A presidential advisory group of leading scientists and engineers has recommended to the White House greater use of systems-engineering principles to transform the U.S. healthcare system.

In a new report, the President’s Council of Advisors on Science and Technology argues that systems engineering has the potential to not only improve the efficiency of healthcare delivery, but also to improve its quality.

"Systems engineering, widely used in manufacturing and aviation, is an interdisciplinary approach to analyze, design, manage, and measure a complex system in order to improve its efficiency, reliability, productivity, quality, and safety," write PCAST co-chairs John Holdren, director of the Office of Science and Technology Policy, and Eric Lander, president at the Broad Institute of Harvard and MIT, in the report's cover letter to President Obama. "It has often produced dramatically positive results in the small number of healthcare organizations that have incorporated it into their processes. But in spite of excellent examples, systems methods and tools are not yet used on a widespread basis in U.S. healthcare." 

The major barrier to greater use of systems methods and tools in healthcare is the "predominant fee-for-service payment system" which "serves as a major disincentive to more efficient care" and rewards procedures, not personalized care, according to the report. PCAST recommends accelerating the transition to payment models that "pay for value rather than volume" and reward better health outcomes.

The advisory group further calls for accelerated development of America's health data infrastructure, which it calls insufficient and with limited technical capabilities. The report recommends the Department of Health and Human Services accelerate creation of a "robust health data infrastructure" through widespread adoption of interoperable electronic health records and advances in data exchange. PCAST notes that data interoperability across EHR systems remains a substantial barrier to the development of a robust health IT infrastructure to support new care models and to health information exchange. 

PCAST proposes providing technical assistance to healthcare providers in applying systems methods and tools, particularly those with limited resources such as small or loosely networked practices, as well as increasing engagement with communities in improving healthcare delivery. 

The report also argues for building a healthcare workforce that is "equipped with essential-systems engineering competencies that will enable system redesign." PCAST advises establishing grant programs for developing curricula that include systems engineering and implementation science, as well as fund systems-engineering centers of excellence to build a robust specialty in "health-improvement science" for physicians, nurses, health professionals, and administrators.

"Most clinicians were not trained in using systems-engineering approaches, and many clinicians may not even recognize that systems methods and tools could be helpful for improving care," report authors note. 

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