Foreword (original) (raw)

One of the important functions of the Institute of Medicine is use of its convening capacity to draw together key stakeholders in a neutral venue, one that allows them to discuss issues and foster collaborative activities around issues in which they have a strong common interest. No issue better demonstrates the importance of such convening than that of evidence-based medicine. We all want to ensure that, as a society, we are doing everything we can to marshal the best evidence in support of the best care for Americans. Yet, we too often fall far short of that ideal. As the Roundtable members have noted in their vision statement, too much care that is important is often not delivered, and too much care that is delivered is often not important.

Part of the problem is due to our inability to provide the evidence we have, and part is due to the inadequacy of the evidence base to keep pace with new tools and approaches for diagnosis and treatment. Both are of central importance to meeting our potential. The latter challenge, in particular, is soon to become much more acute, as new pharmaceuticals, medical devices, biologics, and procedures are introduced into the marketplace—and as advances in genetics give us a better sense of individual differences in response to various interventions. We clearly need a very different approach to the way we develop evidence. Fortunately, the tools are developing to refashion our approaches. The emerging era of individualized medicine and widespread utilization of health information technology presents a dramatically different terrain for clinical research, practice, and healthcare delivery. We can see rich opportunities for improving health through the creation of new knowledge about what works best for whom under what circumstance, and to apply it more expeditiously. Still, ongoing systemic issues pose significant barriers to our ability to generate and translate such knowledge to improved patient care. Improvements in health care are increasingly to be determined by our capacity to manage information and our ability to develop accurate, timely, and reliable information and expedite the application of evidence in clinical decision making. The IOM Roundtable on Evidence-Based Medicine was created in 2006 to bring together leaders from multiple sectors—patients, health providers, payers, employees, health product manufacturers, information technology companies, policy makers, and researchers—to identify and discuss the issues and approaches to help transform how evidence on clinical effectiveness is generated and used to improve health and health care. As part of the charge, the Roundtable has developed a vision for a healthcare system that has the capacity to draw on the best evidence to provide the care most appropriate to each patient as well as the ability to add to knowledge throughout the delivery of care—a healthcare system that learns.

This publication, The Learning Healthcare System, presents a summary of a workshop held in July 2006 to identify and discuss the broad range of issues that must be engaged if we are to meet the ever-growing demand for evidence that will help bring better health and economic value for our sizable investment in health care. In that workshop, experts from a variety of fields came together to discuss the current approach to evidence development, the standards that are used in drawing conclusions, new research methodologies, some promising initiatives that are under way, and what is needed to enhance the cooperative roles of patients and providers in this work. This volume is rich with insights and sets a solid stage for follow-on activities and discussions on the issues identified.

I would like to offer my personal thanks to the Roundtable members for the important service they are performing on behalf of better health for Americans, to the Roundtable staff for their excellent contributions in coordinating the activities, and importantly, to the sponsors who support this vital activity: the Agency for Healthcare Research and Quality, America’s Health Insurance Plans, AstraZeneca, Blue Shield of California Foundation, Burroughs Wellcome Fund, California Health Care Foundation, Centers for Medicare and Medicaid Services, Department of Veterans Affairs, Food and Drug Administration, Johnson & Johnson, sanofi-aventis, and Stryker. It is this sort of commitment and leadership that give us confidence in our healthcare future.

Harvey V. Fineberg, M.D., Ph.D.

President, Institute of Medicine