The President’s Council of Advisors on Science and Technology (PCAST) have reviewed their report “Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering”. Systems engineering widely used in manufacturing and aviation is an interdisciplinary approach to analyze design, manage, and measure a complex system to improve efficiency, reliability, productivity, quality, and safety.
The report indicates that by using a systems approach, positive results can be achieved. However today only a small number of healthcare organizations have incorporated a systems approach into their processes. So in spite of excellent examples, systems methods and tools are not yet used on a widespread basis in the American healthcare system.
According to the PCAST report, the Vanderbilt University Medical Center and affiliates are scaling up a program for people with chronic diseases across a large region of Tennessee and Kentucky. The model called ‘MyHealthTeam” works with teams of primary care clinicians, specialists, and care coordinators to care for patients using health IT.
The project uses real-time dashboards to track how patients are doing and to ensure that care is delivered reliably. The model identifies those patients in the greatest need of healthcare, so that clinicians can focus their attention on those patients that need care the most.
Once identified, those patients at highest risk of health problems are connected with a clinician who rapidly applies evidence-based interventions. The project has experienced challenges and has had to deal with payment model changes, bandwidth issues, and the problems that can occur when exchanging information across different information systems.
Another example is Denver Health, a safety net healthcare system taking care of a large number of vulnerable populations has used systems engineering to greatly reduce waste. Redesigning their operations and utilizing systems engineering reduced waste resulting in a total savings of $200 million.
Kaiser Permanente a big system located in 13 states with about 9 million members is using a systems engineering approach to identify sepsis and has actually cut mortality rates by half within the last two years.
Systems engineering requires multiple types of data. The report points out that working with greater amounts of data is not helpful if the data is not of good quality and easily exchangeable among all of the clinicians involved in a patient’s care. Good quality data must be accurate, complete, timely, relevant, and consistent.
Patient-generated health data an important source of data unfortunately is not yet largely used by the health system. However, increasing the use of this data presents an opportunity to not only improve clinical care and patient engagement, but also to provide researchers with a more comprehensive review of the patients’ experience.
The systems engineering approach is being used to require data on the flow of patients within hospital systems plus the time it takes clinicians to complete specific tasks. Data is often collected in different systems which may mean that the clinical information may not be collected in a format that can be easily applied to system redesign. Smaller practices may be challenged to routinely collect this type of data and do not always have data systems that can store the data.
The report recommends that while local clinical and operational data sources are critical, additional data is needed to understand health issues in communities and be able to examine broader regional or national trends This data is critical for successful systems reengineering as the data could help an organization identify opportunities for improvement in communities and assess their progress in real-time.
The report also recommends that HHS should create a senior leadership position at the Assistant Secretary level to focus on healthcare transformation. Duties would include making an inventory of existing data sources, expanding access to existing data through open data initiatives, and promoting collaboration with other Federal partners and private organizations. This would create a more focused and deep data-science capability by advancing data analytics and help implement systems engineering.
Go to www.whitehouse.gov/administration/eop/ostp/pcast/docsreports to view the report.