Is Brent James the savior of American health care?

If you read this week's Sunday New York Times Magazine, you saw this article about Brent James, the chief quality officer at Intermountain Health in Utah. The premise of the article, and Dr. James' philosophy is that data, systems thinking, and process improvement are the absolute best ways to improve patient outcomes.

For a while now, I've rejected the prevailing wisdom that individualized patient care is the best care. The US prides itself on the doctor's ability to decide what the right treatment is for any given condition, allowing him/her to tailor the panoply of available therapeutic options to make it just right for the patient. Of course, these choices are influenced by reimbursements, what's easiest for the doctor, and what restaurant the pharmaceutical rep lured you to last week. Naturally, if you ask doctors why they do what they do, they claim their actions are evidenced-based, yet the data overwhelmingly suggests enormous variation in physician practice.

In contrast, Intermountain has developed hundreds of protocols for routine care, which essentially automate decision making down to the level of what dose of beta blocker to prescribe for heart failure. The outcomes under this system beat the rest of the nation, and interestingly, doctors are not upset about the computerization of medicine. In fact, many docs feel that these protocols help them a) understand the evidence base, and b) relieve them of the myriad complex decisions that have to be made for every patient and are often overlooked during the course of a busy day.

While I think that the "Intermountain Way" isn't perfect, I think it's a great example of an organization who is really thinking about how to streamline and "hardwire" best practice into usual clinical routines. Add in Geisinger, Mayo, Kaiser Permanente, and the Cleveland Clinic, and you have the avant-garde of health systems thinking in America.