Deconstructing the IOM’s Report on a Learning Healthcare System

I had the pleasure of being one of a small handful of people live tweeting the IOM’s simulcasted release of their latest report: “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” For those interested in the conversation, and those who want to listen to the committee members as they present the highlights of the report and engage in a panel discussion about what the report means, the endured webinar can be found here.

It will take some time to work through the full report 381 page report (which can be downloaded here) but in the meantime it is worth the effort to try to see what we can learn from the comments and discussions had at yesterday’s meeting.

My #1 takeaway: The committee members and chair confirmed, at a very broad and general level, everything that I have been blogging about herein and everything I have written about in #socialQI: Simple Solutions for Improving Your Healthcare. Remember that my logic and goals are the following:

  1. The complexity of science, medicine, and healthcare has surpassed the cognitive capacity of the individual stakeholder
  2. To ensure optimal healthcare outcomes and to flatten the variability across the systems, patients need other patients, physicians need other physicians, scientists need other scientists.
  3. To maximize wellness and healthcare quality, we must have a system architecture that simplifies social engagement, information flow, and collaboration.
  4. As the system architecture is built, we must support the end users (patients, physicians, and scientists) such that they can effectively leverage the system.
  5. As new collaborative healthcare models emerge, they cannot be left to chance. We need broad, intelligent engineering to accelerate change.
  6. We must learn from the science of social networks and the science of behavior change to inform the systems and skills that we are leveraging

As you read through the tweetstream, my blow-by-blow account from the simulcast, see how often these themes are addressed. Even in the opening salvo of the report you can seen the similarity of ideas:

The committee identified two reasons for the problems that grow more urgent every year. One is the increasingly unmanageable complexity of the science of health care. During the past half-century, there has been an explosion of biomedical and clinical knowledge, with even more dazzling clinical capabilities just over the horizon. However, the systems by which health care providers are trained, deployed, paid, and updated cannot usefully digest this deluge of information. Second is the ever-escalating cost of care, which is widely acknowledged to be wasteful and unsustainable. Unless ways are found to provide more efficient, lower-cost health care, more and more Americans will lose coverage of and access to care. The committee also believes that opportunities exist for attacking these problems — opportunities that did not exist even a decade ago.

  1. Vast computational power (with associated sophistication of information technology) has become affordable and widely available. This capability makes it possible to harvest useful information from actual patient care (as opposed to one-time studies), something that previously was impossible.
  2. Connectivity allows that power to be accessed in real-time virtually anywhere by professionals and patients, permitting unprecedented diffusion of information cheaply, quickly, and on demand.
  3. Progress in human and organizational capabilities and management science can improve the reliability and efficiency of care, permitting more scientific deployment of human and technical resources to match the complexity of systems and institutions.
  4. Increasing empowerment of patients unleashes the potential for their participation, in concert with clinicians, in the prevention and treatment of disease — tasks that increasingly depend on personal behavior change.

My #2 takeaway: The report is an important step to bring about change, but we will need a concerted effort to consume, digest, and systematically address each of the committee’s recommendations – some of which we have traction towards, many of which the broader community has only given faint lip service to. Here are the recommendations: (and for many Chapter 10 of the report might be the best place to start – so here is the Recommendations chapter).

In a way, since the very system that this report is designed to fix, is the very system that has to use the report to fix itself…it is possible that this may get us nowhere fast
(…let that sink in for a second.)

My #3 takeaway: I am holding out the highest of hopes and expectations for what this report might mean to the community. While it is perhaps a bit thin at times on exact steps to be taken and while it may be a bit traditional in its style, the report serves a very important purpose. By echoing and codifying (in a formal report) so many of the ideas and efforts that have been evolving on the edges of the ‘house of medicine,’ this report validates the efforts of the innovators and the champions for change. And, the impact of this is immeasurable. What Topol and Christensen and Hwang and Brenner and Gawande and others have been working towards for the past decade and what I have attempted to address within the #socialQI framework has now been defined by the IOM as the collective intent and the shared praxes of the healthcare improvement community. In this way this report might very well galvanize a broad and focused effort…the key word there is ‘might.’ Time will tell if the lessons shared within this report are embraced more systematically and more holistically than the prior ‘landmark’ reports from the IOM.

As a post script, I should also add that many of the best ideas raised in this report (and again, I have just begun working through the 381 pages) are clearly written in the voice of Lynn Etheredge. If you don’t know who he is, please look him up. If there were ever a triumvirate of healthcare quality advocates that can help us get from the ideas presented in this report to the practical change we need it is Lynn, Peter Pronovost, and Don Berwick.

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