(Circulation. 2001;103:e9022.)
© 2001 American Heart Association, Inc.
Institute of Medicine Report Seeks Overhaul of Health System
The United States needs a new healthcare system that centers on the needs and preferences of patients and assures that they receive the care they need in a timely manner, says a new report from the Washington, DC–based Institute of Medicine. The report, Crossing the Quality Chasm: A New Health System for the 21st Century, was released March 1, 2001.
The report calls for Congress to establish a $1 billion innovation fund to be used to subsidize promising projects over the next 3 to 5 years. "Today, we cannot guarantee that patients will receive state-of-the-art care," said Donald Berwick, MD, one of the study’s authors. "We need to develop a system where we can guarantee patients will receive the best care that exists." The report is a follow-up to the Institute’s widely disseminated study To Err is Human: Building a Safer Health System. In that study, the authors predicted that without substantial changes in the way that health care is delivered, problems will only increase.
Care can be made more personal and timely if healthcare professionals take advantage of technology such as communicating with patients by e-mail, according to the most recent report. However, such changes will require alterations in legal requirements and payment strategies.
The new report also recommends the following.
- Ruth SoRelle, MPHHealthcare
organizations, professional groups, and private and public healthcare
purchasers should adopt as a purpose the continual reduction in
America’s burden of illness, injury, and
disability.
- Monitoring and tracking processes should be established to evaluate the progress of the healthcare system in pursuing its quality aims; these monitoring activities should be reported by the Secretary of Health and Human Services to the President and Congress each year.
- Healthcare processes should be redesigned to encourage continuous health relationships between patients and doctors and customized to meet the needs of patients; patients should be given more control over their health care; information should flow freely between patients and healthcare providers; the waste in health care should be continuously decreased; and providers and patients should cooperate.
- The Agency for Healthcare Research and Quality should identify 15 priority health conditions, and strategies, goals, and action policies should be developed for caring for patients with those conditions; this process should include patients as well as healthcare providers and administrators.
- An information infrastructure should be created to support healthcare delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education.
- A summit of the leadership of health professions should be convened to develop strategies for restructuring clinical education in a manner consistent with the revamped healthcare system.
- Monitoring and tracking processes should be established to evaluate the progress of the healthcare system in pursuing its quality aims; these monitoring activities should be reported by the Secretary of Health and Human Services to the President and Congress each year.
The report received approval from the American Hospital Association, which noted that the report "paints a picture of what our health system could be."
Delaying Privacy Regulations
The implementation of controversial rules shielding medical data from public view that were passed in the final days of the Clinton Administration has been delayed by new Health and Human Services Secretary Tommy Thompson. The new comment period on the regulations under the Health Insurance Portability and Accountability Act ends March 30, 2001, under the new, reopened comment period approved by Secretary Thompson.
At a February 26, 2001 speech before a conference of the American Association of Health plans, Thompson said he would reconsider the rules but that he first wanted further comment on the regulations. The rules were published as final in the Federal Register on December 28, 2000. However, they were not sent for a 60-day review by Congress until February 13, 2001, meaning that they would not have become effective until mid-April. Clinton spokesmen said the delay was the result of an oversight at the Department of Health and Human Services.
The rules give patients the right to access, copy, and propose corrections in their medical records. Providers must obtain written consent before disclosing any personal health information. The healthcare industry lobbied against implementing the rules on the grounds that they would disrupt the usual operation of healthcare practice and would increase the cost of health care.
Janlori Goldman, director of the Health Privacy Project at Georgetown University, told The New York Times in its February 27, 2001 issue, "The reopening of the comment period is unjustified and appears to signal an attempt to weaken and roll back the privacy regulations. It’s a bad sign. People have been waiting for years for these rules."
Conversely, the delay met with the approval of the Health Insurance Association of America, an industry group. In a released statement, Dean Rosen, Senior Vice President of Policy and General Counsel, said, "We commend the Bush Administration for deciding today to open up the Clinton Administration’s confidentiality regulations for further review." He said the regulations were adopted in haste. Although his organization is numbered among those backing privacy for medical records, Rosen said the rules from the previous Administration would be "unnecessarily burdensome," raising costs and jeopardizing the quality of health care.
"We look forward to working with the Bush Administration, as we did with the Clinton Administration, to ensure that patients’ medical records are secure, without jeopardizing the quality of health care upon which they depend," said Rosen.
American Medical Association Sets Agenda for Current Congressional Session
The American Medical Association intends to concentrate on advocating the passage of laws granting relief from anti-trust laws, guaranteeing patients’ rights, and providing health care to the 43 million Americans who are without health insurance, according to information released by the group on February 27, 2001.
"About 90% of the American public supports a strong patients’ bill of rights, including the right to hold health plans accountable for the harm they do to patients as they deny care in their overzealous efforts to add to their bottom line," said Thomas Reardon, MD, immediate past-president of the professional group. The group also intends to support broadened participation in the Children’s Health Insurance Program and in Medicaid for the 5 million children who are eligible but not enrolled in those plans. \.
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