Speaker

Robert Califf, MD
Instructor in Medicine
Duke University Medical Center
Former Commissioner of Food and Drugs

Keywords

Healthcare; Learning Health System; Evidence-Based Practices; Health Outcomes

Q&A

The following reflects key takeaways from a fireside chat with Dr. Robert Califf, in which he shared his perspective on the “non-learning” health system. For a comprehensive account of Dr. Califf’s insights, watch the recording.

What do you mean by the “non-learning” health system?

25 years ago, certain visionaries looked at the advancement of computing, electronic health records, and other digital data and noted that data could and should be used to improve healthcare delivery and, in turn, health outcomes.

But increasingly, the healthcare system in the United States is “learning” based on institutional financial outcomes as opposed to patient outcomes. That’s not to say it’s a zero-sum game—but efforts are being directed towards expensive technologies that offer marginal benefit (but deliver good economic returns) as opposed to primary care, prevention, and interventions that address basic risk factors.

How can we reshape those incentives?

If the goal is to optimize the longevity, well-being, and functionality of the American population, incentives within the healthcare system should be aligned with health outcomes.

Why has it been so difficult to integrate evidence-based practices into healthcare settings? And how can we begin to change that?

If we align health care systems’ incentives with health outcomes, they will figure out how to operationalize these practices. But if we assume the incentives will not be realigned in the near future, we will need to eke out areas of alignment with decision-makers, incremental improvements that are not so disruptive that they get squashed. And finally, we need to develop disruptive external systems to challenge health systems.

What tasks should this community focus on?

Keep working on pragmatic trials; show that interventions have practical applications. Keep developing the skills to communicate about your work to the public. And be prepared to put our system back together when it breaks.

Discussion Themes

Other discussion themes included the critical role of randomized trials and the potential role of AI in answering scientific questions; what the research community can learn from other industries; and anticipated changes to the healthcare system and research landscape.