Why 'systems engineering' is crucial to healthcare delivery transformation

A report published in May by the President's Council of Advisors on Science and Technology (PCAST) calls on the U.S. Department of Health and Human Services to transform healthcare nationally by engineering a "robust" health information infrastructure. Following up on that report, researchers from the National Quality Forum in the District of Columbia--who helped pen the document--outline and dissect the report's recommendations in a viewpoint article published online this week in the Journal of the American Medical Association.

"Healthcare delivery transformation is essential to the linked goals of affordability, quality of care and healthy communities," authors Christine Cassel, M.D., and Robert Saunders, Ph.D., say. "During the next years of implementation of the Affordable Care Act, systems engineering should become a core function for improving the health of all Americans."

For instance, the current fee-for-service model, Cassel and Saunders say, represents the No. 1 hurdle to use of such engineering. To that end, they say, payment systems must be aligned with desired patient outcomes, citing that while Seattle-based Virginia Mason Medical Center was able to reduce wait times and speed patient recoveries through the use of production system tools to redesign its spine clinic, the hospital still lost money.

"[B]ecause this redesign reduced the use of expensive tests, like magnetic resonance imaging, the center lost revenue," Cassel and Saunders say.

Additionally, they say, the "pipeline" of individuals trained in both systems science and systems engineering methods needs to improve. "Federal support is needed to create a cadre of trained experts who can create a new specialty area of systems engineering science in healthcare," Cassel and Saunders say.

The original report references both the 2010 PCAST report on health IT and the JASON report published for ONC in April, saying that those analyses remain "relevant" as future policies are developed.

To learn more:
- here's the JAMA post

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