Town Hall Meeting - Opening Remarks

Keynote Address by Carolyn Clancy

Town Hall Meeting at the AHRQ 2007 Annual Meeting

Carolyn Clancy:

As all of the average conference goers know, the sound of the bells means we're really getting started, so thank you for your patience with our technical difficulties here this morning.  I hope that you've had a good morning so far, and I want to welcome you to the Town Hall session called "Visionary Leadership Inspires Transformation."

Yesterday we concluded the day talking about challenges facing us right now, and I must say I've been incredibly gratified this morning to hear people saying, "Wow, there's really good stuff in these sessions. I need more, but I wanted to be in two or three at the same time, and I don't know how to do that." We're going to work on that for next year, we promise. But the question that we closed on is, "What is it that you would tell policymakers that we can do to accelerate pace of change right now?" And I know that the leaders on this panel have some thoughts on this, particularly as it relates to current and emerging technologies. These experts come from a diverse range of sectors within the health care industry. Each of them has been at the forefront of organizational and cultural changes that have resulted in breakthrough impacts within their organizations. So I'm going to introduce them in a couple of minutes, and then you're going to get a chance to ask questions.

I'm going to give some opening comments to help you all reflect on what kind of health care system do we want, so we're sort of going fast forward, and then you're going to hear from these folks who have basically been anticipating that future and have been ahead of the curve for a number of years now.

So, the panelists in the order that they're seated: First is Carolina Hinestrosa. She is the Executive Vice-President of the National Breast Cancer Coalition. She's also co-founder of Nueva Vida, a support network in Washington, D.C., for Hispanics with breast and cervical cancer, and what I think of as her most important credential, she is a Member of AHRQ's National Advisory Council.

Sitting next to her is Jill Berger, who's Vice President of Health and Welfare Plan Management and Design at Marriott International. Marriott has 130,000 employees nationwide, and Jill is responsible for the strategy, design, and management of the company's benefit plan. Every place I go and we say, "You know, I'd like to hear from some purchasers who are ahead of the curve and really innovative," Jill Berger's name comes up all the time. She was particularly thrilled to know that she would be speaking at a Marriott, but I don't think that was a requirement.

Sitting next to her is Dr. Thomas Kline, who is the Medicaid Medical Director for the state of Iowa. Many of his efforts focused there on medical and pharmaceutical services. He's also worked with the Iowa Foundation for Medical Care, which is Iowa's quality improvement organization and has been part of a learning network that AHRQ has been sponsoring with Medicaid Medical Directors.

Next to him is Dr. Jeff Rich. Now, Jeff Rich is President of the Society of Thoracic Surgeons. He's a National Quality Forum Board member and Board Chair of the Virginia Cardiac Surgery Quality Initiative. From what I understand, Jeff and his colleagues in the Society for Thoracic Surgeons started anticipating the future we're heading to about 20 years ago. He also works very closely with a leading edge health care system in Norfolk, so you'll hear about that.

And then last, but by no means least, is Dr. Dan Varga, who is currently Chief Medical Officer for the SSM Health Care System, which is headquartered in St. Louis. Dr. Varga is also a member of AHRQ's National Advisory Council and Co-Chairs the National Quality Forum Steering Committee on health care-acquired infections.

So, they're coming very shortly. But before I give them their time, I just wanted to just make a few comments here. As we look for ways to accelerate the pace of change, we also have to have in mind what these fast advances will mean for the health care system of the future. So I thought it would be good to actually think about what is the health care system of the future that we're striving towards. And in my mind, it's information rich and information sharing. Now, we are data rich oftentimes in health care—sometimes we're data poor when we can't find charts, but that's another story. But actually having information at our fingertips that's relevant and we know is quality, at the moment we need it, is something that's more the exception than the rule, and most importantly, this would be a patient-centered or patient-focused enterprise. From outpatient clinics to operating rooms to emergency departments, people providing care would have real-time data to help them provide the safest, best, and most effective service as possible. I'll let you pause and reflect on that for just a moment.

Ultimately, what we're starting to see from some systems that are, I think, a little bit further down the path of getting there, is that this system would be proactive rather than reactive, and it would be responsive to patients' needs.  Now, this seems to me, if you think about it, to be a readily attainable goal, especially with all the resources that we have in U.S. health care. We've got the expertise. We have some of the finest physicians, nurses, and other health care workers in the world. We certainly have the money. We're spending more than two trillion dollars annually on health care, and we've got the latest tools, new and better ones coming and being developed all the time, and we're beginning to reap the benefits from advances in such areas as health IT. Obviously, we've had several sessions here so far about creating improved quality and improved value through health IT. And in fact, Blackford Middleton was just tugging at my sleeve to say we need to go faster. I see how we're going to do this, we're going to blow the system up and then get to the better place. [laughter]  It's not official administration policy [laughter]. But the stories you're hearing here will become even more impressive as the technology evolves and more people begin to use it.

Ultimately, health IT will work, and we'll know that we've gotten it when it makes the right thing to do the easy thing to do. Those of you who provide care or work closely with those who do know that far too often, doing the right thing requires heroic, sort of super-human effort. If it's the easy thing to do, it is clearly the exception.

So, how does health IT help? Well, it can certainly make health information available when and where it's needed. We know that electronic prescribing can improve safety and reduce medical errors. I spoke to a colleague last night who is actually the first resident I had as a medical intern -- although that year has been blocked from his memory, so he can't share any stories with you. But you know, I was asking him what did he think doctors got from some of this, and he said, "You know, when I'm seeing patients, and I get a reminder that there's a potential adverse effect, and someone's on a medication that I don't deal with very often, I say, 'Thank you. Thank you for keeping me from making an avoidable error here.'" And that's going to be a key part of it.

Ultimately, clinical decision support can be available on demand to help doctors, nurses, and others diagnose or treat a difficult condition, and I think that personal health records can help providers and patients work more closely together. And very importantly from AHRQ's perspective, health IT can do something else—it can help us learn. If you think about our search for evidence every day in health care, it's a little bit like hunting. We're hunting for evidence. Is it on the Web? Can I get it here? Where can I download a paper, and so forth, and actually the Web has made it much, much easier. Before, we used to be hunting for books, which some of you will remember were up and on chains, right, so they wouldn't walk out of the clinic area. But we're going to be able to shift that, I think, to an analogy or metaphor that's closer to farming. We'll be able to grow evidence as a routine by-product of care.

We know, for example, that in health care, about 20 percent of use of medications and other treatments is off-label. It's usually appropriate, it's legal, and it's a great thing to do, but we don't learn a thing from it, except for the rare occasions when lonely souls write a letter to the editor. So, it's that kind of learning that we could be doing a whole lot faster.

Right now we see huge variations across communities, and we need to know how to spread that know-how. So I think what you're going to be hearing here and in other venues is that we are seeing isolated examples of excellence in health care, where people have begun to make the pieces fit together in a way that gets us closer to this 21st century vision of health care, and what we need to do is to figure out how to spread that.

Ultimately, getting high quality of care is a partnership—a lifetime commitment to learning—and this partnership is only as strong as its weakest partner. One of the barriers we hear all the time is fear—fear of implementing expensive technologies that we know nothing about; resistance to the cultural change that's often required. I heard someone say a few years ago that if you were a hospital CEO and you were to announce a new information system, you had better have your CV on the street right about the same moment that you announce that, because what you are announcing is a massive cultural change internally.

Now, if you were to announce a new parking lot, well, that's a different deal. People would be very, very excited. But cultural change is hard. So who we're going to hear from today are people who only see the glass as half-full. In fact, sometimes they see it as full all the time. They've been ahead of the curve for a while, and they work rigorously to keep the glass full and even overflowing.

So they're going to share with us some of their approaches for helping us get to the health care system that we want in the 21st century.

Current as of July 2008