Balancing the Research Portfolio
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Transcript of Balancing the Research Portfolio
Balancing the Research Portfolio
Jerome H. Grossman, MDDirector, Health Care Delivery Policy ProgramHarvard University JFK School of Government
October 28, 2003
Economic and Societal Changes
• Zuboff (1988) – In the Age of the Smart Machine
• Giddens (1988) – The Third Way: The Renewal of Social Democracy
• Rivlin (2002) – Challenges of Modern Capitalism
Elements of Healthcare Delivery
• Starr (1982) – The Social Transformation of Medicine
• Fuchs (1996) – Individual and Social Responsibility
• Institute of Medicine (2000/01) – To Err is Human, Crossing the Quality Chasm
Solving the Simultaneous Equations
Consumer AggregatorsInsurers/Risk Managers/Plans
Delivery Aggregators
Government Regulation Productivity
Delivery System
Government Consumers Employers
Knowledge Into Practice
Biologic Science• Clinical trial to production• Genome as building block• Systems biology• Reimbursement• Implementation• Diffusion
Engineering Science• Prototype to production • Productivity as building block• Systems engineering• Bundled payment/disease• Implementation • Diffusion
Engineering Based Delivery System
Patient-Centered SystemPatient
Front Line Team
Support Organizations
Environment
Information
Connectivity
Responsibility Innovation
CoordinationStandards
Sequential Information Experiments
Data Analysis Hypothesis Validation
Integration of Multiple Subsystems
PCP
ED
Admitting
SurgeryLabTriage
Patient Ed.
Library
Specialist
ICU
Post-OP
Nursing
Every Home an ICU
Source: Boston Globe
Evolving Role of Insurers
• Catastrophic care
• Disease management
• Pay for performance
• Tools for consumer education
Care for the Future
Source: Boston Globe
The Genome of Productivity
• Measurement of quality and efficiency
• Patient (biosensors, micro-systems)
• EMR, CPOE (CAD/CAM)
• Organization (scheduling, queuing)
• Environment (regulation, policy, homeland security)
Keeping Patients Connected
Source: Boston Globe
Barriers to Progress
• Medical industrial complex
• Provider as professional/patient as passive
• Lack of oversight
• Fragmented health care system
• Reform proposals not founded on research
• Healthcare delivery vs. medical care
What Hasn’t Happened
Very little progress has been made.
Source: Wall Street Journal
Medical Injuries CostBillions Every Year
Researchers studying health-care quality have concluded that medical injuries caused during hospital stay kill tens of thousands of patients annually, requiring at least 2.4 billion extra hospital days resulting in potential medical charges of $9.3 billion.
The work underscores both the scope of the problem and the relative lack of action in solving it. In 1999, for instance, the Institute of Medicine recommended the creation of a “nationwide mandatory reporting system” for medical errors. That hasn’t happened. Very little progress has been made.
Program Recommendations
• Research on engineering systems design
• Information and connectivity
• Coordination and standards
• Responsibility
• Continuous innovation
Our Vision
“The clinical operating system will improve interactions between doctors and patients, who will not have to be in the same room or even in the same time frame.
Enterprise software will provide a patient’s personal health record with information from the person’s entire clinical history”. (Jeffrey Goldsmith)