An IOM Learning Healthcare System Workshop Preliminary Discussion Brief
March 2009
The Institute of Medicine’s Roundtable on Evidence-Based Medicine provides a trusted venue for key stakeholders to work cooperatively on innovative approaches to the generation and application of evidence that will drive improvements in the effectiveness and efficiency of medical care in the United States. Participants seek the development of a learning healthcare system that enhances the availability and use of the best evidence for the collaborative healthcare choices of each consumer and healthcare professional; drives the process of discovery as a natural outgrowth of patient care; and ensures innovation, quality, safety, and value in health care. Roundtable members have set a goal that, by the year 2020, ninety percent of clinical decisions will be supported by accurate, timely, and up-to-date clinical information, and will reflect the best available evidence on what works best for whom, under what circumstances.
The demand for better evidence to guide healthcare decision-making is growing rapidly against the backdrop of heightened public awareness and concern about the very high cost of medical care, the growing proportion of the average wage earners’ income that must be devoted to paying for health costs out of pocket, the proportion of healthcare interventions that are unnecessary, the frequency of medical errors, and the adverse consequences of care administered without adequate evidence. It is now much better recognized that although more than $2 trillion is spent annually on health in the United States, a very small share is devoted to learning what works best in health care, for whom and under what circumstances— perhaps less than one tenth of 1% of the total. To improve the effectiveness and value of the care delivered, there is a need to build the capacity for ongoing study, monitoring, and application of the relative effectiveness of clinical interventions and care processes, through expanded trials and studies, systematic reviews, innovative research strategies, clinical registries, the translation and provision of information, and decision support. Several recent initiatives have proposed the development of increased capacity for expanded study of the comparative effectiveness of interventions and for increasing the IT infrastructure necessary to accelerate both this work and the evolution of the Learning Healthcare System. The American Recovery & Reconstruction Act of 2009 commits $1.1 billion to Comparative Effectiveness Research, and $19 billion to increasing health information technology.
To inform the policy discussion on these issues, on July 30-31, 2008, the IOM Roundtable on Evidence-Based Medicine convened a workshop entitled Learning What Works: Infrastructure Required to Learn Which Care is Best. The goal of the workshop was to clarify the elements and nature of the needed capacity, solicit quantitative and qualitative assessments of the needs, and characterize them in a fashion that will facilitate engagement of the issues by policymakers. Two assumptions guided the discussions: that resources will be available to expand work on the comparative effectiveness of medical interventions; and that given recent public discourse on the need for a stronger focus to the work, a designated entity would be developed with a formal charge to coordinate the expanded work.
This workshop gathered leading practitioners in health policy, technology assessment, health services research, health economics, information technology and health professions education and training, to explore through invited presentations the current and future capacity needed to generate new knowledge and evidence about what works best, including skills and workforce, data linkage and improvement, study coordination and result dissemination, and research methods innovation. Participants explored in both qualitative and quantitative terms, the nature of the work required, the information technology and integrative vehicles required, the skills and training programs required, the priorities to be considered, the role of public-private partnerships, and the strategies for immediate attention while playing to the long-term needs and opportunities. Throughout the course of the workshop, a number of common themes and implications emerged, along with a number of possible follow-up actions to be considered for ongoing multi-stakeholder involvement through the IOM Roundtable on Evidence-Based Medicine.
