[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