A Road Map to Engineer a Better Health Care Delivery System

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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

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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

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Concept of a Four-Level Health Care System
PATIENT
CARE TEAM Frontline care providers
Source Building a Better Delivery System, A New
Engineering/Health Care Partnership, IOM, 2005
ORGANIZATION Infrastructure, resources
ENVIRONMENT Regulatory, market and policy
framework
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Generic Vision of the Health Care Delivery System
Lab Imaging Ambulatory Surgery Bed/OR/ICU
Personnel Mgt Facility Optimization Supply Chain
Mgt
Patient
HOME
OFFICE
Front Line Team
HOSPITAL
Financial Engineering/ Productivity
Predictive Modeling
Translational Genomics
JCAHO/NCQA/NQF
FDA/CDC/CMS/AARCQ
ENVIRONMENT
INSURERS
REGULATION AND OVERSIGHT
RESEARCH
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The Unique Information Aspects of Health Care on
a Generic Enterprise Management System
Patient Information
P R O C E S S M G T
E N T E R P R I S E M G T S Y S
Generic Support System Mgt Information Systems
Unique Health Care Information
Patient Status

• Business process reengineering
• Personnel machines
• Supply chain mgt
• Knowledge mgt
• Financial mgt

Action Plan
Decision Support
Customer Relationship Management
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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
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Systems Engineering

• 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/connectiv
  ity 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

Source Building a Better Delivery System
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Systems Engineering

• 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

Source Building a Better Delivery System
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Strategy to Accelerate Change
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

• 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
• Demonstrate and diffuse the use of these tools,
  technologies and knowledge throughout the
  healthcare delivery system
• Educate and train current/future healthcare,
  engineering and management professionals and
  researchers in the science, practices and
  challenges of systems engineering for healthcare
  delivery

Source Building a Better Delivery System
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Prototypes in Development

• Georgia Institute of Technology
• Kaiser Permanente
• Mayo Clinic
• Regenstrief/Purdue University

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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.
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Next Stages

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