HIRI and the HiRES (Health informatics in Research, Education and Service) Project are founded upon the principles and finding laid out in the 2005 publication of the National Academy of Science publication;

“Building a Better Delivery System: A New Engineering/Health Care Partnership”; Proctor P. Reid, W. Dale Compton, Jerome H. Grossman, and Gary Fanjiang, Editors, Committee on Engineering and the Health Care System, Institute of Medicine and National Academy of Engineering; The National Academies Press 2005


Statement of the Problem

“…relatively little technical talent or material resources have been devoted to improving or optimizing the operations or measuring the quality and productivity of health care systems. The costs of this collective inattention and the failure to take advantage of the tools, knowledge, and infrastructure that have yielded quality and productivity revolutions in many other sectors of the economy have been enormous.” 

“…little more than half of patients receive known “best practice” treatments for their illnesses and less than half of physician practices use recommended processes for care (Casalino et al., 2003; McGlynn et al., 2003)”

“…thirty to forty cents of every dollar spent on health care, or more than a half-trillion dollars per year, is spent on costs associated with “overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency” (Lawrence, in this volume)”




“…systems-engineering tools that have transformed the quality and productivity performance of other large-scale complex systems (e.g., telecommunications, transportation, and manufacturing systems) could also be used to improve health care delivery.

“…the lack of support for research has discouraged the development, adaptation, and use of these systems-engineering tools.”




“…identify (and implement) engineering tools and technologies that could help the health system overcome these crises and deliver care that is safe, effective, timely, patient-centered, efficient, and equitable—the six quality aims envisioned in the landmark IOM report, Crossing the Quality Chasm



 “…particularly (1) engineering applications with the potential to improve health care delivery in the short, medium, and long terms; (2) factors that would facilitate or inhibit the deployment of these applications; and (3) priorities for research and education in engineering, the health professions, and related areas that would contribute to rapid improvements in the performance of the health care delivery system.”

The (HiRES) Project supports 14 of the 18 recommendations of the

National Academy of Engineering / Institute of Medicine (NAE/IOM) Recommendations



Recommendation 3-2. Outreach and dissemination efforts by public- and private-sector organizations that have used or promoted systems-engineering tools in health care delivery

Recommendation 3-3. The use and diffusion of systems-engineering tools in health care delivery should be promoted by a National Institute

Recommendation 3-4. The use of any single systems tool or approach should not be put “on hold” until other tools become available.

Recommendation 3-5. …research to advance the application and utility of systems engineering in health care delivery, including research on new systems tools and the adaptation, implementation, and improvement of existing tools for all levels of health care delivery


Recommendation 4-1. …continued development of health care data standards

Recommendation 4-2. …application of lessons learned from advances in other fields (e.g., computer infrastructure, privacy issues, and security issues)

Recommendation 4-3. Research and development in the following areas

  • human-information/communications technology system interfaces
  • software that improves interoperability and connectivity among systems from different vendors
  • systems that spread costs among multiple users
  • software dependability in systems critical to health care delivery
  • secure, dispersed, multi-agent databases that meet the needs of both providers and patients
  • measurement of the impact of information/communications systems on the quality and productivity of health care

Recommendation 4-6. …research on the development of very small, low-power, biocompatible devices will be essential for improving health care delivery

Recommendation 4-7. Engineering research should be focused on defining an architecture capable of incorporating data from micro-systems into the wider health care network and developing interface standards and protocols

Recommendation 5-1a. …establish multidisciplinary centers at institutions of higher learning …capable of bringing together researchers, practitioners, educators, and students from appropriate fields of engineering, health sciences, management, social and behavioral sciences, and other disciplines to address the quality and productivity challenges facing the nation’s health care delivery system.

Recommendation 5-1b. …multidisciplinary research centers three-fold mission: (1) to conduct basic and applied research on the systems challenges to health care delivery and on the development and use of systems-engineering tools, information/communications technologies, and complementary knowledge from other fields to address them; (2) to demonstrate and diffuse the use of these tools, technologies, and knowledge throughout the health care delivery system (technology transfer); and (3) to educate and train a large cadre of current and future health care, engineering, and management professionals and researchers in the science, practices, and challenges of systems engineering for health care delivery.

Recommendation 5-2. …funding for the multidisciplinary centers will come from a variety …of public- and private-sector stakeholders to ensure that funding for the centers is stable and adequate

Recommendation 5-3. … Educators of health professionals should develop curricular materials and programs to train graduate students and practicing professionals in systems approaches to health care delivery and the use of systems tools and information/communications technologies. Accrediting organizations (sig. College of Family Practice of Canada), could also require that medical schools and teaching hospitals provide training in the use of systems tools and information/communications technologies. Specialty boards could include training as a requirement for recertification.

Recommendation 5-4. Introducing health care issues into the engineering curriculum

Recommendation 5-5. …incorporating examples from health care into the core MBA curriculum would increase the visibility of health care as a career opportunity.

Recommendation 5-6. Federal mission agencies and private-sector foundations should support the establishment of fellowship programs to educate and train present and future leaders and scholars in health care, engineering, and management in health systems engineering and management.

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