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Institute of Medicine (US) and National Academy of Engineering (US) Roundtable on Value & Science-Driven Health Care. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington (DC): National Academies Press (US); 2011.

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Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary.

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Appendix AWorkshop Agenda

Engineering a Learning Healthcare System: A Look at the Future

A Learning Healthcare System Workshop

Roundtable on Evidence-Based Medicine

The Institute of Medicine (IOM)

… in cooperation with …

the National Academy of Engineering (NAE)

April 29–30, 2008

The Keck Center of The National Academies

Washington, DC 20001

Issues Motivating the Discussion

  1. Health care is substantially underperforming on most dimensions: effectiveness, appropriateness, safety, cost, efficiency, and value.
  2. Increasing complexity in health care is likely to accentuate current problems unless reform efforts go beyond financing to foster significant changes in the culture, practice, and delivery of health care.
  3. Extensive administrative and clinical data collected in healthcare settings are largely unused for new insights on the effectiveness of healthcare interventions and systems of care.
  4. If the effectiveness of health care is to keep pace with the opportunity of diagnostic and treatment innovation, system design and information technology must be structured to ensure application of the best evidence, continuous learning, and research insights generated as a natural by-product of the care process.
  5. Engineering principles are at the core of a learning healthcare system—one structured to keep the patient constantly in focus, while continuously improving quality, safety, knowledge, and value in health care.
  6. Impressive transformations have occurred through systems and process engineering in service and manufacturing sectors—e.g., banking, airline safety, automobile manufacturing.
  7. Despite the obvious differences that exist in the dynamics of mechanical vs. biological and social systems, the current challenges in health care necessitate an entirely fresh view of the organization, structure, and function of the delivery and monitoring processes in health care.
  8. Taking on the challenges in health care offers the engineering sciences an opportunity to test, learn, and refine approaches to understanding and improving innovation in complex adaptive systems.


8:30Welcome and Introductions
Denis A. Cortese, Mayo Clinic and Roundtable on Evidence-Based Medicine (IOM)
William B. Rouse, Georgia Institute of Technology and Planning Committee Chair (NAE)
  1. Learning Opportunities for Health Care
  2. Teaching Opportunities from Engineering
Opening keynote speakers will address some of the key systemic shortfalls and challenges in health care today, reflecting on the changes needed and how systems engineering might help foster a healthcare system that delivers the care we know works and that learns from the care delivered.
Brent C. James, Intermountain Healthcare (IOM)
W. Dale Compton, Purdue University (NAE)
9:45Session 1: Engaging Complex Systems Through Engineering Concepts
How do the various engineering disciplines (e.g., systems engineering, industrial engineering, operations research, human factors engineering, financial engineering, risk analysis) engage system complexity, and how might this perspective inform and improve health care? What can we learn from the contrasts?
Chair: Paul H. O'Neill, Value Capture, LLC

Systems engineering perspectives

William B. Rouse, Georgia Institute of Technology (NAE)

Engineering systems analysis tools

Richard C. Larson, Massachusetts Institute of Technology (NAE)

[10:35–10:55 Break]

Engineering systems design tools

James M. Tien, University of Miami (NAE)

Engineering systems control tools

Harold W. Sorenson, University of California, San Diego

Panel discussion to follow
1:00Session 2: Healthcare System Complexities, Impediments, and Failures
What are the multiple healthcare system components and processes that affect the generation and application of evidence, and which inefficiencies, impediments, structural barriers, and failures are most acutely in need of attention and correction? How might systems engineering address these issues?
Chair and Introduction: Cato T. Laurencin, University of Virginia Health Systems (IOM)

Healthcare culture

William W. Stead, Vanderbilt University Medical Center (IOM)

Diagnostic and treatment technologies

Rita F. Redberg, University of California, San Francisco

Clinical data systems and clinical decision support

Michael D. Chase, Kaiser Permanente Colorado

Care coordination and linkage

Amy L. Deutschendorf, Johns Hopkins Hospital and Health System

Administrative and business systems

Ralph W. Muller, University of Pennsylvania Health System

Information and knowledge development

Eugene C. Nelson, Dartmouth–Hitchcock Medical Center

Panel discussion to follow
[3:15–3:30 Break]
3:30Session 3: Case Studies in Transformation Through Systems Engineering
How has systems engineering been successfully used in certain industries and sectors? Which key lessons best apply in the transformation of a sociologically and technologically complex healthcare arena? Are there examples of successful applications to health care? What are some key lessons from other sectors and service industries in managing complexity?
Chair: Carmen Hooker Odom, Milbank Memorial Fund

Airline safety

John J. Nance, formerly of National Patient Safety Foundation

Alcoa reorientation

Earnest J. Edwards, formerly of Alcoa

Veterans Health Affairs

Kenneth W. Kizer, Medsphere Systems Corporation (IOM)

Ascension Health

David B. Pryor, Ascension Health

Panel discussion to follow
5:15Day's Summary and Framework Discussion
What framework might illustrate ways in which lessons from engineering could map onto healthcare systems?
Paul H. O'Neill, Value Capture, LLC, and William B. Rouse, Georgia Institute of Technology (NAE)


8:00Welcome and Recap of the First Day
William B. Rouse, Georgia Institute of Technology and Planning Committee Chair (NAE)
8:15Session 4: Fostering Systems Change to Drive Continuous Learning in Health Care
The IOM Learning Healthcare System workshop publication identified several common characteristics of a learning healthcare organization, including culture that emphasizes transparency and learning through continuous feedback loops, care as a seamless team process, best practices that are embedded in system design, information systems that reliably deliver evidence and capture results, and results that are bundled to improve the level of practice and the state of the science. What do feedback and performance improvement look like for each topic below, and how can impediments be turned into enablers?
Chair: Richard C. Larson, Massachusetts Institute of Technology (NAE)

Learning-, team-, and patient-oriented culture

Steven J. Spear, Massachusetts Institute of Technology

Knowledge development, access, and use

Donald E. Detmer, American Medical Informatics Association (IOM)

Technologies management

Stephen J. Swensen, Mayo Clinic

Information systems organization and management

David C. Classen, Computer Sciences Corporation

Panel discussion to follow
[10:00–10:30 Break]
10:30Breakout Session: Capturing More Value in Health Care
Five groups to meet and discuss three questions:

At a macro level, what's your best guess on how much more value (health returned for money invested) could be obtained through application of systems engineering principles in health care?

If you had to identify one area in which the greatest value could be returned, what would that be?

What are the actions, taken by whom, that could do the most to facilitate the needed changes?

Breakout Chairs

Kenneth Boff, Room 205

Richard C. Larson, Room 206

William B. Rouse, Room 204

Harold W. Sorenson, Room 208

James M. Tien, Room 213

11:45Lunch Available (outside room 100)
1:00Breakout Session Reports
1:45Session 5: Observations on Initiating Systems Change in Health Care
Donald M. Berwick, Institute for Healthcare Improvement (IOM)
2:15Session 6: Next Steps: Aligning Policies with Leadership Opportunities
What are the key policy priorities if the best and most applicable lessons from the engineering sciences are to be applied in bringing about the necessary transformational changes? A panel of leaders from key settings will offer brief (5-minute) reflections on the policy and related culture changes necessary, followed by an interactive discussion.
Chair: Donald M. Berwick, Institute for Healthcare Improvement (IOM)

Academic medical centers

Denis A. Cortese, Mayo Clinic (IOM)

Community hospital settings

Paul F. Conlon, Trinity Health

Integrated healthcare delivery organizations

Louise L. Liang, Kaiser Permanente

Small ambulatory care settings

Douglas W. Lowery-North, Emory University

Skilled nursing facilities

Mary Jane Koren, The Commonwealth Fund

Panel discussion to follow
4:30Concluding Summary Remarks and Adjournment
Denis A. Cortese, Mayo Clinic and Roundtable on Evidence-Based Medicine (IOM)
J. Michael McGinnis, IOM

Planning Committee:

  • William B. Rouse. Ph.D., M.S. (Chair), Georgia Institute of Technology
  • Jerome H. Grossman, M.D., Harvard University
  • Brent C. James, M.D., M.Stat., Intermountain Healthcare, Inc.
  • Helen S. Kim, M.B.A., Gordon and Betty Moore Foundation
  • Cato T. Laurencin, M.D., Ph.D., University of Virginia
  • The Honorable Paul H. O'Neill, Value Capture, LLC
Copyright © 2011, National Academy of Sciences.
Bookshelf ID: NBK61962


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