Are Healthcare’s Problems Incurable? One Integrated Delivery System’s Program for Transforming Its Care

James J. Mongan and Thomas H. Lee

Rapid advances in medical knowledge have improved care for many conditions, but also produced unpleasant “side effects”including rising costs and disappointing quality. This brief argues that an important strategy for improving healthcare is the development of provider organizations that can implement electronic medical records (EMR) and other systems that can enhance coordination of clinicians, reduce inefficiency, and improve safety and quality.

EMRs and other such systems have been implemented in some organizations that employ salaried physicians (e.g., the Veterans Healthcare System and several staff model health maintenance organizations), but are not common among the more loosely-organized providers that dominate U.S. healthcare. We describe the example of an academic integrated delivery network with a heterogeneous mix of physicians and hospitals that began a program to use such systems to improve efficiency and quality in 2003. This program consists of initiatives with specific focuses including (1) implementation of the information systems infrastructure; (2) patient safety; (3) uniform high quality; (4) disease management; and (5) moderating the rate of rise of healthcare costs. Information on each initiative and its impact is provided.

We believe that U.S. healthcare cost and quality challenges cannot be addressed without the implementation of EMRs and other systems to coordinate care. We also believe that such systems are unlikely to be implemented unless providers are allowed—and even encouraged—to organize themselves into networks with incentives to improve their care. Policy decisions have the potential to slow or accelerate the development of provider organizations that can improve care. A companion brief examines policy issues related to this choice.