A Road Map to Engineer a Better Health Care Delivery System Jerome H. Grossman, MD Director, Health Care Delivery Policy Program Harvard University JFK School of Government Harvard/Kennedy School Health Care Delivery Project October 13, 2005

Progress to Date 2001 – To Err is Human – 100,000 deaths from errors 2001 – Crossing the Quality Chasm – problem identification 2004 – Medicare Modernization Act: Rx drug coverage Consumer directed care (HSA) Demonstrations in P4P Transparency Disease management 2005 – Legislation and alliances for quality and accountability Patient Safety and Quality Improvement Act IOM Engineering/Health Care Partnership

Concept of a Four-Level Health Care System ENVIRONMENT Regulatory, market and policy framework ORGANIZATION Infrastructure, resources CARE TEAM Frontline care providers PATIENT Source: Building a Better Delivery System, A New Engineering/Health Care Partnership, IOM, 2005

Generic Vision of the Health Care Delivery System Lab Imaging Ambulatory Surgery Bed/OR/ICU Personnel Mgt Facility Optimization Supply Chain Mgt Patient Front Line Team HOME OFFICE HOSPITAL Financial Engineering/ Productivity Predictive Modeling Translational Genomics ENVIRONMENT RESEARCH REGULATION AND OVERSIGHT INSURERS JCAHO/NCQA/NQF FDA/CDC/CMS/AARCQ

The Unique Information Aspects of Health Care on a Generic Enterprise Management System Patient Information Patient Status Action Plan Decision Support PROCESSMGTPROCESSMGT ENTERPRISEMGTSYSENTERPRISEMGTSYS Customer Relationship Management Business process reengineering Personnel machines Supply chain mgt Knowledge mgt Financial mgt Generic Support System Mgt Information Systems Unique Health Care Information

Service Science Systems Engineering Systems Design Tools - concurrent engineering/quality function deployment, human factors tools, failure analysis tools Systems Analysis Tools Modeling and Simulation - queuing methods, discrete event simulation Enterprise Management – supply chain management, game theory/contracts, systems- dynamics models, productivity measuring/monitoring Financial Engineering and Risk Analysis – stochastic analysis, value-at-risk, optimization tools for individual decision making, distributed decision making market models/agency theory Knowledge Discovery in Databases – data mining, predictive modeling, neural networks Systems Control Tools – statistical process control, scheduling Computer Science Applying lessons learned from advances in other fields Increased coordination of research and development supported through the Networking and Information Technology Research and Development Program Communication Engineering research focused on defining an architecture to incorporate data from microsystems into the wider health network and developing interface standards/protocols to implement this larger network Micro Sensors Public/private sector support for research on development of very small, low-power, bicompatible devices essential for improving healthcare delivery Source: Building a Better Delivery System

Systems Engineering Source: Building a Better Delivery System Computer Science and communications research should be focused on the following areas: Human information/communications technology system interfaces Voice recognition systems Software that improves interoperability/connectivity among systems from different vendors Software dependability in systems critical to health care delivery Secure, dispersed, multiagent databases meets needs of providers and patients Measuring impact of information/communications systems on quality and productivity of health care

Systems Engineering Source: Building a Better Delivery System Microsystems research should be focused on the following areas: Integration, packaging and miniaturization (to be consistent with implantation in the body Tissue interfaces and bicompatibility for long-term implantation Interfaces and approaches to noninvasive (wearable) devices for measuring a broad range of physiological parameters Systems that can transform data reliably and accurately into information and information into knowledge as a basis for treatment decisions

Strategy to Accelerate Change 1.Conduct basic and applied research on systems challenges to healthcare delivery and development/use of: Systems engineering tools Information/communications technologies Knowledge from other fields 2.Demonstrate and diffuse the use of these tools, technologies and knowledge throughout the healthcare delivery system 3.Educate and train current/future healthcare, engineering and management professionals and researchers in the science, practices and challenges of systems engineering for healthcare delivery The federal government, in partnership with the private sector, universities, federal laboratories and state governments, should establish multidisciplinary centers at institutions of higher learning throughout the country to: Source: Building a Better Delivery System

Prototypes in Development Georgia Institute of Technology Kaiser Permanente Mayo Clinic Regenstrief/Purdue University

A Model Based on Disruptive Innovations 1. Quality is a relative concept. It can only be expressed relative to the job a person is trying to get done. 2. Disruption allows people to do it themselves – it brings consumption closer to the end consumer. 3. Rules fuel disruption. Before a problem is well understood, experts need to experiment to solve it. Once a problem is well understood, lesser-trained people can follow simple rules to deliver a “good enough” solution. Source: Christensen, CM and Anthony, SD. “Cheaper, Faster, Easier: Disruption in the Service Sector.” Strategy & Innovation, 2004.

Next Stages Systems engineering research and development Computer science and communications Tools and techniques to improve productivity Coordination and standards Responsibility Continuous innovation