My thoughts on the MIT Solve Talks at Google Hosted by Kara Miller on Healthcare

MIT Solve Talks at Google Hosted by Kara Miller
Video: https://youtu.be/MpMrK2nm3pU

Streamed live on 28 Oct 2015

Guests:

  • Rushika Ferdandopulle, CEO of Iora Health
  • Denny Ausiello, Chairman Emeritus at Mass General Hospital
  • Heidi Williams, MIT

About Solve: “Learn about MIT’s initiative that asks extraordinary people to work together to find solutions to the extraordinarily hard problems facing our global community.” http://solve.mit.edu

My take home message was that Healthcare needs to consider building these Healthcare Operating Systems Platforms that leverages Big Data and other new technology of this digital era to integrate between sources of data, the practise and the patients. It will allow collaboration between clinicians and patients both in the provision of care and in research.

My Observations about the speakers

  1. Heidi has a very typical data scientist and epidemiologist perspective, cautious and tempered by date
  2. Denny has a very typical experienced practitioner perspective, interested in reform but cautious about hype around revolutions.
  3. Rushika has a next generation medical conceirge or patient advocate kind of perspective.
  4. The host Kara does not have deep enough knowledge of the domain to truly leverage on the panels knowledge, but she does a good job. The panel however don’t always take her queues, as evidenced in the Watson comments.
  5. The overal theme and consensus is the need for leveraging new IT capabilities to provided more wholistic lifetime medical records to clinicians at the point of care so that evidence based medicine can become the norm of practise.

My Observations about the issues

  1. Issue raised in 5:35, US using biggest % of GDP in healthcare but not getting as good quality measures as some other nations who spend less.
  2. In 7:50 its established that the driver of inflated healthcare cost in the US is waste. One driver of waste is fee for service, which skews incentives to provision unecessary procedures and therapies.
  3. The story from 17:54 by Rushika demonstrates the issue of fee for service procedure pushing and upselling that needs a better and stronger primary care doctor to prevent. At the heart of the issue is a lack of a patient advocate and the information assymetry
  4. Comments from Denny in 23:06 onwards show the need for good data science and epidemiology to avoid inaccurate misconceptions and generalisations
  5. Comments from Denny in 26:42 bring up the culture of the US, and how it rejects ‘benign neglect’, where accepting less is acceptable, but it the US, patients are vigilant and expect more. He goes on to say that medicine today is probably only operating on a 50% ratio on evidence based, the other 50% of blindness is caused by lack of information.
  6. Key point from Denny in 28:00 “The quality and quantity we get from our patients at the point of care is quite random and episodic”, its in this absence of information that a physician may resort to basing their decisions on their personal expereince rather then the nature of evidence that is available.
  7. 3:35 Kara: “how do we get from 50% to 80%?” Denny: “The quality of that information has to be guarded under more continous and presymtomatic ways” – He goes on to say that we need to use the digital tools of today to capture all phenotype information to provide clinicians with the information needed to make informed decisions. “We need a complete retake on how we garner these information, how do we partner with our patients not only in clinical care but in discovery, and then how we annotate that information to give a much more evidence based and scientific base to medicine.”
  8. 34:35 Rushika: “The right way to do this obviously is to get a tonne of data in from when people are living their normal life, we have to figure out how we interpret that data, how do we pick signals out of the noise, and turn that into action”
  9. When Kara talks about IBM’s Watson in 36:20, Denny responds to say Watson is good for dealing with structured data but not unstructured data. I know IBM’ers who will jump at this statement, but I think Denny’s point here is that until Watson can be part of ingesting and consuming data from the points of care and make sense of it depsite its lack of structure and ontology, it will be relegated to studdying journals and already structured medical knowlegde and correlating that to post structured content created by clinicians.
  10. Denny paints a picture from 37:20 of a scenario where we are able to process the data glut and turn it into a data resource that includes journaling and participation from patients, then then turned to knowledge and actions. The market now is full of apps that are comodities, that are not prioritized for goals of precision and not intergrated into the overall patient record. “We need a fully integrated and wholistic system”
  11. 39:49 Heidi points out that IT has failed to be the magic bullet to solve issues as promised
  12. 40:52 Rushika explains that the reason for this failure of IT to deliver has been rooted in the fact that much of the systems built were pivoted on billing and with that focus, the ROI and gains were focused on billing optimisation, and therefore they seeked to make Doctors structure on input, turning their documentation from a simple note in plain english to 50 clicks of forms and severely driving down productivity.
  13. 42:40 Denny: “we were all trained to diagnose disease and treat disease and its progression to ultimately death, we are the only profession in the world that doesn’t know its gold standard, we can’t diagnose wellness”. To drive wellness and engage patients, we need to work on defining what wellness looks like.
  14. Comments till 48:00 on the theme of whoslistic planning for policy makers and factoring the social aspect for health, to be able to meet the public policy goals they typically have.
  15. 49:00 Denny: “Partnerships with patients, not just in care, but also in discovery”. Behaviour science is a science, and its something to master to modify behaviour. Read Social Physics http://goo.gl/IGPaJw
  16. 57:29 Rushika describes Iora as building an operating system for healthcare instead of an EHR, a link between technology and people. Not billing but collaborative care. “Technology in the context of realtionship”
  17. 58:56 Denny: “Integrated Healthcare Systems” – “Intergration depends on people not machines, BUT machines, toolkits and skillsets can ehance much of that, and we would be foolish living in such a technologically advanced era in not taking advantage of that”

Consider this before choosing a system for your hospital

putting

I once gave a talk called “How to manage your CIO” for CFOs and CEOs from the region in an event in Bangkok. My main premise was that the single biggest factor to consider when buying a system or systems for your hospital/hospitals is understanding your organisation and its IT / Informatics maturity and the vision of where you need to be in the next few years. Nothing revolutionary I know, it would even seem like it should be obvious – but you would be surprised how often healthcare providers don’t get this. So much effort and focus is spent on understanding technology, features and vendors before sufficient soul searching has been done to answer preliminary questions such as;

  1. what is going to be our business focus and differentiation over the next few years, ambulatory care?  wellness?
  2. can we ever picture ourselves as leveraging IT to unlock new capabilities and markets or is that too far fetched for now?
  3. are we looking to build a community? branches? regionally?
  4. will we build up internal IT capability or will we always be dependent on partners?
  5. do we know where we are in terms of IT maturity now? do we have a way to measure it and chart a course?
  6. will we be able to secure executive sponsorship and a competitive budget? how will we manage the BOD?

The answer to these questions have serious impact to the vendors and solutions a hospital should be choosing. The economics of Malaysia usually mean that we do not have sufficient buying power as a nation to demand customisation from mature technologies. So often buyers in Malaysia have to choose between reengineering their processes and informatics to conform to mature technology and workflows from proven overseas systems or to have something bespoked to their needs locally and risking the quality issues inherent to this option. Some vendors have strong systems but others have strong implementation skills – which is more important for your situation? Some hospitals lack the IT maturity and need a vendor who will come and tell them what to do and conform them to their image – others have such strong preferences and needs, they will be better suited to a vendor who listens and conforms. In my experience many customers do not understand themselves, thinking they are the latter when they are really the former – resulting in implementation deadlocks where they feel the vendor is not helping them to complete a task or make meaningful choices. The analogy I like to use is a golfer putting. A successful putter is one who is not only sufficiently practised but able to read the greens and choose the right stroke and approach to sink that ball.

Mobility in Healthcare

Mobility enables real time consumption and contribution of critical medical data to the clinicians at the point of care. Mobility is more than a convenience or trend, it can enable quicker documentation reducing errors and provide critical decision support to Clinicians at the point of care.