Health, Biomedical Science and Society Initiative
Health, Biomedical Science and Society Initiative
Turn information into insight
Turn information into insight. Information technology and biomedical research form the backbone of our health care system. We must minimize barriers to innovation and use information more effectively to better understand disease and therefore better treat it. The time has come to use information technology across the entire health care spectrum and to introduce tools that will protect privacy while driving efficiency and improving health outcomes. If we want better health, we must define it. To define it, we must gain insight by measuring outcomes and identifying what works. And once better health is measured, we should reward those who are achieving it best. Better information will help us meet our objectives.
The United States spent $116 billion on medical research in 2006.1 Innovations resulting from these investments have made enormous contributions to health and increased longevity. Studies find that the value of increased longevity in the U.S. is almost as large as the combined value of all other goods and services consumed by Americans.2
The costs of new treatments are often assumed to be one of health care’s problems. But this is simplistic; more medical spending is neither always better nor always worse for patients. Critical insights develop from considering both spending and the benefits it achieves. Also, aggregate spending is driven by the both the costs of care and the number of people seeking the care. Demand may rise because the value of an improved treatment is high, so more patients benefit. But when value is not understood, the usual assumption is that more care is better, so demand may rise simply because physicians or facilities are available.3 Better data and insight must underlie health care. Insightful analysis enables good decisions by all parties about what treatments make sense for patients, how to improve care and outcomes, and how to prevent disease or complications.
For example, innovations in treating cardiovascular disease account for 70% of the increase in longevity since 1965.4 Given the improved capabilities in cardiovascular care, demand and spending have risen. Costs per cardiovascular procedure, however, have risen less than the rate of inflation, so in real terms, costs have decreased. In short, we are achieving better outcomes at lower costs per patient, or in other words, higher value.5 It is not unusual for spending to increase when value increases. We spend more on computers today than we did two decades ago, although the costs of computer capability have decreased. For both computers and healthcare, spending may be a great investment or unnecessary. We cannot reasonably assess any innovation by looking only at costs or spending without also considering benefits.6
In addition to new products and procedures, medical research includes a wide array of other types of innovation. Reorganizing care delivery, improving processes of care, enhancing safety and reducing errors creates enormous benefit. Preventable adverse events are among the leading causes of death in the U.S.—between 44,000 and 98,000 deaths in U.S. hospitals annually, at a cost estimated between $17 billion and $29 billion.7 Yet, AHRQ, the government agency responsible for research on improving quality and reducing errors, as well as on organizing, financing and managing care delivery has a research budget of about 1% of the NIH budget.8 The nation needs more emphasis on measuring outcomes and supporting organizational innovation. Only then can we achieve the breakthroughs that will enable quality care for all Americans: the innovations that will change the culture and structure of care delivery to coordinate prevention, disease management and acute care.
Developing actionable insight requires us to look at the health outcomes and costs for medical conditions over the cycle of care. For example, the expense of imaging technologies is often lamented; the real question, however, is not just what the imaging costs, but also what improvements in outcomes it enables over the full care cycle. For example, imaging that enables very early detection of breast cancer changes the costs and the outcomes of treatment. Very early stage treatment is less complicated, often less costly, and has cure rates of almost 100%. A full cycle perspective gives critical insight.
Information technology can accelerate improvements in clinical practice. IT alone is not a solution, but it can powerfully enable coordinated teams who are organized to improve health outcomes. It can also speed the circulation of new knowledge. The IOM reported that results of clinical trials take an average of 17 years to be adopted by the average physician.9 Even the greatest advances in care have no value if they are not used in practice. Further, IT facilitates the tasks of collecting, analyzing, and sharing information on the results of treatment, giving clinicians the opportunity to build robust clinical insight more rapidly.
Without information, we cannot develop insight about what is working or how to improve health and care. The nation must do a better job of collecting outcome data for all medical conditions and using that data to speed learning and improve health care.
 Research America, 2006 Investment in U.S. Health Research, August 2007, available at www.researchamerica.org.
W.D. Nordhaus, The Health of Nations: The Contribution of Improved Health to Living Standards (New York: Lasker Foundation, 1999), available at <www.laskerfoundation.org/reports/pdf/healthofnations.pdf>. This does not include the benefits of reduced sickness or improved quality of life.
 E.S. Fisher and J.E. Wennberg, “Health Care Quality, Geographic Variations, and the Challenge of Supply-Sensitive Care,” Perspectives in Biology and Medicine 46, no. 1, (2003): 69-79; J.E. Wennberg, “Variation in Use of Medicare Services among Regions and Selected Academic Medical Centers: Is More Better” Duncan W. Clark Lecture, presented at the New York Academy of Medicine, New York, January 24, 2005, available at www.dartmouthatlas.org.
 D.M Cutler, M. McClellan, J.P. Newhouse, and D. Remler, “Pricing Heart Attack Treatments,” NBER working paper W7089 (Cambridge, MA: National Bureau of Economic Research, 1999).
 Porter and Teisberg, Redefining Health Care, see chapter four, especially pages 98-111.
 See Porter and Teisberg, Redefining Health Care, pages 140-147, for further discussion of these issues.
 Institute of Medicine (IOM), To Err Is Human. Building a Safer Health System (Washington, D.C.: National Academy Press, 1999).
 Research America, 2006 Investment in U.S. Health Research.
 E.A. Balas and S.A. Boren, “Managing Clinical Knowledge for Health Care Improvement,” Yearbook of Medical Informatics (Bethesda: National Library of Medicine, 2000), pages 65-70; cited in Institute of Medicine (IOM), Crossing the Quality Chasm (Washington, D.C.: National Academy Press, 2001), page 13, available at www.iom.edu.