In its role as adviser to the nation to improve health, the Institute of Medicine (IOM) endeavors to bring individuals with the best scientific expertise together for discussion and deliberation on issues of national importance. Driving change often requires that scientific consensus be linked with leadership and a shared commitment to action. This spirit is embodied in the work of the IOM’s Roundtable on Evidence-Based Medicine. Convened in 2006, the Roundtable comprises senior private- and public-sector leaders representing the key stakeholders shaping health care for Americans. It provides a neutral venue for discussion and collaborative action to transform how evidence is generated and applied to improve the nation’s health. Together, Roundtable members have outlined their vision for a learning healthcare system, as expressed in their charter statement, and a goal by which to mark progress—that by 2020, 90 percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information and will reflect the best available evidence. Through a series of workshops and publications, the Roundtable works to explore the issues and barriers and to identify the key opportunities for collaborative work toward the development of a learning healthcare system.

This publication represents the third in the Learning Healthcare System series and is the result of work by each sector represented on the Roundtable—patients, healthcare professionals, healthcare delivery organizations, healthcare product developers, clinical investigators-evaluators, regulators, insurers, employers-employees, and information technology—to identify the key opportunities for individual and collaborative work to foster progress toward the Roundtable’s goal. The results of the work of the Roundtable members were presented at a 2-day workshop entitled, Leadership Commitments to Improve Value in Health Care: Finding Common Ground. The sector statements and subsequent workshop discussion are summarized in this volume.

Embedded in these pages are insights gleaned from across the spectrum of healthcare stakeholders. Although each sector brought a unique set of challenges, skills, and expertise to its work, many common concerns, issues, and opportunities emerged, including the pressing needs to build more trust and transparency into the system, to identify national priorities and build the necessary capacity, to foster a shared commitment to evidence-driven care, and to build learning into the culture of health care by accelerating advances in medical informatics and engaging the frontline providers in change. Among the opportunities identified, the most essential was that these activities be taken up as a shared endeavor. No one sector, acting alone, can bring about the scope and scale of transformative change necessary to develop a system that can consistently and efficiently deliver the safe, effective, and quality care of value that should be our nation’s standard. Stakeholder leadership from the Roundtable and beyond will be vital to success.

I would like to offer my personal thanks to Roundtable members for the leadership that they bring to these important issues, to the Roundtable staff for their skill and dedication in coordinating and facilitating the activities, and importantly, to the sponsors who make this work possible: the Agency for Healthcare Research and Quality, America’s Health Insurance Plans, AstraZeneca, Blue Shield of California Foundation, Burroughs Wellcome Fund, California Health Care Foundation, Centers for Medicare and Medicaid Services, Charina Endowment Fund, Food and Drug Administration, Johnson & Johnson, sanofi-aventis, Stryker, and U.S. Department of Veterans Affairs.

Harvey V. Fineberg, M.D., Ph.D.

President, Institute of Medicine