospital service areas; I. Comparative study of appendectomy rates. , 1952, American journal of public health and the nation's health.

[79]  Sheila Leatherman,et al.  The business case for quality: case studies and an analysis. , 2003, Health affairs.

[80]  S M Huff,et al.  Linking a Medical Vocabulary to a Clinical Data Model using Abstract Syntax Notation 1 , 1998, Methods of Information in Medicine.

[81]  D. Berwick,et al.  Advanced access: reducing waiting and delays in primary care. , 2003, JAMA.

[82]  R. Helmreich,et al.  Culture at Work in Aviation and Medicine: National, Organizational and Professional Influences , 1998 .

[83]  David Classen,et al.  Implementing Antibiotic Practice Guidelines through Computer-Assisted Decision Support: Clinical and Financial Outcomes , 1996, Annals of Internal Medicine.

[84]  J J Mamlin,et al.  Combined time-motion and work sampling study in a general medicine clinic. , 1973, Medical care.

[85]  D. S. Rosenthal,et al.  Collaborative approaches to purchasing and managing oncology services for a prepaid population , 1998, Cancer.

[86]  T. Caeiro,et al.  [Error in medicine]. , 2004, Medicina.

[87]  B Starfield,et al.  Is US health really the best in the world? , 2000, JAMA.

[88]  D. Babbel Asset/Liability Management for Insurers in the New Era: Focus on Value , 2001 .

[89]  I. Rutkow The Doctors Mayo , 2001 .

[90]  D Gopher,et al.  A look into the nature and causes of human errors in the intensive care unit* , 2003, Quality & safety in health care.

[91]  M R Neuman,et al.  Cardiopulmonary monitoring at home: the CHIME monitor. , 2001, Physiological measurement.

[92]  S. Woolf,et al.  Colorectal cancer screening and surveillance: clinical guidelines and rationale-Update based on new evidence. , 2003, Gastroenterology.

[93]  A. Orb,et al.  Models of integrated cancer care: a critique of the literature. , 2000, Australian health review : a publication of the Australian Hospital Association.

[94]  S M Shortell,et al.  Organizational Assessment in Intensive Care Units (ICUs): Construct Development, Reliability, and Validity of the ICU Nurse-Physician Questionnaire , 1991, Medical care.

[95]  D. Garvin Building a learning organization. , 1993, Harvard business review.

[96]  Eric C. Pan,et al.  The value of health care information exchange and interoperability. , 2005, Health affairs.

[97]  K. Zahasky,et al.  A multidisciplinary healthcare delivery model for women with breast cancer: patient satisfaction and physical and psychosocial adjustment. , 1999, Oncology nursing forum.

[98]  D A August,et al.  Using simulation to improve the operational efficiency of a multi-disciplinary clinic. , 1997, Journal of the Society for Health Systems.

[99]  L. Piro,et al.  Managed oncology care , 1998, Cancer.

[100]  D. Gustafson,et al.  Effect of computer support on younger women with breast cancer , 2001, Journal of General Internal Medicine.

[101]  S. Greenfield,et al.  The Medical Outcomes Study. An application of methods for monitoring the results of medical care. , 1989, JAMA.

[102]  C. Vincent,et al.  Framework for analysing risk and safety in clinical medicine. , 1998, BMJ.

[103]  D Fife,et al.  Coprescribing and codispensing of cisapride and contraindicated drugs. , 2001, JAMA.

[104]  Averill M. Law,et al.  Simulation Modeling and Analysis , 1982 .

[105]  M. Chassin Is health care ready for Six Sigma quality? , 1998, The Milbank quarterly.

[106]  R. M. Shelton,et al.  Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. , 1989, The New England journal of medicine.

[107]  C. Bubin Mistakes happen. Improved processes mean fewer mistakes. , 1999, Ambulatory outreach.

[108]  R L Helmreich,et al.  Cockpit Management Attitudes , 1984, Human factors.

[109]  D. Bates,et al.  Relationship between medication errors and adverse drug events , 1995, Journal of General Internal Medicine.

[110]  David M. Eddy,et al.  Archimedes: a new model for simulating health care systems--the mathematical formulation , 2002, J. Biomed. Informatics.

[111]  M. Brandeau,et al.  Operations research and health care : a handbook of methods and applications , 2004 .

[112]  Sally Trude,et al.  Employers shift rising health care costs to workers: no long-term solution in sight. , 2004, Issue brief.