The essence of this publication, Leadership Commitments to Improve Value in Health Care: Finding Common Ground, reflects the motivations and driving forces behind the Roundtable on Evidence-Based Medicine. That is, that no one sector can effect the transformation needed in health care and that collaborative work and action are vital to developing the learning healthcare system that provides care of the best possible value to all of our citizens. By value, we mean the full value equation—the best outcomes, safety, and service for the best price. The Institute of Medicine (IOM) Roundtable is made up of stakeholders with often different perspectives and incentives, but we are all stakeholders committed to obtaining better results and better value from the health care that we deliver and we receive. Outlined in this volume are exciting and important opportunities to collectively move toward our vision and goal.
This publication represents just one component of the Roundtable’s work to help transform how evidence is both generated and used to improve health and health care. Our charter statement articulates a collective vision for a healthcare system that “draws upon the best evidence to provide the care most appropriate to each patient, emphasizes prevention and health promotion, delivers the most value, adds to learning throughout the delivery of care, and leads to improvements in the nation’s health.” Our goal is 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. Although it is ambitious, this goal presents a tangible focus for progress and should be achievable given our nation’s substantial investment in health care.
The guiding framework for the Roundtable’s work is its focus on fostering the development of a learning healthcare system. Because our current system is so fragmented, achieving this aim will require the extraordinary creativity and energy discussed at the workshop and in this publication. Our initial workshop and resulting publication, The Learning Healthcare System, characterized the system that we seek, one that is designed to generate the best evidence and to apply that evidence to the healthcare choices that each patient and provider make in collaboration; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care. The key characteristics of a learning healthcare system include adaptation to the pace of change; strong systemwide synergy and synchrony; a culture of shared responsibility; a practical clinical research paradigm in play; evidence standards that are consistent and tailored; clinical decision support systems that are fully applied; universal electronic health records; the establishment of clinical data as a public good; databases that are linked, mined in real time, and used; incentives that are aligned for practice-based evidence; patients who are engaged as evidence proponents; and a trusted scientific broker of needed guidance.
The Learning Healthcare System workshop series is designed to explore in greater detail these component issues. None is more important in this respect than the mutual commitment of the stakeholders discussed here. To identify the greatest opportunities and to begin the process of intersectoral collaboration, on July 24–25, 2007, the Roundtable convened a 2-day workshop titled Leadership Commitments to Improve Value in Health Care: Finding Common Ground. The third in the Learning Health-care System series, this workshop convened representatives from a variety of sectors—patients, healthcare professionals, healthcare delivery organizations, healthcare product developers, clinical investigators-evaluators, regulators, insurers, employers-employees, and information technology professionals—to discuss the ways that each sector, individually and collaboratively, can contribute to the transformative change necessary to achieve the Roundtable’s goal.
Workshop presentations resulted from several months of work by Roundtable members to develop, in cooperation with other participants recruited from their respective arenas, statements that laid out the issues and opportunities from the perspectives of each of the sectors. These statements detailed the important characteristics and activities of each sector with respect to evidence development and application and advanced some key opportunities and specific initiatives for individual and cross-sectoral work to bring about transformative change. These statements were presented over the course of the 2-day workshop and set the stage for rich discussion and debate. This publication includes the sectoral statements, a summary of the workshop proceedings, and identification of the common themes.
Among the participants, several important foundation stones were considered vital to progress. Common ground could be forged by building trust between the many stakeholders and fostering a shared commitment to evidence-driven care. Also needed are efforts to consistently build learning into the culture of health care and the establishment of a common focal point or trusted source to coordinate the development and dissemination of evidence. The greatest transformational opportunities identified include the clarification of core concepts, beginning with a sharper focus on the value proposition and the establishment of transparent principles and processes for evidence interpretation and use; identifying a set of national priorities around unused evidence and unavailable evidence and strengthening the national capacity for evidence development and guidance; reorienting the healthcare system to produce the evidence for today’s decisions, with tomorrow in view; encouraging rapid progress in medical informatics; and engaging healthcare providers in establishing interdisciplinary evidence-driven team care as standard care. Above all, stakeholder leadership will be essential to encourage and promote the needed change.
We would like to acknowledge the many individuals and organizations that donated their valuable time to the development of this workshop summary. In particular, we acknowledge the contributors to this volume for their presence at the workshop and their efforts to further develop their presentations into the chapters contained within this summary. We would also like to acknowledge those who provided counsel during the planning stages of this workshop, including Patrick Anderson (Stryker), Helen Darling (National Business Group on Health), Michael Johns (Emory University), and Carmen Hooker Odom (Milbank Memorial Fund).1 A number of IOM staff were instrumental in the preparation and conduct of the 2-day workshop in July 2007, including Rachel Passman, Kristina Shulkin, and Jamie Skipper. Roundtable staff, including Katharine Bothner, Alex Goolsby, LeighAnne Olsen, and Daniel O’Neill, helped to translate the workshop proceedings and discussion into this workshop summary. Stephen Pelletier also contributed substantially to publication development. We would also like to thank Michele de la Menardiere, Bronwyn Schrecker, Vilija Teel, and Jackie Turner for helping to coordinate the various aspects of review, production, and publication.
As illustrated in this publication, a shared commitment to evidence-driven care offers a means to define common goals, set priorities, and identify practical ways to initiate action. However, collaboration is more than just a tool. Given the transformative change needed in health care, it is an imperative. The Roundtable looks forward to expanding the sphere of sector involvement, collaboration, and action in the field to build upon the substantial opportunities identified in this publication.
Denis A. Cortese, M.D.
Chair, Roundtable on Evidence-Based Medicine
J. Michael McGinnis, M.D., M.P.P.
Executive Director, Roundtable on Evidence-Based Medicine
IOM planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteur and the institution.
National Academies Press (US), Washington (DC)
Institute of Medicine (US) Roundtable on Evidence-Based Medicine. Leadership Commitments to Improve Value in Healthcare: Finding Common Ground: Workshop Summary. Washington (DC): National Academies Press (US); 2009. Preface.