The IOM Paints the Picture of Health


If you have a long moment you might check out the Institute of Medicine’s (IOM) latest report, Best Care at Lower Cost – The Path to Continuously Learning Health Care in America.  This report offers a 50,000 foot view of how science, technology and a new culture of medicine can transform American health care.  Underscoring the shortfalls of our current system, the IOM has conceptualized what they refer to as a learning health care system, one that links personal and population data to offer real-time information and improved outcomes.

I’m suspicious that the folks at the IOM have been reading Eric Topol’s visionary book, The Creative Destruction of Medicine.

A couple of key elements that resonated with me:

Information.  The report underscores one of the most pressing challenges of this generation: data and information management.

“The foundation for a learning health care system is continuous knowledge development, improvement, and application. Although unprecedented levels of information are available, patients and clinicians often lack access to guidance that is relevant, timely, and useful for the circumstances at hand. Overcoming this challenge will require applying computing capabilities and analytic approaches to develop real-time insights from routine patient care, disseminating knowledge using new technological tools, and addressing the regulatory challenges that can inhibit progress.”

Patients.  While not necessarily advocating a patient-centered world, the critical role of the patient in shared decision-making is evident throughout the report.  Hold onto something before you read this….

“Engaged patients are central to an effective, efficient, and continuously learning system.  Clinicians supply information and advice based on their scientific expertise in treatment and intervention options, along with potential outcomes, while patients, their families, and other caregivers bring personal knowledge on the suitability—or lack thereof—of different treatments for the patient’s circumstances and preferences. Both perspectives are needed to select the right care option for the patient. Communication and collaboration among patients, their families, and care teams are needed to fully address the issues affecting patients.”

Culture.  The report references a new culture of health care that I found interesting.

“Creating continuously learning organizations that generate and transfer knowledge from every patient interaction will require systematic problem solving; the application of systems engineering techniques; operational models that encourage and reward sustained quality and improved patient outcomes; transparency on cost and outcomes; and strong leadership and governance that define, disseminate, and support a vision of continuous improvement.”

Despite it’s progressive overtones there are the scraps of 20th century thinking evident at a couple of points.  I might have struck the discussion surrounding the traditional medical society’s role in a learning health care system and instead recognized the emerging digital modes of organization among doctors.

I would like to have seen more substantive attention drawn to medical education reform and the need to prepare the next generation for the future outlined by the IOM.

While lacking the granularity that I might have preferred, Best Care at Lower Cost represents a first step in medicine’s acknowledgement of the creative destruction of medicine.  And the references alone make it something to hold onto.

Follow the dialog surrounding the IOM report with #Bestcare.