[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
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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