In this last of four blogs reporting from WTN’s Disruptive Healthcare Conference 2014, I focus on a realization I came to during the conference: Big Data and the Internet of Things have finally come-of-age in healthcare. Examples of how data, analytics and mobile platforms connected to cloud-based data centers are transforming healthcare were woven into many presentations. Here are some examples:
- Aurora Health Care, which spends $780 million on its supply chain annually, is using data comparing different surgeons’ supply usage to identify savings that do not hurt quality of care. It is also identifying frequent users of ERs who could be served less expensively in a primary care location.
- Specialists and primary care physicians are able to collaborate virtually or via e-referrals that, according to PDS CEO Jonathan Ravdin, are reducing the need for visits to specialists or wait times for appointments.
Yet all is not rosy on the data and technology front. Christine Bessler, CIO/VP of ProHealth Care, Inc., argued that data is of little use unless it is trusted and in the hands of the people who can use it. She added, “The data must be available right alongside other physician tools; it has to matter to be meaningful to them if we ever want to get needed behavioral changes.”
Unfortunately, in her view and that of many other speakers, current Electronic Health Records (EHRs) aren’t cutting it. “The EHR does not give you the data – not quite where you need it to be. You want to drive decision-making far better than what the native decision tools in the EHR enable, so we need applications to help us get there,” Bessler continued.
Indeed, the action is all around adding value to the EHR. Ken Kleinberg, Managing Director of The Advisory Board, a leading healthcare consulting firm, believes data should be more than a repository. Once information systems add advanced analytics (known as Artificial Intelligence at its most sophisticated) Kleinberg argues they could serve as an alert system, an informed suggestion system, and even a recommender of next actions . But there are many barriers to capturing the full value of data now that EHRs are on their way to being universal.
First, the quality of the information in the EHR is not what it needs to be. Physicians are frustrated with EHR systems. EPIC and others simply automated medical records that had been forced on clinicians by regulators. “What information do clinicians really need?” was not at the center of EHR design. As a result, EHR systems reduce physician productivity, even if, as in some places, scribes are hired to help fill out the records.
So there is a mad dash to add value to the EHR by EPIC (which has moved finally into analytics), software companies, and start-up firms. 100State, a healthcare IT incubator, aims to start 100 firms focused on capturing and improving the value of data to solve important provider problems, according to co-founder Nikko Skievaski.
Second, use of EHR data requires a sea change in medical training and physician behavior, changes that have so far not materialized. According to Philip Loftus, Aurora CIO, the key question is “Which technologies and information will change the culture in the way that we need it to change? If we could use EHRs to reduce unnecessary diagnostic imaging and connect it to population health, physicians will be far more motivated to adopt the new technology.” Yet, says Loftus, “current EHRs remain largely a finance tool with no clear link to clinical care.”
Third, there is a flood of data entering from wireless health solutions with many individuals seeking to connect their data to their EHR. But which data is helpful and which is just clutter? Who controls the quality of the measurement?
Finally, there is the liability issue. If physicians do not follow an artificial intelligence generated alert, will they be liable? If so, how will physicians deal with the plethora of alerts and avoid alert fatigue?
Can these challenges be overcome? I suspect they will be and the companies, entrepreneurs, and healthcare systems that figure it out will emerge as the leaders. Mayo Clinic and Cleveland Clinic will be on the frontier, as they have already changed their culture to collaborative care teams that offer some the highest value healthcare in our nation. Duke has figured out how to care for populations of 7,500 people with a team of 7 people; Aurora, one of the leaders in Wisconsin, is trying to grow from 1500 to 2000 for similar care teams. Information systems are essential in accomplishing this feat.
While the future of healthcare IT may seem rocky based on the issues raised at the conference, the financial community is certainly betting that the challenges will be solved. In the first half of 2014, digital health funding reached $2.3 billion, according to a report from accelerator Rock Health, surpassing all such funding in 2013, as well as investments in healthcare sectors like biotech and medical devices.
I hope the investors are right, for the sake of healthcare in this country. Real time clinical information extracted from better curated data repositories will be the key to lowering costs while improving quality of care. John Byrnes, CEO of Mason Wells, a private equity firm in Milwaukee, has it right: “It’s time to get the bean counters out of managing healthcare IT.”