Care Redesign
Talk
The Self-Driving Cars of Health Care (12:44)

“Patients are complicated. Health care providers are complicated. Driving a car is complicated. Deaths from driver errors are epidemic and may be influenced by the complexity of decision-making,” says Scott Weingarten, Senior Vice President and Chief Clinical Transformation Officer for Cedars-Sinai Health System.

But it doesn’t have to be that way.

Accident avoidance systems in self-driving cars, which work through decision support, could reduce fatal car crashes by 90% by the middle of the 21st century. Decision support processes a large number of inputs from sensors, such as traffic signals and other cars, and provides real-time guidance to the vehicle.

A myriad of studies show why we also need decision support in medicine. Weingarten cites the Johns Hopkins study that showed medical errors are the third leading cause of death in the U.S; the JAMA study that showed women physicians have significantly lower patient mortality rates than men physicians, potentially because they’re more likely to practice evidence-based medicine; and studies that physician decisions can influence as much as 80–90% of health care costs. He also cites a JAMA study that found one-third of health care expenditures are waste and 10% of health care expenditures are overtreatment; studies from the Rand Corporation that show patient care is consistent with evidence only about half the time; and studies that there could be a 17-year lag between the discovery of life-saving treatments and when they are uniformly adopted into practice.

“This is very hard to believe. Physicians are highly trained, intelligent people who care deeply about their patients. Why could this be?” Weingarten asks. It’s because of information overload. “The volume of information potentially available to help each patient’s care, along with relevant or potentially relevant scientific evidence, overwhelms our capacity to process all of this information in real time.”

The information technology to enable decision support already exists in the form of electronic health records. “They’re there today, they have the capability, and patients can and should benefit from this investment,” he says. “So if all of the patients’ information is available, can we process it and provide the best diagnostic tests and treatments to providers and patients? This is really precision medicine.”

The patient of tomorrow will have their omic, microbiome, social determinant, symptom, imaging, and laboratory information, along with personal preferences and level of engagement, enabling the best treatment and the optimal approach to that treatment. It’s not science fiction, Weingarten emphasizes. In a 21st-century medical accident avoidance system, we could have better quality of care, better value, lower costs — and more time spent talking to patients — enabling us to harness information that could save lives.

“Decision support is transforming the way that we will drive a car. Why shouldn’t it also transform the way that we care for patients or that patients care for themselves?”

From the NEJM Catalyst event The Future of Care Delivery: Relentless Redesign at Providence St. Joseph Health, January 19, 2017.

More From Care Redesign
Relentless Reinvention

Adopting Innovations in Care Delivery — The Case of Shared Medical Appointments

Given the effectiveness of group interventions, why aren’t doctors routinely using them to treat physical and mental conditions?

Relentless Reinvention

“Being the Best at Getting Better” — Creating a Culture of Change

How Cincinnati Children’s Hospital Medical Center built a culture focused on broad-based change that is transformational for children and their families.

Relentless Reinvention

Rural Health Care: Thirty Miles at Sea — Providing Consistent Care in an Inconsistent Environment

How one of the smallest hospitals in Massachusetts addresses the needs of its unique population.

Relentless Reinvention

Lessons from Oregon in Embracing Complexity in End-of-Life Care

Persons with chronic progressive medical illness require more care in the ICU and more hospitalizations, and often receive late or no referrals to hospice care. These utilization patterns are strikingly different in Oregon.

Relentless Reinvention

The Move to Value-Based Care in Navy Medicine

Achieving the mission of Navy Medicine to “keep the Navy and Marine Corps family ready, healthy, and on the job” requires rethinking current health care delivery models.

Relentless Reinvention

Improving Access to Specialist Expertise via eConsult in a Safety-Net Health System

Electronic referral system supports communication between primary care and specialty providers.

Relentless Reinvention

Redesigning the Delivery of Specialty Care Within Newly Formed Hospital Networks

As the trend toward hospital mergers and consolidations continues, how can newly formed health care networks optimize their delivery of specialty care? They will need to consider a redesign of service lines that includes both centralizing and decentralizing strategies.

Relentless Reinvention

Survey Snapshot: Genomic Data Is Far from Clinical Use

NEJM Catalyst Insights Council members say that clinical and cost data will continue to be the most useful data sources.

Relentless Reinvention

Why Every Health Care Organization Needs a Data Science Strategy

Data science strategy can help providers tap into the power of their data, improve its quality, and keep it safe.

Relentless Reinvention

Learning to Drive — Early Exposure to End-of-Life Conversations in Medical Training

The importance of listening to the patient at the end of life.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Coordinated Care

87 Articles

Patient Engagement Survey: How to Hardwire…

Technology and social networks can help, but nurses and care teams remain essential, say NEJM…

Social Needs

41 Articles

Evaluating Complex Care Programs: Is It…

Policymakers see programs for complex patient populations as a way to bend the health care…

Reading List: Dave Chokshi and François…

NEJM Catalyst Thought Leaders weigh in on the most influential and inspiring texts of their…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now