    [Public Papers of the Presidents of the United States: WILLIAM J. CLINTON (1999, Book II)]
    [December 7, 1999]
    [Pages 2219-2220]
    [From the U.S. Government Publishing Office www.gpo.gov]

    Memorandum on Improving Health Care Quality and Ensuring Patient Safety
    December 7, 1999

    Memorandum for the Secretary of Defense, the Secretary of Labor, the
    Secretary of Health and Human Services, the Secretary of Veterans
    Affairs, the Director of the Office of Personnel Management

    Subject: Improving Health Care Quality and Ensuring Patient Safety:
    Directive to the Quality Interagency Coordination Task Force (QuIC)

        Assuring quality through patient protections is a long-standing
    priority for my Administration. Over the past 2 years, with the
    leadership of the Vice President, Secretary
    Shalala, and Secretary Herman, my Advisory Commission on Consumer Protection and
    Quality in the Health Care Industry (Quality Commission) produced a
    landmark report on health care quality. Through executive action, I
    extended the patient protection provisions outlined in this report to
    the 85 million Americans enrolled in Federal health plans, setting the
    stage for the Congress to pass a strong, enforceable Patients' Bill of
    Rights. As important as putting patient protections in place, however,
    is improving the quality of the services available to these patients.
        The United States has some of the finest medical institutions and
    best trained health care professionals in the world. However, as the
    Quality Commission reported last year, millions of Americans are harmed
    or even killed each year as a result of inappropriate or erroneous
    medical treatment. These health care quality problems include the
    underutilization of needed services, the overutilization of unnecessary
    services, and medical errors in the delivery of care. In addition, there
    is a continuing pattern of wide variation in health care practice.
        As a recent Institute of Medicine study confirms, preventable
    medical errors present an example of the critical importance of
    improving the quality of health care in our Nation. Over half of the
    adverse medical events that occur

    [[Page 2220]]

    each year are preventable, causing the deaths of as many as 98,000
    Americans annually and adding as much as $29 billion to our Nation's
    health care spending. These errors also deeply affect the lives of many
    individuals and families and the trust of the American people in the
    quality of the care they receive.
        To build on the initial efforts of the Quality Commission and the
    leadership of the Departments of Health and Human Services, Labor,
    Veterans Affairs, and Defense, the Office of Personnel Management, and
    other agencies in implementing a range of quality improvement
    initiatives, I directed the establishment of the Quality Interagency
    Coordination Task Force to help coordinate Administration efforts in
    this area. I also asked the Vice President
    to help launch the National Forum for Health Care Quality Measurement
    and Reporting (Quality Forum). This broad-based, widely representative
    private advisory body, which includes senior government participants, is
    developing standard quality measurement tools to help all purchasers,
    providers, and consumers of health care better evaluate and ensure the
    delivery of quality services.
        In addition to the work and significant potential of the QuIC and
    Quality Forum, the Departments of Veterans Affairs and Defense have been
    leaders in employing information technology to enhance their ability to
    provide a higher quality of care to patients. Moreover, the Food and
    Drug Administration is working to implement new reporting systems that
    allow for a rapid response to medical errors causing patient injury.
    However, despite all the progress that has been made, it is clear that
    more must be done.
        Recent advances in technology and information systems can help
    eliminate dangerous medical errors, lower costs by improving
    communications between doctors, eliminate redundant tests and
    procedures, and build automatic safeguards against harmful drug
    interactions and other adverse side effects into the treatment process.
    Despite this fact, very few public and private health plans, hospitals,
    and employers appropriately use these new techniques.
        Therefore, I hereby direct the Quality Interagency Coordination Task
    Force, to report to me a set of recommendations on specific actions to
    improve health care outcomes and prevent medical errors in both the
    public and private sectors in a manner that is consistent with the
    strong privacy protections we have proposed. This report shall:
        Identify prevalent threats to patient safety and medical
                errors that can be prevented through the use of decision
                support systems, such as patient monitoring and reminder
                systems;
        Evaluate the feasibility and advisability of the
                recommendations of the Institute of Medicine's Quality of
                Health Care in America Committee on patient safety;
        Identify additional strategies to reduce medical errors and
                ensure patient safety in Federal health care programs;
        Evaluate the extent to which medical errors are caused by
                misuse of medications and medical devices and consider steps
                to strengthen the Food and Drug Administration's
                surveillance and response system to reduce their incidence;
                and
        Identify opportunities for the Federal Government to take
                specific action to improve patient safety and health care
                quality nationwide through collaboration with the private
                sector, including the National Forum for Health Care Quality
                Measurement and Reporting.
        I direct the Department of Health and Human Services and the
    Department of Labor to serve as the coordinating agencies to assist in
    the development and integration of recommendations and to report back to
    me within 60 days. The recommended actions should lay the foundation for
    a national system that prevents adverse medical events before they
    occur.

                                                          William J. Clinton