The Roundtable on Evidence-Based Medicine held a workshop on the Learning Healthcare System on April 29-30, 2008. This workshop was a collaboration between the Institute of Medicine and the National Academy of Engineering.

Health care is substantially underperforming on most dimensions: effectiveness, appropriateness, safety, cost, efficiency, and value. Increasing complexity in health care is likely to accentuate current problems unless reform efforts go far beyond financing, to foster significant changes in the culture, practice, and delivery of health care. If the effectiveness of health care is to keep pace with the opportunity of diagnostic and treatment innovation, system design and information technology must be structured to assure application of the best evidence, continuous learning, and research insights as a natural by-product of the care process. In effect, the nation needs to engineer the development of a learning healthcare system—one structured to keep the patient constantly in focus, while continuously improving quality, safety, knowledge, and value in health care. Striking transformations have occurred through systems and process engineering in service and manufacturing sectors—e.g. banking, airline safety, and automobile manufacturing. Despite the obvious differences that exist in the dynamics of mechanical versus biological and social systems, the current challenges in health care compel an entirely fresh view of the organization, structure, and function of the delivery and monitoring processes in health care.