Re­move bar­ri­ers to shar­ing health data and cre­ate a con­tin­u­ously learn­ing health­care sys­tem

Modern Healthcare - - COMMENT - By Dr. Harold L. Paz

In a May 2016 pa­per in the jour­nal Aca­demic Medicine, I de­scribed mov­ing to the “third curve” of health­care. The first curve is tra­di­tional fee-for-ser­vice medicine. The sec­ond is pop­u­la­tion health, as rep­re­sented by tra­di­tional health­care or­ga­ni­za­tions shift­ing their focus to value-based re­la­tion­ships.

Pre­ci­sion medicine, big data and dig­i­tal tech­nol­ogy of­fer us the prom­ise of mov­ing to a world where we can truly cre­ate the third curve— per­son­al­ized health for ev­ery in­di­vid­ual, no mat­ter what their cir­cum­stances or health.

To achieve per­son­al­ized health, in­di­vid­u­als must truly own their health in­for­ma­tion in ways that make it ac­tion­able for them and their care­givers. This data can­not be limited to clin­i­cal and di­ag­nos­tic re­sults, but must also in­clude vi­tal in­for­ma­tion that re­flects so­cial, eco­nomic and en­vi­ron­men­tal de­ter­mi­nants of health. In this new move­ment, each of us has a per­son­al­ized, evidence-based, lon­gi­tu­di­nal care map and ac­cess to a health ecosys­tem that brings to­gether ex­actly the ser­vices we need, be­gin­ning in the home.

To cre­ate a health ecosys­tem that is ef­fec­tive and ef­fi­cient for each per­son, we must have the in­fra­struc­ture to sup­port it. While ex­cel­lent clin­i­cians and fa­cil­i­ties are es­sen­tial in this trans­for­ma­tion, to be truly suc­cess­ful in elim­i­nat­ing the over $1 tril­lion of waste in the Amer­i­can health­care sys­tem and im­prov­ing out­comes, we must com­mit to end-toend in­ter­op­er­abil­ity for all healthre­lated in­for­ma­tion. We also must cre­ate in­for­ma­tion tech­nol­ogy in­ter­op­er­abil­ity that en­ables in­di­vid­u­als to use their smart­phones or other de­vices to link with per­son­al­ized dig­i­tal mon­i­tor­ing tools, in­stantly ac­cess their health data, and track not just med­i­cal data but be­hav­ioral and en­vi­ron­men­tal fac­tors. Once that data are col­lected, it can turn into ac­tion­able in­for­ma­tion that re­sults in im­proved ad­her­ence to ev­i­dence­based treat­ment. I would like to see the day when each of us truly owns our own health in­for­ma­tion like we do our fi­nan­cial in­for­ma­tion and we don’t have to pe­nal­ize hos­pi­tals and doc­tors for not shar­ing it.

Driv­ing the trans­for­ma­tion to sys­temic data shar­ing

As in­di­vid­u­als gain ac­cess to an open, data-shar­ing sys­tem, our bio­science re­search in­fra­struc­ture will also reap tremen­dous ben­e­fits. In a learn­ing health sys­tem, ef­fec­tive data shar­ing ac­cel­er­ates the cre­ation of new knowl­edge that can im­prove out­comes, re­move waste and en­sure im­proved ac­cess by pro­vid­ing clin­i­cal and so­cial ser­vices at the right time and right place by the right clin­i­cian. As my coau­thors and I pro­posed in a dis­cus­sion pa­per ti­tled Data Ac­qui­si­tion, Cu­ra­tion, and Use for a Con­tin­u­ously Learn­ing Health Sys­tem: A Vi­tal Di­rec­tion for Health and Health Care, re­cently re­leased by the Na­tional Academy of Medicine’s Vi­tal Di­rec­tions Ini­tia­tive, the suc­cess­ful cre­ation of a re­search and health sys­tem based on data shar­ing will de­pend on three fac­tors: in­cen­tives that change the cur­rent cul­ture of siloed data; cre­at­ing the ex­pec­ta­tion that every­one has a right to their data; and the for­ma­tion of a tightly in­te­grated in­fra­struc­ture that en­ables data ag­gre­ga­tion from dis­parate sources.

Look­ing to the fu­ture, I be­lieve that a trio of driv­ers will ac­cel­er­ate the for­ma­tion of a pa­tient-cen­tric health ecosys­tem in­formed by data. The first is the move to al­ter­na­tive pay­ment mod­els where ev­ery stake­holder shares risk that is mit­i­gated by open ac­cess to data. Sec­ond is the move to con­sumer-driven ex­pec­ta­tions that mir­ror changes in other seg­ments of the econ­omy. Con­sumers who hail an Uber or can­not re­mem­ber the last time they vis­ited a bank will be­come less will­ing to en­dure the frus­tra­tions of a frag­mented health sys­tem. The third driver is the in­evitable im­pact of fed­eral ini­tia­tives to pro­mote data shar­ing and trans­parency.

Dis­rup­tion is com­ing

We must se­ri­ously con­tem­plate the im­pact of a host of new and in­no­va­tive tech­no­log­i­cal so­lu­tions, from big data, to dig­i­tal, to blockchain, that will move us to the third curve and fa­cil­i­tate per­son­al­ized health and health­care. From physi­cians who spend in­creas­ingly frus­trated hours deal­ing with ad­min­is­tra­tive bur­dens in or­der to have a few pre­cious min­utes with their pa­tients, to pa­tients who are in­creas­ingly frus­trated by the com­plex­ity and cost of care, the sta­tus quo is ripe for dis­rup­tion.

Dr. Harold L. Paz is ex­ec­u­tive vice pres­i­dent and chief med­i­cal of­fi­cer at Aetna.

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