Report: Health system broken

By Robert Davis and Julie Appleby, USA TODAY

WASHINGTON — The nation's health care system is not able to provide consistent, high-quality medical care to all Americans and must be "reinvented," the Institute of Medicine warned Thursday.

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Patients, particularly those with long-term illnesses, fall through the gaps when medical professionals don't communicate or records are lost, illegible or not quickly retrievable, the IOM says in a 320-page report.

The institute — a non-profit advisory organization that in 1999 warned that the health system's failures resulted in up to 98,000 deaths from medical errors each year — wants Congress to create a $1 billion "innovation fund" to spend on efforts to fix the system over 3 to 5 years.

"Patient safety was the tip of the iceberg," says William Richardson, who chaired the IOM committee. "This is the rest of the iceberg."

Even medicine's best people are struggling to keep up with medical advances and communicate with each other and patients, the IOM says. It blames the system's lag in adopting computer technology.

"We're in the Internet age, and the average American can't e-mail their doctor," says another study author, Donald Berwick of Harvard Medical School.

The report says the system needs to vastly improve the way doctors, nurses and other professionals communicate and train them to act as teams. It also says:

Care should be available when patients need it, 24 hours a day, by Internet, phone or face to face.

Patients should have more control of their treatments and medical records. They should be able to get data on how doctors and hospitals measure up.

Financial incentives are needed to reward quality.

But obstacles abound: the cost of installing information systems, doctors' reluctance to embrace online medicine, patient privacy concerns, liability issues and the long-standing resistance of hospitals, doctors and others to releasing data about their performance.

"Many of these recommendations could be feasible in the long term but in the short term will not seem realistic to people in government or those who run the health system," says Robert Blendon of Harvard University, who did not work on the IOM report.

There is an urgent need for change, particularly as baby boomers age and develop more chronic conditions, the authors say. Improvement won't be about finger-pointing, Berwick says, a sentiment heard in other industries, like aviation, that have worked to improve safety. "It's not about blame. It's about change."