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.

Contents

• The National Academies
• Committee on Engineering and the Health Care System
• Preface
• Acknowledgment of Reviewers
• Executive Summary
  • ENGINEERING/HEALTH CARE PARTNERSHIP
  • SYSTEMS-ENGINEERING TOOLS FOR HEALTH CARE DELIVERY
  • INFORMATION AND COMMUNICATION TECHNOLOGIES FOR HEALTH CARE DELIVERY
  • A STRATEGY TO ACCELERATE CHANGE
  • CALL TO ACTION
  • REFERENCES
• I. Consensus Report
  • 1. A New Partnership between Systems Engineering and Health Care
    • THE PARADOX OF AMERICAN HEALTH CARE
    • INTERCONNECTED CRISES IN U.S. HEALTH CARE
    • PROXIMATE CAUSES OF HEALTH CARE CRISES
    • THE ROLE OF ENGINEERING IN THE TRANSFORMATION OF HEALTH CARE
    • THE ENGINEERING/HEALTH CARE PARTNERSHIP
    • STRUCTURE OF THE REPORT
    • REFERENCES
  • 2. A Framework for a Systems Approach to Health Care Delivery
    • A FOUR-LEVEL MODEL OF THE HEALTH CARE SYSTEM
    • The Individual Patient
    • A SYSTEMS VIEW OF HEALTH CARE
    • THE ROLE OF INFORMATION AND COMMUNICATIONS TECHNOLOGY
    • REFERENCES
  • 3. The Tools of Systems Engineering
    • THE NEED FOR GOOD DATA
    • SYSTEMS-DESIGN TOOLS
    • SYSTEMS-ANALYSIS TOOLS
    • SYSTEMS-CONTROL TOOLS
    • APPLYING SYSTEMS TOOLS TO HEALTH CARE DELIVERY
    • BARRIERS TO IMPLEMENTATION
    • FINDINGS
    • RECOMMENDATIONS
    • CONCLUSION
    • REFERENCES
  • 4. Information and Communications Systems: The Backbone of the Health Care Delivery System
    • THE CENTRALITY OF INFORMATION TO HEALTH CARE DELIVERY
    • FROM ELECTRONIC MEDICAL RECORDS TO A NATIONAL HEALTH INFORMATION INFRASTRUCTURE
    • FOUNDATIONS OF A NATIONAL HEALTH INFORMATION INFRASTRUCTURE
    • COMMUNICATIONS TECHNOLOGIES
    • MICROELECTRONIC SYSTEMS AND EMERGING MODES OF COMMUNICATION
    • CONCLUSION
    • REFERENCES
  • 5. A Strategy to Accelerate Change
    • EDUCATIONAL BARRIERS TO CHANGE
    • A PLATFORM FOR INTERDISCIPLINARY RESEARCH, EDUCATION, AND OUTREACH
    • CALL TO ACTION
    • REFERENCES
• II. Workshop Presentations
  • Framing the Health Care Challenge
    • Crossing the Quality Chasm
      • FIVE-PART AGENDA FOR CHANGE
      • TEN RULES FOR REDESIGNING AND IMPROVING CARE
      • REFERENCE
    • Bridging the Quality Chasm
    • Envisioning the Future
      • UNRAVELING THE GENOME AND EXTENDING THE HUMAN LIFE SPAN
      • COMPUTERIZED PATIENT RECORDS AND DECISION-SUPPORT SYSTEMS
      • INTERACTIONS BETWEEN PATIENTS AND THE HEALTH CARE SYSTEM
      • SUMMARY
    • Improving Health and Health Care
    • Engineering and the Health Care System
    • Engineering and the Health Care Organization
  • Equipping the Patient and the Care Team
    • Evidence-Based Medicine
    • The Context of Care and the Patient Care Team: The Safety Attitudes Questionnaire
      • THE SAFETY ATTITUDES QUESTIONNAIRE
      • REFERENCES
    • Engineering the Patient and Family into the Patient Care Team
    • Connecting Patients, Providers, and Payers
    • New Paradigms for Working and Learning
    • Designing Caregiver- and Patient-Centered Health Care Systems
  • Engineering Tools and Procedures for Meeting the Challenges
    • Systems Engineering: Opportunities for Health Care
    • Supply-Chain Management and Health Care Delivery: Pursuing a System-Level Understanding
      • FROM UNIT PROCESSES TO SUPPLY CHAINS
      • KNOWLEDGE OF SUPPLY-CHAIN MANAGEMENT
      • RESEARCH NEEDS AND FUTURE DIRECTIONS
      • REFERENCES
    • The Human Factor in Health Care Systems Design
    • Changing Health Care Delivery Enterprises
    • Transforming Current Hospital Design: Engineering Concepts Applied to the Patient Care Team and Hospital Design
      • BACKGROUND
      • A NEW DESIGN
      • REFERENCES
    • Discrete-Event Simulation Modeling of the Content, Processes, and Structures of Health Care
      • CONTENT OF CARE
      • PROCESSES OF CARE
      • STRUCTURES OF CARE
      • TWO SIMULATION MODELING PROJECTS
      • CONCLUSION
      • REFERENCES
    • Measuring and Reporting on Health Care Quality
    • Archimedes: An Analytical Tool for Improving the Quality and Efficiency of Health Care
      • STRUCTURE AND SCOPE
      • METHODS
      • BUILDING THE MODEL
      • VALIDATION
      • USES OF AN ARCHIMEDES MODEL
      • DISCUSSION
      • REFERENCES
    • Applying Financial Engineering to the Health Services Industry
      • IMPROVING EFFICIENCY IN THE INSURANCE INDUSTRY
      • GLOBAL INSURANCE COMPANIES
      • PLANNING TO ACHIEVE FUTURE GOALS AND OBLIGATIONS
      • LIMITATIONS OF INDIVIDUALS MAKING DECISIONS UNDER UNCERTAINTY
      • IMPLICATIONS FOR THE HEALTH CARE INDUSTRY
      • RELATED READING
    • Engineering Tools and Methods in the Delivery of Cancer Care Services
    • Patient Trajectory Risk Management
    • Deploying Resources for an Idealized Office Practice: Access, Interactions, Reliability, and Vitality
      • REPETITIVE MASTER SCHEDULE
  • Information Technology for Clinical Applications and Microsystems
    • Engineering and the System Environment
    • Challenges in Informatics
      • SUMMARY
    • A National Standard for Medication Use
    • Obstacles to the Implementation and Acceptance of Electronic Medical Record Systems
    • Automation of the Clinical Practice: Cost-Effective and Efficient Health Care
    • The eICU^® Solution: A Technology-Enabled Care Paradigm for ICU Performance
    • Wireless Biomonitoring for Health Care
      • TRACKING FALLS
      • TRACKING THE AGED, CHILDREN, AND PETS
      • HOME CARE
      • RESPIRATORY MONITORING
      • MONITORING ACTIVITY
      • BLOOD PRESSURE AND VASCULAR COMPLIANCE
      • WIRELESS TECHNOLOGIES FOR PARALYZED PATIENTS
      • WIRELESS SYSTEMS FOR HEALTH CARE
      • ACKNOWLEDGMENTS
      • REFERENCES
    • Rehabilitation Redefined
    • Evaluating the Potential of New Technologies
  • Barriers and Incentives to Change
    • Political Barriers to Change
    • Lessons from Financial Services
    • Can Purchasers Leverage Engineering Principles to Improve Health Care?
    • Shibboleths in Modeling Public Policy
    • Matching and Allocation in Medicine and Health Care
• Appendixes
  • Appendix A Agenda for First Workshop
  • Appendix B Participants in First Workshop
  • Appendix C Agenda for Second Workshop
  • Appendix D Participants in Second Workshop
  • Appendix E Agenda for Third Workshop
  • Appendix F Participants in Third Workshop
  • Appendix G Biographical information

Support for this project was provided by the National Science Foundation (Award No. DMI-0222041), the Robert Wood Johnson Foundation (Grant No. 044640), and the National Institutes of Health (Contract No. N01-OD-4-2139, Task Order No. 111). Any opinions, findings, and conclusions or recommendations expressed in this report are those of the National Academy of Engineering/Institute of Medicine Committee on Engineering and the Health Care System and do not necessarily reflect the views of the funding organizations, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Science, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.