b'The Emergency Departments Unique ViewpointA significant number of patients seek care in the ED not because they are acutely sick or injured, but as a direct result of problems in the health care system itself. Lack of resourcesLack of patient engagementPoor access to other physiciansPoor transitions of careIneffective patient teachingA 2019 study published in JAMA 1estimated that factors including lack of care coordination, failures of care delivery, and poorWe need to do more, but not more execution of best practices account for anywhere between $129of the same. We need something billion to $244 billion in wasted health care spending per year. transformative. Maybe not Amid these problems however, there is opportunity. In the healthrevolutionary, but significantly care system we have today, the ED has a unique vantage point fordifferent, or this longstanding detecting what is right and what is wrong in the very health system itpattern will continue and, more serves.likely, get worse. These patterns are unfortunate for our patients, Yet we are more than passive observers. The ED has frequentand the very health of our health contact with significant patient populations. This combinationcare system is suffering. The result of direct observation, clinical accountability, and the realities is unsustainable cost and further encountered during patient-by-patient problem-solving gives theerosion in clinical outcomes.emergency physician not just insight but opportunity and most importantly, responsibility.We must ask ourselves: what does this unique vantage point mean for clinical outcomes, the stewardship of resources, and the sustainability of our health care system? What does the EDs unique insight ask us to change, as we work toward the future we need?Those questions are the subject of this paper. In the sections below, I will trace the EDs evolution from accident response to increasing levels of system responsibility and accountability and suggest why that evolution has occurred. With data gleaned from within the ED, I will show examples of what this unique vantage point can tell us about the highest-risk, highest-cost and what can be done better. I will review other vantage points within the health care system, including their strengths and limitations. And finally, I will suggest how this countrys 24/7/365, EMTALA-governed emergency departments may be better utilized as strategic assets within the health care system itself.The consistent, repeated issues that occur in a local health care system are not unlike clinical conditions.They can be diagnosed. They have treatments. Some even have cures. The ED can uniquely advise changes.But most importantly, the ED can actively participate in transformation.Together, we healTogether, we heal 2Together, we heal SCP HEALTHIFROM INSIGHTS TO INTERVENTIONS'