Competent  Health Reform 




Competent Health Reform: The United States health system is currently lacking "competence," which I defined as achieving a strategic goal effectively in terms of time, cost, and realization of a goal. Achieving "strategic"  is a long-term mission or goal through which information makes the strategy operational for achieving organizational mission success. This means that health outcomes for the American population are divided by the cost to deliver performance. This builds on Harvard Business School professor Michael Porter’s definition of value: “health outcome per dollar of cost expended.”[1]


Highly reputable healthcare leaders and health economists have concluded that by this definition the United States health system is not competent, in fact, these experts have concluded that the health system is badly broken.[2] My six decades of teaching, lectures, research, publications, and consulting assignments with a depth of senior responsibility in the information technology revolution have supported this conclusion.


The early primary focus of commercial use of computers was the processing of accounting transactions. Information technology improved rapidly in the power-to-cost ratio in the first decades of the information technology revolution. This enabled the industrial experience to move toward strategic information power, where “strategic” is defined as enabling business competitive advantage. This extraordinary business transformation is dated to the start of the 1970s, was missed by the healthcare sector in which a well-documented level of incompetence by a number of measures continued. There is now unsustainable cost inflation and a high rate of medical errors that cause harm or even death of patients. Delivery of healthcare was seriously under-supported by research on “what works”[3] and relative cost-effectiveness.


Health Reform Happening: The core of healthcare, from the perspective of the information technology revolution, is the full function electronic health record (EHR), a focus of my research, teaching, consulting, and publications since the 1980s. In the 20th century, this key innovation was largely missing from healthcare. [4] However, rapid progress in the 21st century augurs well for a very wide diffusion of the full function EHR by 2020.


The scientific information revolution finally achieved a critical mass of utilization in healthcare in the 21st century. The very early innovations in exemplary healthcare organizations demonstrated the feasibility and a learning curve in the last decade of the 20th century. The forecast of competent strategic information-enabled health reform in the 21st century is supported by these early exemplars in healthcare innovation and by the realization of strategic information competence in the industrial sectors of the economy.


The database maintained by Dr. Gruber of the strategic information-enabled transformation of the pre-industrial health system provides strong evidence that the remarkable progress thus far will further accelerate as forces monitored by Dr. Gruber continue to push rapid improvement in the performance-to-cost ratio of strategic information.


Savings from Health Reform: A powerful force driving strategic information-enabled health reform is the long history of unsustainable health cost inflation. National health expenditure increase national health expenditures increased from $27 billion, or 5% of GDP,[5] in 1960 to $3 trillion, or 17.5% of GDP, in 2014.[6] Projections from CMS estimate an increase to over $5.4 trillion by 2024.[7] Healthcare inflation has been a consequential factor in what has clearly been inadequate government funding for a response to serious national and global crises, such as underfunded education system, climate change, rising federal debt, a crumbling transportation system, a sobering threat from terror, and the falling middle class.


Dr. Gruber has concluded that a high rate of savings from waste in health spending[8] will not only fund investment for the transformation of the United States health system but also contribute significantly to funding for other national and global crises.


[1] Porter ME and Olmsted Teisberg E. Redefining Health Care: Creating Value-Based Competition on Results. Boston, MA. Harvard Business School Press; 2006: 4

[2] George C. Halvorson. Health Care Will Now Reform Itself! A User’s Guide to Refocusing and Reforming American Health Care. New York, NY. Productivity Press. 2009: XV

[3] Brent James Keynote address at the Partners Healthcare Connected Health Symposium October 2011.

[4] Dick RS, Steen EB, and Detmer DE, (EDS) The Computer-Based Patient Record: An Essential Technology for Health Care (revised edition). Washington, DC: Institute of Medicine, National Academies Press; 1997

[5] Table 102 (page 1 of 2). Gross domestic product, national health expenditures, per capita amounts, percent distribution and average annual percent change: United States, selected years 1960–2013, Centers for Disease Control, 2014. Accessed on October 19, 2015. Available at:

[6] Martin AB, Hartman M, Catlin A, and National Health Expenditure Accounts Team. "National Health Spending In 2014: Faster Growth Driven by Coverage Expansion And Prescription Drug Spending." Health Affairs, 35, no. 1, 2016; 150-160.

[7] National Health Expenditure Projections 2014-2024. CMS, June 2015. Available at:

[8] Smith M, Saunders R, Stuckhardt L, et al. (EDS) Best Care at Lower Cost: The Path to Continuously Learning Healthcare in America. Washington, DC: Institute of Medicine, National Academies Press; 2012.


Contribution to Strategic Competent Health Reform

Competent Health Reform

Strategic Information-Enabled Health Reform


$1-$3 trillion annual savings projection

Health Reform Happening

Understanding Innovation Momentum