ORLANDO, Fla. — It is a little amazing what is happening in health care quality improvement these days.

As an observer of the health care system, I generally see bits and pieces of what's going on, such as a study here, or a pilot project there. But after attending the first day of general sessions at the 25th Annual Institute for Healthcare Improvement National Forum on Quality, I got a better taste of the varied efforts to improve health care.

Taken together, they offer a spectrum of what's in the works from broad top-down efforts to smaller bottom-up initiatives.

I don't know what health care is going to look like in five or 10 years, but I know it's going to look very different and I bet it's going to look better.

Health care experts are promoting projects big and small, and while there's no guarantee that they will succeed, it's apparent very few people want to see the status quo.

The IHI is using its muscle to promote the "flipping of health care" by transforming it into a collaborative process with the patient at the center, an effort that is firmly in patient engagement territory.

"Let's learn together how we can make changes," Maureen Bisognano, IHI president and CEO, said in her opening keynote.

While the "flipping health care" theme is not as targeted as previous IHI campaigns that focused on such things as saving 100,000 lives, the goals are lofty. At a press meeting, Bisognano said the IHI wants to collaboratively tackle the toughest obstacles to improving health care quality. In doing so, the IHI wants to reach out beyond its traditional audience to figure out how to improve quality among hospitals with limited resources.

Another presenter discussed why it could be beneficial to patients to give them full access to their medical records. Tom Delbanco, M.D., co-director of Open Notes and a professor of general medicine and primary care at Harvard Medical School and Beth Israel Deaconess Medical Center, said there's a disconnect between what patients believe and want and what their doctors think they believe and want. "We're so arrogant that we think we know what patients want," Delbanco said. What patients want is more relevant medical information; they are less concerned about other issues, such as privacy when discussing their status, he said.

In another session, which I was fortunate to moderate, former IHI board Vice Chairman David Gustafson described a computer-based health monitoring and communication system designed to help keep at-risk elderly active. Currently the subject of a randomized trial, the goal is to take it statewide in Wisconsin where it is currently based, and eventually nationally, said Gustafson, who is director of the Center for Health Enhancement and Systems at the University of Wisconsin in Madison.

Will any of these approaches be around 10 years from now? I don't know, but they are playing a role in improving how health care is provided.

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