Top In­no­va­tions Poll Re­sults

Fu­ture space: Har­ness­ing the power of big data

Modern Healthcare - - TECHNOLOGY - BY JOSEPH CONN

With the fed­eral gov­ern­ment spend­ing tens of bil­lions of dol­lars to push health­care providers to in­stall elec­tronic health record sys­tems, health in­for­ma­tion tech­nol­ogy has been at the fore­front of in­no­va­tion in the health­care in­dus­try for most of the past decade.

So it came as no sur­prise that the rise of health IT fig­ured promi­nently in reader choices when they were asked which in­no­va­tions are mak­ing the big­gest dif­fer­ences in health­care to­day—or will in the fu­ture.

In­for­ma­tion tech­nolo­gies took three of the top five spots out of 31 pos­si­ble choices. There were 543 re­spon­dents to the on­line poll. Each voter could make up to 10 se­lec­tions in the poll taken to help cel­e­brate Mod­ern Health­care’s 40th an­niver­sary.

Elec­tronic health records topped the in­no­va­tions list, cho­sen by 53% of re­spon­dents. The in­ter­net ranked No. 3, cho­sen by 48%, and big data was No. 4, se­lected by 46%.

The in­ter­twined health­care payment/clin­i­cal re­forms of ac­count­able care and pop­u­la­tion health man­age­ment placed No. 2 with nearly half (49%) of sur­vey par­tic­i­pants se­lect­ing them as a top in­no­va­tion. Stem cell ther­apy ranked No. 5, with 43% of re­spon­dents choos­ing it.

An Amer­i­can Hos­pi­tal As­so­ci­a­tion sur­vey shows 96% of U.S. hos­pi­tals now have an EHR. But even some of the big­gest boost­ers of EHRs say they and other health IT sys­tems are merely promis­ing tools in a com­plex health­care in­no­va­tions ar­ma­men­tar­ium.

“We want to take ad­van­tage of all this data and make it ap­plied at the point of care,” said Dr. Paul Tang, cochair­man of the fed­er­ally char­tered Health IT Pol­icy Com­mit­tee and chief health trans­for­ma­tion of­fi­cer for IBM’s Wat­son Health di­vi­sion. His firm’s goal is to har­ness the com­put­ing power of the Wat­son su­per­com­puter and use big data to de­liver ac­tion­able in­tel­li­gence to EHRs for the pur­pose of pop­u­la­tion health im­prove­ment. “You can see how I’m wrap­ping in No. 2 and No. 4 to make No. 1 more po­tent,” he said of the sur­vey re­sponses.

There also were dis­senters. EHRs, while sig­nif­i­cant, shouldn’t have been ranked first, ac­cord­ing to Dr. Wil­liam Bria, chair­man of the As­so­ci­a­tion of Med­i­cal Di­rec­tors of In­for­ma­tion Sys­tems, a pro­fes­sional or­ga­ni­za­tion for physi­cian in­for­mati­cists. While he has been pro­mot­ing their use for decades, he said he be­lieves the poll over­es­ti­mated the im­por­tance of EHRs to health­care be­cause pa­tients weren’t sur­veyed. “No one is go­ing to throw it (the EHR) away,” he said. “But to say the EHR is the alpha and the omega—no, it’s not.”

As health­care moves to­ward more patient-cen­tered care, Bria said, the im­por­tance of the EHR will fade and other tech­nolo­gies will be­come more use­ful. Bria cited de­vices that mon­i­tor, sup­port and ad­vise the patient, or se­cure provider-patient com­mu­ni­ca­tion tools. “The in­ter­net has won the bat­tle,” he said. “Ev­ery­body’s got ac­cess to it. The idea is we’ve got to di­rectly com­mu­ni­cate with the pa­tients with it.”

His­tor­i­cally, in­no­va­tion in medicine has cen­tered on sci­en­tific dis­cov­ery, said Dr. Harry Green­spun, man­ag­ing di­rec­tor at the Deloitte Cen­ter for Health So­lu­tions, a con­sul­tancy. “The strik­ing thing about the (sur­vey) list is the promi­nence of data—cap­tured elec­tron­i­cally, flow­ing among di­verse stake­hold­ers, an­a­lyzed thought­fully, shared with pa­tients, em­a­nat­ing from de­vices and em­pow­er­ing con­sumers,” he said.

The abil­ity to trans­form the health sys­tem into one that can de­liver ev­i­dence-based, patient-cen­tric and val­uedriven care “hinges on suc­cess­fully ob­tain­ing and har­ness­ing data,” he said.

Dr. Mar­garet Collins is a pro­fes­sor of pathol­ogy and pe­di­atrics at the Univer­sity of Cincin­nati and a pathol­o­gist par­tic­i­pat­ing in the Con­sor­tium of Eosinophilic Gas­troin­testi­nal Dis­ease Re­searchers, a project of the Na­tional In­sti­tutes of Health. It tracks the causes and treat­ments of a GI tract dis­or­der that’s fairly rare—1 in 10,000 Amer­i­cans has the esophageal ver­sion— in which an over­load of a par­tic­u­lar type of white blood cell ir­ri­tates and in­flames the lin­ing of the esoph­a­gus, stom­ach or colon or com­bi­na­tions of them.

The project is us­ing Drop­box, a pop­u­lar, in­ter­net-based file-shar­ing ser­vice. It’s been adapted to ex­change PDFbased track­ing forms and dig­i­tized pathol­ogy “slides” of tis­sue sam­ples taken from the GI tracts of the study’s patient vol­un­teers. With Drop­box, the files can be

ex­changed among nine par­tic­i­pat­ing re­search or­ga­ni­za­tions across the coun­try.

The way sim­i­lar re­search projects are typ­i­cally con­ducted, Collins said, is pathol­o­gists box up and carry their own slides, and share them at pe­ri­odic, face-to-face meet­ings. Or, she said, the slides can be mailed to re­searchers be­tween meet­ings. Both meth­ods are sub­op­ti­mal. Travel takes time and money. “It’s dis­rup­tive to the pathol­o­gist’s life, but it gets pathol­o­gists look­ing at the same slides at the same time.” Mail­ing slides gets ex­pen­sive, too, she said, and “it also can re­sult in the loss of or dam­age to the slides.”

The new method also de­pends on dig­i­tal imag­ing, still fairly new in pathol­ogy. It’s good enough for re­search, but not yet ap­proved for clin­i­cal di­ag­no­sis, Collins said. “I think in the next cou­ple of years” it will be, she added. “The images are bet­ter and bet­ter every day, and the soft­ware gets bet­ter and bet­ter.”

For file shar­ing, how­ever, the in­ter­net-based ser­vice is ready for prime time. “We’ll have mul­ti­ple images of mul­ti­ple pieces of tis­sue, a lot of data, so Drop­box for this is per­fect,” Collins said. “The images (from par­tic­i­pat­ing re­searchers) are picked up here by one of our scan­ning tech­nolo­gies and are picked up by our pathol­o­gists very eas­ily. It’s so in­tu­itive. Once you’re shown how to do it, it’s just click and drag and drop. It doesn’t get eas­ier than that.”

Dr. Marc Rothen­berg, who heads the project as di­rec­tor of the Cincin­nati Cen­ter for Eosinophilic Dis­or­ders at Cincin­nati Chil­dren’s Hos­pi­tal Med­i­cal Cen­ter, said sev­eral of the top 10 in­no­va­tions cho­sen by Mod­ern Health­care’s read­ers are al­ready hav­ing a ma­jor im­pact.

“I was re­cently asked about us­ing big data in my re­search, and I re­al­ized that any cut­ting-edge re­search go­ing for­ward will be imbed­ded (with) var­i­ous forms of big data,” Rothen­berg said. “The days of look­ing at sin­gle vari­ables is over.”

The use of ge­nomics to sup­port can­cer treat­ment is just one of many uses for ge­nomics in the di­ag­no­sis and treat­ment of other dis­or­ders, he said.

“We have taken a sim­i­lar early approach to probe and treat eosinophilic esophagi­tis,” Rothen­berg said. It uses an in­no­va­tive tech­nol­ogy called EoE­ge­nius, which reads a patient’s genetic code to aid clin­i­cians in mak­ing a di­ag­no­sis of eosinophilic ail­ments.

The sin­gle big­gest in­no­va­tion “is ac­tu­ally the core busi­ness model of health­care it­self,” said Dan Michel­son, CEO of Strata De­ci­sion Tech­nol­ogy, a Chicago-based health­care fi­nan­cial analytics firm. “The shift from mak­ing money by driv­ing vol­ume (and) grow­ing the top line to mak­ing money by driv­ing value-based (care) and the move to a cap­i­tated or bun­dled model for (pay­ments) is a truly stun­ning shift. While we are still in the first in­ning, it has al­ready changed the men­tal model and af­fected the in­vest­ments of all of the ma­jor play­ers.”

Soar­ing health­care costs and, in turn, con­sumers’ im­pact on health­care will be driv­ing in­no­va­tion as well, he said. Michel­son points to the lat­est re­port by Mil­li­man, the ac­tu­ar­ial con­sul­tant, which pegged to­tal av­er­age health­care spend­ing of a fam­ily of four this year at $25,826. Costs, ac­cord­ing to the Mil­li­man in­dex, have tripled in the last 15 years.

“Clearly, this is un­sus­tain­able,” he said. “On the patient side, high-de­ductible plans are al­ready driv­ing pa­tients to ask ques­tions about price,” and that will cre­ate an­other in­no­va­tion—“price trans­parency,” he said.

Health­care IT en­tre­pre­neur Dr. Bertina Ex­per­ton sees five of re­spon­dents’ top 10 se­lec­tions—the top choice, EHRs, along with No. 2, ac­count­able care and pop­u­la­tion health;

No. 3, the in­ter­net; No. 4, big data and No. 8, wear­able tech­nolo­gies—as an in­te­grated whole.

“There is a new place for the health­care con­sumer,” said Ex­per­ton, CEO of Humetrix, a de­vel­oper of mo­bile health­care apps for health­care providers and con­sumers. “The sub­script is you can share your data—it’s not just that it’s in an EHR. The in­ter­net en­ables con­sumers to send and re­ceive their in­for­ma­tion, while mo­bile de­vices af­ford them the means to store and cre­ate data.

“When we talk about value-based care and payment re­form, (it) re­lies on a flow of in­for­ma­tion ev­ery­where,” Ex­per­ton said. “A patient has ac­cess to that full flow of in­for­ma­tion, and then the patient is best-po­si­tioned to tell the providers where they have been and where they’ll go next.

“Even when you talk about big data, it im­plies ac­cess to small data from the in­di­vid­ual con­sumer—and that re­quires con­sent of the con­sumer,” she said. “When you have tech­nol­ogy touch­ing the patient, whether it’s a mo­bile app or a tracker, you can re­ally have pa­tient­cen­tered care and push that in­for­ma­tion back to the provider.”

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