Big Data and Health Care: The Value of Con­nected Care

Policy - - In This Issue - Peter W. Vaughan

Canada’s health sys­tems are frag­mented ge­o­graph­i­cally and by sec­tor. In the 2017 Com­mon­wealth Fund re­port com­par­ing health sys­tem per­for­mance in 11 coun­tries, Canada ranked 9th. Only six per cent of Cana­di­ans viewed their per­sonal health in­for­ma­tion on­line in the last two years. Yet valu­able data re­side in repos­i­to­ries in both the pub­lic and pri­vate sec­tors in Canada. A na­tional digital health big data strat­egy is the foun­da­tion of a 21st cen­tury health care ecosys­tem.

Dig­i­ti­za­tion has changed al­most ev­ery sec­tor of the econ­omy; yet health care, one of the largest goods and ser­vices in­dus­tries in the world, hasn’t seen ma­jor dis­rup­tion—yet.

The mar­kets were taken by sur­prise with the re­cent an­nounce­ment by Ama­zon, Brook­shire Hath­away, and J.P. Mor­gan Chase that they would fund a new ven­ture to pro­vide cheaper and bet­ter health care for their em­ploy­ees. Why would these com­pa­nies ven­ture into the black hole of health care?

Digital trans­for­ma­tion is about to dis­rupt the health care sta­tus quo. Data, big data, ad­vanced an­a­lyt­ics and the com­pa­nies poised to take ad­van­tage of them will fa­cil­i­tate that revo­lu­tion across the en­tire spec­trum of the health care in­dus­try. It’s al­ready hap­pen­ing. Baby­lon Health (UK) cur­rently has more on­line pa­tients in Rwanda than in Bri­tain.

As Cana­di­ans, we need to quickly reimag­ine a digital Medi­care 2.0, and soon, oth­er­wise some­one like an Ama­zon, Google, Ap­ple or Baby­lon Health will be pro­vid­ing health care to Cana­di­ans for a fee. The Net­flix of health care is com­ing and it’s float­ing on a sea of ever-in­creas­ing big data in health care.

While there is no gen­er­ally ac­cepted def­i­ni­tion of Big Data, for our pur­poses I mean large vol­umes of struc­tured and un­struc­tured in­for­ma­tion from a va­ri­ety of sources, and ac­ces­si­ble at great speed, or what has been re­ferred to as the three V’s (vol­ume, ve­loc­ity and va­ri­ety).

In Canada, most health data are locked away and dif­fi­cult to ac­cess for mean­ing­ful use. Data are stored in mul­ti­ple forms and lo­ca­tions: in tens of thou­sands of doc­tors’ of­fices as elec­tronic or pa­per records (health care is still pri­mar­ily a cot­tage in­dus­try in Canada); in pri­vate cor­po­ra­tions, in­sur­ance com­pany servers, uni­ver­si­ties and re­search agencies; in lab and di­ag­nos­tic-imag­ing hard drives; as ad­min­is­tra­tive in­for­ma­tion in hos­pi­tals or health min­istries and fed­eral agencies; and yes, on smart­phones. All are dis­con­nected from ag­gre­gate mean­ing and the new pat­terns and al­go­rithms that some­day might more ac­cu­rately di­ag­nose, treat faster, and yield bet­ter re­sults. For pay­ers, and in Canada that is every­one who pays taxes, health care big data holds the key to un­lock­ing value in health care.

The rise of cloud-en­abled so­lu­tions has yielded a wealth of ways to iden­tify pat­terns and an­a­lyze treat­ments in real-time. We are wit­ness­ing an ex­plo­sion of re­al­time data, data on wear­able de­vices, what has been called the “quan­ti­fied self.”

The In­ter­net of things (IoT) in­cludes sen­sor en­abled data shift­ing the com­mu­nity of care from the hos­pi­tal (back) to the home. This is al­ready the case in St. Louis, Mis­souri where Mercy Health’s Vir­tual Hos­pi­tal—a hos­pi­tal with no beds—has been lead­ing the way with higher pa­tient sat­is­fac­tion, lower cost and bet­ter out­comes.

While the prom­ise of per­son­al­ized medicine has been slow, many ob­servers be­lieve we are reach­ing a tip­ping point as our un­der­stand­ing of ge­net­ics and epi­ge­net­ics (how the en­vi­ron­ment and other ex­ter­nal fac­tors in­ter­act with our bi­ol­ogy) evolves.

With more on­line health ser­vices avail­able, the po­ten­tial to im­prove ac­cess with mo­bile tech­nolo­gies re­quires the or­ga­ni­za­tion and gov­er­nance struc­ture to de­liver it.

Canada can be a global leader in the age of real-time, cit­i­zen-cen­tric health care. Canada’s provin­cial and ter­ri­to­rial sin­gle payer sys­tems could be­come a first-mover ad­van­tage if har­nessed in a col­lab­o­ra­tive, cit­i­zen-friendly way.

Real-time data is the foun­da­tion of the fu­ture of health care, en­hanced by ar­ti­fi­cial in­tel­li­gence (AI), pre­dic­tive an­a­lyt­ics, and data-driven deci-

sion mak­ing at the heart of val­ue­based health care.

Today Canada’s health in­for­ma­tion sys­tems are ex­tremely frag­mented ge­o­graph­i­cally and by sec­tor.

Real-time data is the foun­da­tion of the fu­ture of health care, en­hanced by ar­ti­fi­cial in­tel­li­gence (AI), pre­dic­tive an­a­lyt­ics, and data-driven de­ci­sion mak­ing at the heart of value-based health care.

Adop­tion of digital health in Canada has been slow and aware­ness by Cana­di­ans is low. In the 2017 Com­mon­wealth Fund re­port com­par­ing health sys­tem per­for­mance of 11 coun­tries, Canada ranked ninth over­all and last on ac­cess.

A Canada Health In­foWay sur­vey in 2016 found only six per cent of Cana­di­ans had viewed on­line or down­loaded their health in­for­ma­tion in the last two years. Only four per cent had emailed their reg­u­lar pri­mary provider with med­i­cal ques­tions in the last two years. Yet, the vast ma­jor­ity of Cana­di­ans would like to be able to erequest a pre­scrip­tion re­newal, ac­cess their med­i­cal records (view) on­line, book an ap­point­ment and con­sult with a health care provider on­line.

There are many valu­able data repos­i­to­ries in Canada in both the pub­lic and pri­vate sec­tor that can gen­er­ate sig­nif­i­cant ben­e­fits and sav­ings to Cana­di­ans, or­ga­ni­za­tions and gov­ern­ments. How­ever, a lack of a co­or­di­nated tech­nol­ogy and reg­u­la­tory ecosys­tem is pre­vent­ing this value from be­ing un­locked and there is a wide vari­ance of stan­dards, pri­vacy con­trols and data gov­er­nance.

The Nether­lands, Croa­tia, the United King­don and In­dia are us­ing digital tech­nolo­gies to pro­vide ac­cess to health records to cit­i­zens, health pro­fes­sion­als and some biotech com­pa­nies.

There are cor­po­ra­tions in Canada who have built sig­nif­i­cant data-driven ecosys­tems in other in­dus­tries in­clud­ing Telus, RBC and eBay to name a few. These in­vest­ments have re­sulted in on­go­ing ben­e­fits in­clud­ing new rev­enue­gen­er­at­ing busi­nesses, value cre­ation, and higher use of data across mul­ti­ple lines of busi­ness.

Canada is the only Or­gan­i­sa­tion of Eco­nomic Co­op­er­a­tion and De­vel­op­ment (OECD) coun­try with­out an elec­tronic pre­scrib­ing so­lu­tion. Canada Health In­foWay and its con­tracted part­ner, Telus, launched e-pre­scrib­ing in Au­gust 2017 (Pre­scribeIT). It of­fers a na­tional so­lu­tion that will in­te­grate with provin­cial drug repos­i­to­ries and provin­cial reg­istries. To date, six prov­inces and a range of phar­macy re­tail­ers have ex­pressed a will­ing­ness to get on board.

In the world of big data, Canada, with its 35 mil­lion peo­ple has the op­por­tu­nity to build a pan-Cana­dian plat­form. This health care plat­form could be used to pro­vide ac­cess to care via mo­bile de­vices or web-based tools for bet­ter ac­cess, and with evolv­ing 5G at a far lower cost, ex­pand­ing cov­er­age into ru­ral and re­mote ar­eas.

Raw data stored in a se­cure trusted big data plat­form or se­ries of con­nected plat­forms could be the foun­da­tion of an ecosys­tem with pri­vacy en­abled fil­ters, cy­ber-shield con­trols and sound data gov­er­nance. This could stim­u­late the pro­lif­er­a­tion of an ap­pli­ca­tion mar­ket­place which in turn would drive eco­nomic de­vel­op­ment. Cit­i­zens would have ac­cess to their own data, in­sights, and cus­tom­ized an­a­lyt­ics.

Canada needs digital health leg­is­la­tion for the 21st cen­tury as part of a broader digital health strat­egy, one that fos­ters lo­cal, re­gional, pan-Cana­dian con­ver­sa­tions around mod­ern­iza­tion of Medi­care in the digital world, in­clud­ing agree­ment on own­er­ship, ac­cess and physi­cian re­mu­ner­a­tion for digital care; one that man­dates elec­tronic pre­scrib­ing.

The Euro­pean Union has put in place Gen­eral Data Pro­tec­tion Reg­u­la­tions to mod­ern­ize pri­vacy and use of data con­trols. The Nether­lands has com­mit­ted to 100 per cent pa­tient ac­cess to elec­tronic health records and to have 50 per cent of out­comes mea­sured. Mea­sur­ing out­comes is the foun­da­tion of value-based health care; a fun­da­men­tal shift away from uti­liza­tion cost­con­tain­ment to value for ser­vice ren­dered. To do that, we have to mea­sure out­comes not ac­tiv­i­ties.

Big Data in health care is a tool. The abil­ity to in­te­grate large health data sets cre­ates both an eco­nomic op­por­tu­nity and an es­sen­tial first step in a value-based health care sys­tem.

Gov­er­nance is key to ac­count­abil­ity. We can learn from other coun­tries, in­clud­ing Den­mark, the Nether­lands, Croa­tia and Aus­tralia which have a cen­tral or­ga­ni­za­tion for data pri­vacy and data gov­er­nance. Work­ing to­gether, Canada al­ready has or­ga­ni­za­tions that could be as­signed the role. Fed­eral lead­er­ship is needed to man­date align­ment on Big Data in health care.

Canada can be a global leader in a new age of real-time health care.

Lever­ag­ing these shared as­sets will fos­ter the next gen­er­a­tion of re­search, prod­uct de­vel­op­ment, com­pa­nies and cre­ative lead­er­ship, which will es­tab­lish Canada as an in­ter­na­tional in­cu­ba­tor, at­tract­ing tal­ent and ex­port­ing new health and bio tech­nol­ogy to tackle the most com­plex health care chal­lenges today and to­mor­row.

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