As a result of severe wounds received in World War II, I have spent many months in military hospitals, including 20 months in an Army hospital immediately after the war. I continue to use the Military Health System, as do many of my colleagues in Congress, because I firmly believe the quality of health care delivered in military and veterans hospitals is second to none. The largest system of its type in the world, the U.S. military healthcare system is undergoing changes as dramatic as those experienced by the entire country. During Desert Storm, we saw new technologies, such as telemedicine, at work in the field. Since then, military medicine has contin­ ued to imprave and develop innovations that often focus on healthcare issues of concern to society as a whole. We already have seen technology transfer at work. Things we use in our everyday lives, from sunscreen to the Internet, have come to us directly from innovations developed by federal researchers. The private sector, working with the public agencies, has creatively adapted federal research. For example, the hemopump is used successfully by heart surgeons world­ wide to save heart patients. This device, developed by Richard Wampler, was based on satellite technology information that was declassified in the early 1980s. The chapters in this book focus on current federal sector efforts to shape health care and technology transfer. Many of the initiatives described involve some degree of partnering between the public and private sectors.

This book focuses on current federal sector efforts to shape healthcare, i.e., to improve performance while containing costs. The solutions offered include redesigning processes and, where appropriate, the use of enabling technologies to do so. Since historically, innovations in the federal sector have often migrated to and profoundly changed practices in the private sector, many of the initiatives described involve some degree of partnering between the public and private sector. Others represent work in the federal sector that address the same problems confronted in the private sector and offer valuable and transferable solutions and approaches. The major strength of this book is its use of concrete examples that show how process redesign and the integration of enabling technologies have led to performance improvement and cost reduction in the largest healthcare system in the world. The contributors--all acknowledged experts in their fields--draw upon their knowledge of the healthcare industry and their expertise in working within and with the federal sector health system. They focus on exciting changes and improvements, and they elaborate on strategies for the future that will reshape federal sector healthcare. The book does not intend to give "correct answers," but to demonstrate mature thinking in shaping healthcare in general. In the years ahead, engineering healthcare to meet the demands of newly knowledgeable consumers will be critical. In addition to giving insights into what the federal sector leadership is doing to address the challenges of population health, each chapter will highlight the perspective of employers, payers, and deliverers of health services.