Overview — Using Data to Support Better Health Care: One Infrastructure with Many Uses
The United States will spend $2.4 trillion on health care this year, yet there is no system in place to efficiently evaluate the quality, effectiveness, and safety of the care that is delivered. In fact, less than 0.1 percent of health care spending is dedicated to developing evidence on what works best. The Institute of Medicine (IOM) has recommended creating a "Learning Health Care System" that would include the capacity for learning more quickly and effectively from the delivery of health care. Such an infrastructure could help meet critical needs for better evidence in many areas, including quality measurement and reporting, medical product safety surveillance, and comparative effectiveness research.
A significant amount of information is generated during the delivery of health care — and most health care reforms emphasize the need for bringing together more timely and clinically sophisticated information to enable patients to get better care while avoiding unnecessary costs. But such data summarized from the experiences of many similar patients could have many “secondary uses” in the development of better evidence to improve patient care decisions. These uses include evidence related to quality, effectiveness, and safety. A number of federal and private sector initiatives are being launched in these areas, and they share many common data and infrastructure needs. Developing the capacity in our health information infrastructure to provide better support for generating evidence across these many uses can in turn support better decisions for individual patients, leading to a system of more efficient, effective care delivered at lower costs.
Developing such a learning health care system capable of answering a variety of timely and important questions is feasible. This system could begin by using data currently collected during the routine delivery of health care, such as administrative claims and electronic health records. Major investments are underway and under consideration in health care reform for data infrastructures that can help answer these kinds of questions. But in many respects, these different uses involve the same kinds of infrastructure investments – summarizing data consistently across different organizations and systems, using consistent and effective methods, and so forth. Consequently, a critical question for actually achieving health care reform is whether and how such investments could be made in a way that supports all of these uses, and that in turn provides the stronger support for improving patient care. This question raises many other issues, such as the specific data needs of such an infrastructure, where that data might come from, how it could be aggregated and analyzed, and key implementation issues like privacy and security, public and private sector coordination, and sustainability.