Transcript A Virtual Unified Normative Health Care Delivery System

A Road Map to Engineer a Better
Health Care Delivery System
Jerome H. Grossman, MD
Director, Health Care Delivery Policy Program
Harvard University JFK School of Government
Harvard/Kennedy School Health Care Delivery Project
October 13, 2005
Progress to Date
2001 – To Err is Human – 100,000 deaths from errors
2001 – Crossing the Quality Chasm – problem identification
2004 – Medicare Modernization Act:
• Rx drug coverage
• Consumer directed care (HSA)
• Demonstrations in P4P
• Transparency
• Disease management
2005 – Legislation and alliances for quality and accountability
• Patient Safety and Quality Improvement Act
• IOM Engineering/Health Care Partnership
Concept of a Four-Level Health Care System
PATIENT
CARE TEAM
Frontline care providers
ORGANIZATION
Infrastructure, resources
ENVIRONMENT
Regulatory, market and policy
framework
Source: Building a Better
Delivery System, A New
Engineering/Health Care
Partnership, IOM, 2005
Generic Vision of the Health Care Delivery System
Lab
Patient
HOME
OFFICE
Front Line
Team
ENVIRONMENT
HOSPITAL
Predictive
Modeling
Translational
Genomics
RESEARCH
Personnel Mgt
Imaging
Ambulatory
Surgery
Facility
Optimization
Supply Chain Mgt
Bed/OR/ICU
Financial Engineering/
Productivity
JCAHO/NCQA/NQF
FDA/CDC/CMS/AARCQ
REGULATION AND OVERSIGHT
INSURERS
The Unique Information Aspects of Health Care on a
Generic Enterprise Management System
Unique
Health Care
Information
Decision
Support
Patient
Status
P
R
O
C
E
S
S
Action
Plan
M
G
T
Patient
Information
Customer
Relationship
Management
E
N
T
E
R
P
R
I
S
E
M
G
T
S
Y
S
Generic
Support
System Mgt
Information
Systems
• Business process
reengineering
• Personnel machines
• Supply chain mgt
• Knowledge mgt
• Financial mgt
Service Science
Systems Engineering
Computer Science
Systems Design Tools - concurrent
• Applying lessons learned from advances in other fields
engineering/quality function deployment, human
factors tools, failure analysis tools
• Increased coordination of research and development
supported through the Networking and Information
Technology Research and Development Program
Systems Analysis Tools
• Modeling and Simulation - queuing methods,
discrete event simulation
• Enterprise Management – supply chain
management, game theory/contracts, systemsdynamics models, productivity measuring/monitoring
• Financial Engineering and Risk Analysis –
stochastic analysis, value-at-risk, optimization tools
for individual decision making, distributed decision
making market models/agency theory
• Knowledge Discovery in Databases – data mining,
predictive modeling, neural networks
Communication
• Engineering research focused on defining an
architecture to incorporate data from microsystems into
the wider health network and developing interface
standards/protocols to implement this larger network
Micro Sensors
• Public/private sector support for research on
development of very small, low-power, bicompatible
devices essential for improving healthcare delivery
Systems Control Tools – statistical process
control, scheduling
Source: Building a
Better Delivery System
Systems Engineering
Computer Science and communications research should be
focused on the following areas:
• Human information/communications technology system interfaces
• Voice recognition systems
• Software that improves interoperability/connectivity among systems from
different vendors
• Software dependability in systems critical to health care delivery
• Secure, dispersed, multiagent databases meets needs of providers and
patients
• Measuring impact of information/communications systems on quality and
productivity of health care
Source: Building a
Better Delivery System
Systems Engineering
Microsystems research should be focused on the following areas:
• Integration, packaging and miniaturization (to be consistent with
implantation in the body
• Tissue interfaces and bicompatibility for long-term implantation
• Interfaces and approaches to noninvasive (wearable) devices for
measuring a broad range of physiological parameters
• Systems that can transform data reliably and accurately into
information and information into knowledge as a basis for treatment
decisions
Source: Building a
Better Delivery System
Strategy to Accelerate Change
The federal government, in partnership with the private sector, universities,
federal laboratories and state governments, should establish multidisciplinary
centers at institutions of higher learning throughout the country to:
1.
Conduct basic and applied research on systems challenges to healthcare
delivery and development/use of:
• Systems engineering tools
• Information/communications technologies
• Knowledge from other fields
2.
Demonstrate and diffuse the use of these tools, technologies and
knowledge throughout the healthcare delivery system
3.
Educate and train current/future healthcare, engineering and
management professionals and researchers in the science, practices and
challenges of systems engineering for healthcare delivery
Source: Building a
Better Delivery System
Prototypes in Development
• Georgia Institute of Technology
• Kaiser Permanente
• Mayo Clinic
• Regenstrief/Purdue University
A Model Based on Disruptive Innovations
1.
Quality is a relative concept. It can only be expressed
relative to the job a person is trying to get done.
2.
Disruption allows people to do it themselves – it brings
consumption closer to the end consumer.
3.
Rules fuel disruption. Before a problem is well
understood, experts need to experiment to solve it. Once a
problem is well understood, lesser-trained people can
follow simple rules to deliver a “good enough” solution.
Source: Christensen, CM and Anthony, SD. “Cheaper, Faster, Easier:
Disruption in the Service Sector.” Strategy & Innovation, 2004.
Next Stages
• Systems engineering research and development
• Computer science and communications
• Tools and techniques to improve productivity
• Coordination and standards
• Responsibility
• Continuous innovation