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Keynote Address by Carolyn Clancy
Town Hall Meeting at the AHRQ 2007 Annual Meeting
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
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
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
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
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
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