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Crosswinds of Change
Five looming issues in health care that we can’t afford to ignore.
DEAN/CEO EDWARD D. MILLER, MD
Date: February 1, 2012
Johns Hopkins faces enormous health care challenges, some of which we cannot control, in the second decade of the 21st century. Here’s what I see as the big items facing our next Dean/CEO— and not in any particular order:
1) Fixing Medicare and Medicaid
If the U.S. fails to address its unsustainable health care programs for retirees and the poor, it will bankrupt the country and devastate medical centers. Blowing up the system or making mindless cuts is not tenable.
A smarter approach is to give large health systems like Hopkins a set budget and let us figure out how to allocate this money so we can deliver high-quality care to a large population. We can do it for less money and give people better services in part by focusing on preventive medicine and in part by utilizing Hopkins’ network of hospitals, ambulatory care facilities, providers, home care services, a managed care group, and the university’s schools of Public Health and Nursing.
We have started linking these entities together through the Epic software system, which will connect providers to a wide range of medical databases. This should cut costs—eliminating duplicate imaging and tests would save billions—and give patients more immediate, hassle-free care. Patients who see providers anywhere within our system will have their records readily available.
We then can plough savings into preventive care. The result: healthier patients and a marked increase in quality while staying within our budget.
2) Creating a regional health system
The next person in this chair needs to concentrate on developing an interconnected medical system in the Baltimore-Washington region. Sibley Memorial and Suburban Hospital are top-drawer community hospitals that joined the Hopkins Medicine family to enhance their academics and research. They bought into our tripartite mission and want to be the best in their area.
We can help them on issues such as patient safety, quality metrics, expanded medical services, and patient access to clinical trials. We also must figure out how to allocate new equipment and resources between the two so they best serve the Washington region.
Down the road, many of our patients will never step foot in The Johns Hopkins Hospital. We must ensure that wherever they go within our network we provide top-notch, compassionate, state-of-the-art care—at a reasonable cost.
3) Developing more core resources
Starting with the High Throughput Biology Center (HiT), we have invested in sophisticated technology that assists all researchers in advancing discoveries from the bench to the bedside. These high-tech tools are so expensive no single lab can afford them.
Shared core resources offer broad benefits. Take Hopkins’ Simulation Center, run by Betsy Hunt. This equipment is used throughout the institution—by medical students, residents, fellows, nurses, surgeons, and by researchers testing new devices. Jointly used technology can enhance outcomes, safety, and quality.
4) Increasing collaboration
Cross-pollination of scientific ideas is essential in solving complex medical mysteries. That’s why we established interdepartmental institutes that widen our search for answers.
One good example is the brainstorming currently taking place on nanobiotechnology and computational medicine between the School of Medicine and the Whiting School of Engineering. These joint efforts are leading to groundbreaking research into the causes and treatment of diseases.
Such institutes work because researchers from many departments want to collaborate. Our department chairs have been diligent in finding the resources and breaking down barriers that might thwart those efforts. It makes sense to develop more joint ventures across the university. The Armstrong Institute for Patient Safety and Quality, for instance, might gain from a partnership with systems engineers at the Whiting School of Engineering or at the Applied Physics Laboratory in developing hospital procedures that reduce or eliminate medical errors.
5) Using space more efficiently
Out of necessity, we’ve been on a construction binge. The faculty’s success in winning NIH grants required more research labs. A new education building was desperately needed to give students cutting-edge technology and learning space. Antiquated clinical buildings cried out for new care towers that enhance privacy and infection control.
We want our facilities to match the caliber of our faculty. The next step is to ensure that new and existing space is used efficiently.
The coming decade won’t be focused on additional construction but on providing resources the faculty needs to take Hopkins Medicine to the next level of excellence. It won’t be easy, but I am confident the best is yet to come.
Above all, we must continue to recruit and retain the best faculty. Our most treasured asset is not our buildings but our people—the faculty, students, nurses, and the administrative staff. As we have grown, we must not lose sight of that basic principle. *