Skip to main content

Advanced Search

Advanced Search

Current Filters

Filter your query

Publication Types



Newsletter Article


IOM: Care So Complex Its Cost Can Only Be Cut Through a 'Learning System'

By John Reichard, CQ HealthBeat Editor

September 6, 2012 -- Reports abound on the need for better, cheaper health care in the United States, but Institute of Medicine (IOM) officials said a new one they unveiled last week marks a fresh approach to the problem by fully confronting the complexity of the system.

That complexity contributed to about $750 billion in wasted health care spending in 2009, said the report, released at a Washington, D.C., news conference. That total, roughly 30 percent of U.S. spending on health care that year, was, the report said, "wasted on unnecessary services, excessive administrative costs, fraud and other problems."

Wasted money isn't the only issue. "By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state," the IoM said.

Doctors now practice in a system in which about 800,000 new medical journal articles are published each year, said Mark D. Smith, chairman of the IOM committee that prepared the report. Seventy-five million Americans have more than one chronic condition, the report noted. Than requires "coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions."

Health care is now characterized "by more to do, more to know, and more to manage than at any time in history," the report observed.

"Incremental upgrades and changes by individual hospitals or providers will not suffice," said the IOM committee that produced the report. Achieving higher quality at a lower cost requires no less than transforming all of U.S. health care into a "learning" system, the panel said. That system "continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery."

It will require "embracing new technologies to collect and tap clinical data at the point of care, engaging patients and their families as partners and establishing greater teamwork" in health care organizations. "Also, incentives and payment systems should emphasize the value of outcomes of care," the IOM said.

One of the themes of the report—the gap between what it known about how to improve care and actually doing it—is hardly new. It was well explored in an IOM report a dozen years ago that described the gap as a "quality chasm."

Smith said, however, that four new tools have been developed since then to better close the gap.

Computing power now exists "that's really beyond what anyone could have imagined" then, said Smith. It is "ubiquitous and affordable."

In addition, he said, "providers can be connected to one another, providers can be connected to patients, patients can be connected to one another."

Management science also has been improved to get waste out of systems and to improve quality, he said. And the fourth tool is "collaboration between teams of clinicians, and between clinicians and patients" made possible through computing power.

Mobile technologies and electronic health records exist that offer "significant potential to capture and share health data better," the report said. "Clinicians and care organizations should fully adopt these technologies," and patients should be encouraged to use tools such as websites that allow them to access their medical files, it added.

Lest the report seem so sweeping in its recommendations as to seem impractical, IOM officials pointed to concrete examples of systems that are doing what they recommend, such as Denver Health in Denver Colorado and the Virginia Mason health system in Seattle Washington.

"We see organizations that really have adopted that philosophical change" that emphasizes greater use of data to assure best practices, greater involvement of patients, and more teamwork, Smith said.

"Where you see it happen it's a profound cultural change," added Craig Jones, another member of the IOM committee that produced the report. Jones is the director of the Vermont Blueprint for Health, an effort by the state's government to improve the efficiency of care.

Publication Details