Each year I like to look back through my interviews at some of the quotes from industry leaders that intrigued me the most to see if they help elucidate any patterns that I might miss in my day-to-day reporting on informatics trends. Often the ones that stand out to me are from people who reject the accepted wisdom or offer some controversial or blunt comments about the state of our healthcare system and the role technology is playing in it. I may not always agree with them, but I appreciate the fact that they are challenging established notions and making us rethink our assumptions. From the following quotes, presented in no particular order, it is clear there is plenty of change afoot, matched by a healthy dose of skepticism and frustration.
1. “Given how much we spend and how much technology we apply, I was struck by how much manual processing is going on. On the issue of measurement burden, that is an area for significant improvement. I wince when I see how much physician time is devoted to data entry. I think we can all agree that makes no sense in 2017 and we can do better.”
-- Lewis Sandy, M.D., UnitedHealth’s executive vice president for clinical advancement
2. “One of the reasons it takes so long for a drug to get to market, or any finding to lead to a change in clinical care is because of this lengthy cycle we go through of hording our data and hiding our algorithms in order to publish a paper so we can be first and get tenure and promotion. The patients deserve better than that. If we can address the attribution and contribution problem, you can be first just by posting it on GitHub or the web.”
-- Melissa Haendel, Ph.D., an associate professor in the Department of Medical Informatics and Clinical Epidemiology at Oregon Health & Science University, and one of the leaders of the new National Center for Data to Health (CD2H)
3. “The idea that machine learning is about to be launched in our healthcare system is tremendously exciting. It could really turn the system on its head. Ever since healthcare was something humans did, the patient has had to hold up his hand and the system would respond. The idea here is that if you have rich enough data you can instead predict who may need help and do outreach and move care upstream. That is a goal for healthcare in general, whether it is dealing with cancer or a person heading toward self-harm. I am excited and thrilled to see how clinicians will use it.”
-- Don Mordecai, M.D., Kaiser Permanente National Leader for Mental Health and Wellness
4. “For my doctor to use my data with me on an individual level advances the quality of care in and of itself, but when you can aggregate data within an institutions and across institutions, there become increasing opportunities to conduct comparative effectiveness research and outcomes research.”
-- Claire Snyder, M.H.S., Ph.D., a professor at the Johns Hopkins University School of Medicine and Bloomberg School of Public Health and co-author of a “Users’ Guide for Integrating Patient-Reported Outcomes in Electronic Health Records: Design and Implementation Considerations”
5. “Every American needs to have the totality of the medical information available to every physician and hospital at every point of contact. It can be done. It's called ATMs. But it won't get done. Why is that? Because the people who manufacture and sell the electronic health records are not going to open up what's called APIs, the application processing software that's necessary for third-party developers to come in, because they know it will break the stranglehold they have on those who have purchased the systems already.”
-- Robert Pearl, M.D., former CEO of the nation's largest medical group, The Permanente Medical Group
6. “We spend more time shoveling coal than steering the ship. We want to shift our energy to looking at the data and navigating where we are going.”
-- Robert Kagarise, director of population health informatics and IT for the Delaware Valley Accountable Care Organization
7. “You need big data to drive you to the right place. Once you know who is at risk, that is where little data comes in. You need the boots on the ground. Large data sets are good, but it comes down to messaging the provider or patient. Then you can use care management to drive provider behavior.”
-- Terri Steinberg, M.D., chief health information officer and vice president of population health informatics, Christiana Care Health in Delaware
8. “At Mount Sinai, we are a big academic medical center, but like most of America, we have an Epic system that is not necessarily easy to get data out of en masse. If you need data out of Epic, you take a ticket and get in line.”
-- Mike Berger, vice president of population health informatics and data science at Mount Sinai Health System
9. “Three numbers tell the story on healthcare systems’ efforts on social determinants of health: 80, 72 and 40. Eighty percent of the people we surveyed said, yes, social needs are a core part of our mission. Seventy-two percent said they don’t have sustainable funding to do it. That is in many ways a heartbreaking mismatch. They are saying ‘we know this should be part of our mission, but we really don’t know how we can pay for it.’ Forty percent felt they were doing something in this regard, but had no way of measuring whether it was working or not.”
-- Josh Lee, principal in Deloitte’s Healthcare Provider Strategy Practice
10. “This is the largest government study ever on its own people. When the government does science on its own people, participant welfare and trust are essential and we may not get second chances.”
-- Nancy Kass, Sc.D., a professor of bioethics and public health at the Johns Hopkins Bloomberg School of Public Health in Baltimore. She was talking about the Precision Medicine Initiative, now called the All of Us Research Program. Kass chairs the institutional review board (IRB) for the project, which aims to create a million-person cohort.
11. “We [Open Notes] are facing pushback to the cultural change we represent. Doctors aren’t used to sharing notes with other people. We think this should be the standard of care. Clinicians will be saved and helped by their patients. They need to get together in a transparent interchange of information.”
-- Tom Delbanco, M.D., professor of general medicine and primary care at Harvard Medical School
12. “You could have some systems with a robust payload of data in their CCD [continuity of care document], and you have others that have really nothing at all. That was a real shock for me. It was my assumption that Meaningful Use was going to help us solve this problem. That is why you are starting to see the rise of FHIR now because it is a vendor-driven initiative, whereas CCDs were the government pushing it down.”
-- Bill Gillis, CIO of the Beth Israel Deaconess Care Organization (BIDCO) in Boston
13. “We have a wonderful hospital across the street, but this is not a healthy community. In the future, a proportion of every hospital’s revenue — and one day it could be a very significant portion — will be held accountable for what is happening in this community, and that will turn things on their head.”
-- Jonathan Weiner, DrPH, director of the Johns Hopkins University Center for Population Health Information Technology in Baltimore
