Lab Coats Plus Laptops Can Equal Better Medical Care
Michael L. Millenson, a Pulitzer-prize-nominated journalist, wrote Demanding Medical Excellence: Doctors and Accountability in the Information Age, which was published by the University of Chicago Press in 1997.
The book examines the move to incorporate computerized clinical information into everyday practice and the use of performance measures to hold providers accountable for their care.
- Demanding Medical Excellence received favorable reviews from The New York Times Book Review and the Philadelphia Inquirer.
- As of February 2000, 16,000 copies of the book had been sold.
In his book, Millenson highlights the trend toward building databases that show how a particular treatment affects a patient's outcome in the real world.
He concludes that if this revolution in health care is to fulfill its potential, a series of events must occur:
- Pressure for physician accountability must continue.
- Employers that demand quality improvement must reward such improvement.
- Consumers must have access to reliable and relevant information.
- "Government needs to set the rules and serve as referee, but not call the plays."
RWJF supported the project with a grant of $145,267.
These grants from RWJF supported Michael L. Millenson consultant, visiting scholar at Northwestern University's Institute for Health Services Research and Policy Studies, Chicago, Ill., and Pulitzer-prize-nominated journalist in an examination of the movement for medical-quality management and measurement and assessment of the current state of the art in those fields.
Millenson's objective was to bring medical-quality issues into the mainstream of the debate over the future of the American health care system. Millenson conducted a literature search and extensive interviews with experts on quality measurement and management efforts. The information provided him with a conceptual framework for considering such varied facets of medical quality as health status questionnaires for ambulatory care, computerized monitoring of intensive care, and process standardization of routine inpatient care.
The book resulting from his research, Demanding Medical Excellence: Doctors and Accountability in the Information Age, was published by the University of Chicago Press in 1997. It examines what Millenson described as a "quiet revolution" in health care that is beginning to incorporate computerized clinical information into everyday practice. Owing "more to laptops than lab coats," the author observed that this revolution aspires to use performance measurement to instill accountability for providing "best-possible" care. Aimed at employers, policymakers, and the lay public, the book makes a case for how improved information on medical quality is "beginning to yield answers to the most basic questions that haunt those who are sick: Who shall live and who shall die? Who will have pain and who will be free from pain? Who will become disabled and who will regain normal functioning?"
FINDINGS AND CONCLUSIONS
Demanding Medical Excellence probes the potential impact of better use of information on medical errors, medical informatics, practice variation, evidence-based medicine, the culture of medicine, the economics of large corporate purchasers, the evolution of managed care, and patient empowerment. It aims to show how better use of information whether disclosing it to the public or manipulating it with computers for clinician and patient use will be the key to attaining better quality of care.
The reality, detailed in Demanding Medical Excellence, is that "even the best-trained doctors go about their work with an astonishingly shallow base of knowledge concerning the link between what they do and how it affects a patient's health . Study after study shows that few physicians systematically apply to everyday treatment the scientific evidence about what works best." The book cites an example: Three years after two studies appeared documenting the effectiveness of aspirin therapy for heart attack prevention and management, researchers examined the medical records of some 2,200 patients to see how physicians had responded to the news. "There were a substantial number of physicians who either didn't hear the news, didn't believe it, or never got around to acting on it," Millenson says. "More than 25 percent of heart attack victims still were not being given easy-to-administer aspirin therapy." Demanding Medical Excellence points to a trend toward building databases that show how a particular treatment affects a patient's outcome in the real world that is, toward using outcomes management that estimates the relation between medical interventions and health outcomes, as well as the relation between health outcomes and costs.
Beyond better use of information, Millenson contends that a political and social climate demanding accountability would also be key to improving medical practice. Nonetheless, Millenson notes, economic incentives that reward organizations that perform better financially remain as important as or more important than technological advances in the collection and use of information. He concludes that if this revolution in health care is to fulfill its potential, a series of events must occur:
- Pressure for physician accountability must continue.
- Employers that demand quality improvement must reward such improvement as much as they do cost cutting.
- Consumers must have access to reliable and relevant information on everything from health plans' rules and procedures to outcomes information from specific hospitals or for specific procedures.
- "Government needs to set the rules and serve as referee, but not call the plays."
Millenson published several journal articles and made numerous presentations on accountability in health care and on assessing the application of medical-quality research to patient care. Demanding Medical Excellence sold out its hardcover print run of 16,000 and was reissued in paperback. It received favorable reviews from The New York Times Book Review, which called it "an exciting and important story," and the Philadelphia Inquirer, which said it was "an involving, human narrative explaining how we got to where we are today and what lies ahead." Within the health care field, the book received positive reviews from the Journal of the American Medical Association, the Annals of Internal Medicine, and the American Journal of Medical Quality. The book has been used in courses at a number of colleges, including the New School (New York City) and the Harvard School of Public Health. And it is listed on a number of Web sites as a resource, including those of the AARP, the Picker Institute, and www.healthgrades.com, a site that gives health care report cards to provider institutions and profiles health care providers. Millenson also wrote a Health Affairs article and was quoted in such publications as Newsweek, US News & World Report, and the Boston Globe.
GRANT DETAILS & CONTACT INFORMATION
Measuring Medicine: A Critical Assessment of the Application of Medical Quality Research to Patient Care
Northwestern University (Evanston, IL)
Dates: March 1994 to March 1995
Dates: January 1995 to January 1996
Michael L. Millenson
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Books and Reports
Millenson ML. "Medical Mistakes: The Case for Optimism," in Expert Voices series, National Institute for Health Care Management. In Press, March, 2001.
Millenson ML. Demanding Medical Excellence: Doctors and Accountability in the Information Age. With A New Afterword. Chicago: University of Chicago Press, 1999. Paperback edition.
Millenson ML. Demanding Medical Excellence: Doctors and Accountability in the Information Age. Chicago: University of Chicago Press, 1997. Sold 16,000 copies.
Millenson ML. Beyond the Managed Care Backlash: Medicine in the Information Age. Health Priorities Project Policy Report No. 1. (Washington: Progressive Policy Institute, July, 1997).
Millenson ML. "The Patient's View of Medical Errors." Medical Error: What Do We Know? What Do We Do? Marilynn Rosenthal and Kathleen Sutcliffe (eds.). Ann Arbor, MI: University of Michigan Press, July 2002.
Millenson ML. Foreword to The Endangered Medical Record: Ensuring Its Integrity in the Age of Informatics. Virgil Slee, Debora Slee and H. Joachim Schmidt (authors). St. Paul, MN: Tringa Press, 2000, pp. viix.
Millenson ML. Foreword to Connecting with the New Healthcare Consumer: Defining Your Strategy. David B. Nash, Mary Pat Manfredi, Barbara Bozarth and Susan Howell (eds.). New York: McGraw-Hill, 2000, pp. ivvi.
Millenson ML. "Public Disclosure: A Media Perspective," in Physician Profiling and Risk Adjustment. Norbert Goldfield and Peter Boland (eds.). Gaithersburg, MD: Aspen Publishers, 1996, pp. 2629.
Millenson ML. "Wild Cards: Surprises? You Bet," Hospitals & Health Networks, 74(12): 4850, 2000.
Millenson ML. "New Roles, New Responsibilities: Can Purchasers Correct the Course?" Business & Health supplement: The State of Health Care in America 2000, 18(6 Suppl. A): 1419.
Millenson ML. "Medicine's Next Big Opportunity," The Industry Standard, 3(13): 272273, 2000.
Millenson ML. "Where's Mine?" Blueprint, Spring 2000: 1415.
Millenson ML. "Power to the Population," New Medicine, 3: 1724, 1999.
Millenson ML. "What Doctors Don't Know: HMOs Aren't the Only Thing Wrong with Modern Medicine," The Washington Monthly, 30(12): 812, 1998.
Millenson ML. "Assessing the Results of Medical Care," Chicago Tribune, July 5, 1998, Section 2, p. 1.
Millenson ML. "Revolution, Not Reform, Shapes The Future Of Managed Care," On Managed Care, 3(5): 78, 1998.
Millenson ML. "Forces for Change: Money, Technology and the Spirit of the Times Will Force Your Hand on Computer Systems That Measure Quality," Hospitals & Health Networks, February 20, 1998, pp. 4446.
Millenson ML, "The Advent of Infomedicine: Performance Measurement Is Changing the Face of Health Care," The New Democrat, 9(6): 2225, 1997.
Millenson ML. "Miracle and Wonder: The AMA Embraces Quality Measurement." Health Affairs, 16(3): 18394, 1997.
Presentations and Testimony
Institute for the Future Health Care Outlook Workshop, Palo Alto, CA, March 15, 1996.
Grand Rounds, Cedars-Sinai Medical Center, Los Angeles, March 21, 1997.
Illinois Senate Insurance and Pension Committee hearing on managed care, Oak Brook, IL, August, 20, 1997.
Blue Cross And Blue Shield Association National Conference On Best Practices in Medical Management, Chicago, October 13, 1997.
US House of Representatives Subcommittee On Health And Environment, House Commerce Committee, hearing on managed care quality, Washington, October 28, 1997.
International Congress On Performance Measurement & Improvement In Health Care, Chicago, November 13, 1997.
Association of Subspecialty Professors Leadership Conference, Coconut Grove, FL, January 31, 1998.
Health Care Quality Alliance, Washington, February 27, 1998.
National Health Policy Forum, Washington, March 5, 1998.
National Arts Club, New York City, March 5, 1998.
Chicago and Great Lakes Health Services Research Symposium, Chicago, March 13, 1998.
National Institute for Health Care Management Health Journalism Awards Dinner, Washington, May 21, 1998.
Kaiser Media Fellows, Washington, June 2, 1998.
Pacific Business Group on Health board of directors, Los Angeles, June 10, 1998.
American Association of Health Plans annual institute, Boston, June 16, 1998.
Family Re-Union 7: Families and Health, Moderated by Vice President and Mrs. Al Gore, Nashville, TN. June 2223, 1998.
International Conference for Quality of Health Care, Taipei, Republic of China, September 11, 1998. National Business Coalition on Health, Nashville, TN, October 4, 1998.
Fifth Harvard Conference on Strategic Alliances in Healthcare, Boston, October 7, 1998.
Executive Club of Chicago, November 17, 1998.
American Public Health Association annual meeting, Washington, November 18, 1998.
Faculty member, Estes Park Institute, 1999 to present.
American Medical Publishers Association, Philadelphia, March 1, 1999.
Solomon Menashe Lecture, Foundation for Medical Excellence, Portland, OR, March 16, 1999.
Alliance of Community Health Plans board of directors symposium, Tucson, AZ, March 29, 1999.
Institute for Healthcare Advancement, Palm Springs, CA, May 2, 1999.
The Leadership Institute, Carmel, CA, May 8, 1999.
DaimlerChrysler Extended Enterprise Continuous Improvement Workshop, Troy, MI, June 8, 1999.
American Medical Group Association annual meeting, San Francisco, June 19, 1999.
Private presentation on quality-of-care issues to the Surgeons-General of the Armed Forces, sponsored by office of Senator Joseph Lieberman (D-CT), Washington, July 8, 1999.
International Foundation of Employee Benefit Plans, Williamsburg, VA, August 31, 1999.
Foundation for American Communications, Conference on Reporting the Changing Managed Care Story, Lake Bluff, IL, September 18, 1999.
Interdisciplinary Doctoral Program in Health Services Research, Kennedy School of Government, Cambridge, MA, September 21, 1999.
Interagency Institute for Federal Health Care Executives, Washington, September 21, 1999.
Massachusetts Health Data Consortium HealthMart '99, Boston, September 22, 1999.
American College of Medical Quality/American Society of Healthcare Quality joint annual meeting, keynote, Atlanta, September 27, 1999.
Robert Wood Johnson Clinical Scholar Program, Yale University, New Haven, CT, October 13, 1999.
Frank P. Finch Lectureship in Managed Care, Scott & White Clinic, Temple, TX, November 12, 1999.
National Association of Health Data Organizations, Pittsburgh, January 18, 2000.
U of Michigan Journalism Fellows Program, Ann Arbor, MI, February 21, 2000.
Palo Alto Medical Foundation Bi-Annual National Symposium, San Francisco, March 24, 2000.
Committee on the National Quality Report on Health Care Delivery, "Workshop: Envisioning a National Quality Report on Health Care," Washington, May 2223, 2000.
Academic Medicine and Managed Care Forum, Washington, June 8, 2000.
International Symposium on Patient Safety, Partnership for Patient Safety, Dallas, June 2830, 2000.
John R. Mannix Memorial Lecture, Health Trustee & Leadership Institute, Cleveland, September 18, 2000.
Georgia Healthcare Leadership Council, Atlanta, October 4, 2000.
American Medical Informatics Association annual symposium, keynote, Los Angeles, November 5, 2000.
American Health Line, November 25, 1997.
Reece, Richard L. "Demanding Medical Excellence," Physician Practice Options, February 1998, pp. 910.
Kaegi, Louise. "Demanding Medical Excellence: An Interview With Michael Millenson," The Joint Commission Journal on Quality Improvement, 24(2): 106110, 1998.
Flower, Joe. "Demanding Medical Excellence: A Conversation with Michael Millenson," Healthcare Forum Journal, September/October: 3639, 1998.
Phillips, Lauren. "Demanding Medical Excellence," Synergy, The Voice of the Physician/Hospital Institute, Spring 1999.
Ames, Patty. "Numbers Rule: Why Outcomes Are the Future," EyeNet 3(8): 5758, 1999.
Mullen, Patrick. "Making Accountability Key in Health Care," Managed Care, 8(12): 3644, 1999.
Samuelson, Robert J. "The Backlash Against HMOs," Newsweek, March 9, 1998. Healthcare Business, May 2000.
Laura M. Litvan, "Has Managed Care Hurt Quality: Red Tape's An Issue, But Care Crisis Is Not Evident," Investor's Business Daily, May 4, 1998, p. 1.
Michael Prince, "Health Buyers Must Use Power: Inaction Might Allow Others Interests to Steer System; Speaker," Business Insurance, October 12, 1998.
Sean Jamieson, "Web Site That Ranks Hospitals' Cardiac Deaths Sparks Debate," Charlotte Observer, November 23, 1998.
Tracy Boyd, "Author At Conference Disparages 'Shocking' Quality of Health Care," Detroit News, January 14, 1999.
Anne Federwisch, "Runaway Costs: How Can We Rein In Healthcare Expenses?" Nurse Week, February 22, 1999.
Brink, Susan, "HMOs Were the Right Rx," U.S. News and World Report, March 9, 1999, pp. 4750.
Joseph E. Scherger, "Family Practice Residencies in the 21st Century: How Much Old? How Much New?" Family Medicine, 31(10): 722725, 1999.
Sandra G. Boodman, "Giving Your Doctor A Helping Hand," Washington Post Health section, December 14, 1999, p. Z07.
New York Times editorial "Preventing Fatal Medical Errors," December 1, 1999, p. A22.
The CQ Researcher, Congressional Quarterly, May 5, 2000, p. 397.
"Demanding Medical Excellence: Doctors and Accountability in the Information Age," Library Journal, October, 1997.
"Demanding Medical Excellence: Doctors and Accountability in the Information Age," Publishers Weekly, October 6, 1997, p. 69.
"Demanding Medical Excellence: Doctors and Accountability in the Information Age," Kirkus Reviews, November, 1997.
Annas, George. "The Illusion of Choice in Patient Power," Nature, 390(6656): 133, 1997.
Geiger, H. Jack. "Marked Down Medicine," The New York Times Book Review, December 21, 1997.
Satya-Murti, Saty. "Book Review: Demanding Medical Excellence: Doctors and Accountability in the Information Age," JAMA, 279(5): 407, 1998.
Taylor, Mark. "A Prescription for More Accountability in Medicine," The Philadelphia Inquirer Books, February 22, 1998, p. Q4.
Nash, David B. and Perilstein, Philip. "Demanding Medical Excellence: Doctors and Accountability in the Information Age," Drug Benefit Trends, March, 1998.
Woolhandler, Steffie and Himmelstein, David. "Book Review: Demanding Medical Excellence: Doctors and Accountability in the Information Age," New England Journal of Medicine, 338(12): 845, 1998.
Rodriguez, Alex R. "Demanding Medical Excellence," American Journal of Medical Quality, 13(1): 54, 1998.
Fay, Jr., John T. "Demanding What?" Healthcare Distributor, April 1998, p.8.
Wennberg, John E. and Otis, II, Kenneth C. "Demanding Medical Excellence: Doctors and Accountability in the Information Age," Healthplan, May/June 1998, pp. 1079.
Caron, Aleece and Neuhauser, Duncan "Saving Lives. Changing Care," Health Affairs 17 (2): 219220, 1998.
Sherwood, Louis M. "How to Lead the Healthcare Revolution," The Pharos, Summer 1998, p. 55.
Warsh, David. "10 Good Business Books (to save for the fall), Boston Globe, August 2, 1998.
Fowles, Jinnet Briggs. "Demanding Medical Excellence: Doctors and Accountability in the Information Age," International Journal for Quality in Health Care 10(5), 1998.
Pollock, George H. "Demanding Medical Excellence: Doctors and Accountability in the Information Age," Chicago Medicine, September 21, 1998.
Borzo, Greg. "Outcomes Measurement And Clinical Quality Improvement Efforts Need To Be Integrated With Health Care Informatics," American Medical News, October 5, 1998.
Siegel, Bernard. "Demanding Medical Excellence: Doctors and Accountability in the Information Age," Oncology Times, December 1998.
Lewis, James B. "Demanding Medical Excellence: Doctors and Accountability in the Information Age," Inquiry 35(4): 448449, Winter 1998/1999.
Goldfield, Norbert. "Demanding Medical Excellence," Journal of Ambulatory Care Management 22(1): 9394, 1999.
Kilo, Charles M. "Demanding Medical Excellence: Doctors and Accountability in the Information Age," Journal of Health Politics, Policy and Law, 24(2): 392396, 1999.
Rappaport, Anna. "New Views on Health Care: Their Implications for Retiree Plans," Compensation & Benefits Management, 15(1): 7376, Winter 1999.
Woods, David. "Book: Demanding Medical Excellence," British Medical Journal, 319(7201): 63, 1999.
Prince, Michael. "Best Outcomes Sorely Needed In Medicine," Business Insurance, April 10, 2000, p.18.
Bates, David W. and Gawande, Atul. "Error in Medicine: What Have We Learned?" Annals of Internal Medicine, 132(9): 763767, 2000.
Derek McGinty Show, WAMU-FM, Washington (DC) Public Radio, October 28, 1997.
Quentin Young Show, WBEZ-FM, Chicago Public Radio, Dec. 17, 1997.
Morning Edition series on quality of care, National Public Radio, March 3, 1999.
WBBM-AM Newsradio 78, Chicago, April 25, 1999.
CNN Interactive mediated chat on HMO quality, July 24, 1998.
WTTW Channel-11, Chicago public television series, "Demanding Health," on April 27, 1999.
Fox Cable News, August 25, 1999.
World Wide Web Coverage
WebMD interactive Web broadcast, June 22, 2000.
Report prepared by: David Kales
Report prepared by: Janet Heroux
Reviewed by: Molly McKaughan
Reviewed by: Marian Bass
Program Officer: David Colby