Today, the President’s Council of Advisors on Science and Technology (PCAST) released a report to the President, Better Health Care and Lower Costs: Accelerating Improvement through Systems Engineering. The report comes at a critical time for the United States and for the health-care system in particular, with millions of Americans recently gaining health-care coverage due to the Affordable Care Act (ACA).
At the same time, the health-care system is challenged by rising costs, which now approach a fifth of the United States’ gross domestic product (GDP). A significant portion of those costs, however, does not produce better health or quality of care. In consultation with a working group including experts from the health and engineering sectors, PCAST, in its new report, identifies a comprehensive set of recommendations to address these cost and quality challenges, including through an interdisciplinary approach known as systems engineering.
Systems engineering has been widely used in other industries, such as manufacturing and aviation, to improve efficiency, reliability, productivity, quality, and safety of systems. It has begun to be used to good effect in health care, but, PCAST finds, the United States would benefit from more widespread adoption.
Among the barriers that limit the spread of systems engineering in health care is the predominant payment system— the fee-for-service method often discourages efficient care. To overcome this challenge, PCAST notes that providers should be paid for value—e.g., patient health-outcomes—rather than the volume of tests or treatments administered.
Systems engineering also depends on the availability of high-quality data that can be used for measuring progress, analyzing current challenges and opportunities, and enabling patients and providers to make more informed decisions.
The Nation has made great strides in encouraging clinicians and health care organizations to adopt electronic health records, although more work is needed to ensure those systems are interoperable and can exchange information. This is particularly challenging for the large percentage of physicians that are a part of small or loosely networked practices, which may have limited resources and capabilities to apply systems methods and tools.
PCAST also finds that the benefits of systems engineering can be realized at the community level and that—since people live the majority of their lives and experience their health outside of traditional health-care settings—engaging public and private community entities in improving the delivery of care and/or promoting health can enhance the quality of care and the health of communities.
Finally, the report speaks to the need for the United States to build a health-care workforce that has the necessary “know-how,” recommending that systems engineering concepts should be embedded in education and training for a wide variety of people involved in health care, from clinicians to administrators to public-health officials.
PCAST believes that implementation of these strategies bears great potential to transform the Nation’s health-care system in positive ways, and hopes this new report will provide a framework to help the Administration achieve these aims as it proceeds with implementation of the Affordable Care Act.
Christine Cassel, Ed Penhoet, and Maxine Savitz are members of PCAST and co-chairs of the PCAST Systems Engineering in Health Care Working Group.