Report Calls for Overhaul of U.S. Healthcare System

America's healthcare system is highly fragmented and wasteful-often duplicating efforts, leaving unaccountable gaps in coverage, and failing to build on the strengths of all health professionals. These are the conclusions of a new report, "Crossing the Quality Chasm: A New Health System for the 21st Century," released by the Institute of Medicine. The report calls for immediate action to improve care over the next decade and offers a comprehensive strategy to accomplish this goal.

To spur an overhaul, the report recommends that Congress create an "innovation fund" of $1 billion to subsidize promising projects and communicate the need for rapid and significant change throughout the health system. According to the report, clinicians, healthcare organizations, and payers should focus on improving care for common, chronic conditions such as heart disease, diabetes, and asthma. These ailments usually involve a variety of clinicians and healthcare settings over extended periods of time. However, physician groups, hospitals, and healthcare organizations work so independently that they often provide care without receiving complete information about patients' conditions, medical histories, or treatment received in other settings.

Information Technology Is Key

The report envisions a revamped system that focuses on the needs, preferences, and values of patients; encourages teamwork among healthcare workers; and makes greater use of information technology. In the current system, patient information is often dispersed in a collection of paper records, which often are poorly organized, illegible, and difficult to retrieve. This outdated system makes it nearly impossible to manage chronic illnesses that require frequent monitoring and ongoing patient support. The report calls for a nationwide effort to build a technology-based information infrastructure that would eliminate most handwritten clinical data within the next 10 years. Such an effort should be a team effort led by Congress, the executive branch, leaders of healthcare organizations, and public and private payers.

In addition, many patients could also have their needs met more quickly and at a lower cost if they had the option of communicating with healthcare professionals via e-mail. The use of automated medication order entry systems could also help to reduce errors in prescribing and dosing drugs, and computerized reminders could help patients and clinicians identify needed services. However, the report recognizes that many policy, payment, and legal issues have to be resolved before much headway can be made.

A Broad View of Quality

To initiate such sweeping reform, the report recommends that the Agency for Healthcare Research and Quality identify 15 or more common chronic health conditions. Healthcare professionals, hospitals, health plans, and payers should then develop strategies and action plans to improve care for each of these priority conditions over a 5-year period. To stay aware of the big picture, the U.S. Department of Health and Human Services (HHS) should monitor and track quality improvements in six key areas: safety, effectiveness, responsiveness to patients, timeliness, efficiency, and equity. The HHS secretary should report annually to Congress and the president on progress made in those areas, the report says.

The report also calls for public and private payers to develop payment policies that reward quality. Current methods provide little financial reward for quality improvements and may even inadvertently pose barriers to innovation. With input from relevant private and public interests, the federal government should identify, test, and evaluate various payment options that more closely align compensation methods with quality improvement goals.

The report also offers 10 new rules intended to make the health system more responsive to patients and encourage their participation in decision-making. The rules are also intended to develop safe systems, anticipate patient needs, promote cooperation among clinicians, use resources wisely, and make available information on quality and safety performance.

The Institute of Medicine, the National Research Council, the Robert Wood Johnson Foundation, the California Health Care Foundation, the Commonwealth Fund, and the HHS sponsored the study. More information on the report is available at the Institute of Medicine web site (www.iom.edu).