Poor data infrastructure hampers quality improvement, PCAST says

The nation's healthcare system needs to follow the lead of the aviation and manufacturing industries and adopt a systems-engineering approach to quality improvement, but fee-for-service payments and an inadequate health data infrastructure are obstacles to doing so, according to a new report from the President's Council of Advisors on Science and Technology (PDF).

“The predominant fee-for-service payment system is the primary barrier to greater use of systems methods and tools in healthcare, as it serves as a major disincentive to more efficient care,” PCAST co-chairs John Holdren, director of the White House Office of Science and Technology Policy, and Eric Lander, president of the Broad Institute of Massachusetts Institute of Technology and Harvard research organization, wrote in the report's introduction. “First and prerequisite for other kinds of progress, the nation must accelerate the transition to payment models that pay for value rather than volume.”New payment models depend on metrics—especially outcome measures—so the nation's health data infrastructure needs to be bolstered, the report noted. Help needs to be provided to overcome technical barriers—particularly for small medical practices, it noted.

The aviation industry has used systems-engineering methods during the past 50 years to reduce commercial airline fatalities from hundreds a year to practically zero, PCAST noted. By using tools developed in aviation—such as alerts, checklists and redundancies— the healthcare system can improve productivity, efficiency, reliability and quality, PCAST argued. It also suggested seven steps to accomplishing this. 

The steps are: accelerate alignment of payment incentives with desired outcomes; increase access to health data and analytics; provide technical assistance in systems engineering; involve communities in healthcare improvement; share lessons learned; and train healthcare professionals in new skills.

“The current stresses on clinicians mean that improvement initiatives cannot simply add to a clinician's workload or rely on the clinicians finding time to participate in additional initiatives,” PCAST authors wrote. “Rather, successful and sustainable improvement must involve reconfiguring the workflow and overall environment in which these professionals practice, which can help to reduce the burden of work while improving the performance of the system.”
Today's “policy environment” and recent advances in technical capabilities combine to make this the right time to expand system methods throughout healthcare, PCAST concluded.

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