the most fundamental challenges to health care today and to propose actions that can be taken to achieve a health care system characterized by continuous learning and improvement. This study builds on earlier IOM studies on various aspects of the health care system, from To Err Is Human: Building a Safer Health System (1999), on patient safety; to Crossing the Quality Chasm: A New Health System for the 21st Century (2001), on health care quality; to Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (2003b), on health care disparities. The study process also was facilitated and informed by published summaries of workshops conducted under the auspices of the IOM Roundtable on Value & Science-Driven Health Care. Over the past 6 years, 11 workshop summaries have been produced, exploring various aspects of the challenges and opportunities in health care today, with a particular focus on the foundational elements of a learning health system.

While examples of progress exist, many of the problems documented by these reports persist. Medical errors are far too common, different patient populations receive different intensities of services for the same conditions, and health care quality remains uneven. The lack of widespread progress on these now well-documented dimensions of care highlights the need for a substantially new approach. In some cases, successful pilot projects have been undertaken, yet their results have not been disseminated. In other cases, the problem may lie in the need to help clinicians manage the flow of knowledge and apply relevant information to their practice. In still other cases, the difficulty may occur because clinicians and front-line staff do not have at their disposal the tools needed to answer the questions they encounter. These problems point to the need for a transformation in how the health care enterprise generates, processes, and applies information to further patient care.

Meeting the challenges outlined in the above IOM reports has taken on great urgency as a result of two overarching imperatives:

  • to manage the health care system’s ever-increasing complexity, and
  • to curb ever-escalating costs.

The convergence of these imperatives makes the status quo untenable. At the same time, however, opportunities exist to address these problems—opportunities that did not exist even a decade ago:

  • vast computational power that is affordable and widely available;
  • connectivity that allows information to be accessed in real time virtually anywhere;
  • human and organizational capabilities that improve the reliability and efficiency of care processes; and


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