To what extent has data analytics begun to really help facilitate transformation in healthcare? The question is far from an abstract one, and elicited a wide range of opinions at a panel that took place Monday at the Marriott Wardman Park Hotel in Washington, D.C. as the first full day of the World Health Care Congress + Exhibition got underway.
A number of questions related to that fundamental one were addressed during a panel entitled “Technology’s Role in Health Care Transformation: Where Will Investments Result in Higher Quality and Greater Affordability?” which was moderated by Robert M. Wachter, M.D., professor and associate chair of the Department of Medicine at the University of California-San Francisco, and author of the new book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age. Joining Wachter on the panel were Victor Dzau, M.D., president of the Institute of Medicine of the National Academy of Sciences, and former president and CEO of the Duke University Health System; John Niederhuber, M.D., CEO of the Inovata Translational Medicine Institute and former director of the National Cancer Institute; and Bryce Williams, CEO and president of the Dallas-based HealthMine, a vendor firm that works with health plans to support plan member engagement in wellness and personal health management programs.
When Wachter asked Dzau what he thinks the term “big data” means, Dzau said, “I think when people say big data, they don’t know what they’re talking about. Because when you look at big data, it really has to do with the social systems, and everything else, around care; it’s about the totality of interaction. Right now,” Dzau said, “we’re really not dealing with big data, we’re dealing with information around the electronic health record. But we’re starting to deal with things like wearables, and eventually, we’ll be dealing with physiology and other elements, and then we’ll be dealing with big data. And I’m quite confident that technically, we’ll be able to deal with [managing data flowing into information systems from wearables and other sources from outside medical institutions], and that interoperability will be overcome.”
But, Dzau added, “The much bigger challenge is the sharing of information, the democratization of data, and the securing of data. We’re really at the beginning of this journey.”
Wachter referenced that Dzau’s recent tenure as CEO of the Duke University Health System, saying, “You were running the Duke Health System just eight months ago; and now projecting forward, let’s say you have all those patient monitors providing data, and all sorts of other feeds” coming into electronic health records (EHRs). “How does a person who is CEO of a health system, deal with that?
“First, you need a systematic collection of information; otherwise,” Dzau said, “you could be bomarded with data. So we have to proceed in a systematic way” with data, “and, we have to train our clinicians not only to be competent in using the EHR, but also to curate data, to participate in collecting information on trends that can help us, and to be able to use it.”
What role does the individual patient have in contributing to the process of data collection and outcomes? HealthMine’s Williams said that, “In terms of data around the consumer, HealthMine allows you to put data into the system, and last year, we had input 495 million pieces of data; and then what do you do with it? We work with health plans, employers, etc., and United Healthcare is our biggest customer, with about 1 million members in our program,” Williams noted. The key in everything related to patient engagement around data, Williams said, is that “You have to tie the data back into incentives for the patients and plan members. And it’s very hard to get patients/plan members engaged unless they can be part of that process.” He added that “We talked recently with executives at a health plan, who said, if we simply involve our plan members in the process” of receiving their own health data, “we get 38 percent member engagement; but we get 82 percent engagement if we tie their participation back to incentives.” At the same time, Williams also noted that the role of the physician is “paramount” in data-driven population health work.
What about the future of data, encompassing the leveraging of genomic data for patient care purposes, among other uses. “This is a year where everybody’s talking about big data, and now we’ve begun talking about precision medicine, with the announcement of a federal initiative in that,” Wachter noted. In that context, he asked, “Where are some of the opportunities and challenges?”
In response, Niederhuber said that, “Clearly, we know that a lot of health problems involve a genomic component. The healthcare system that we are so familiar with and that all of us were trained in, has really focused on the patient coming in who is sick, and all our efforts are directed at diagnosing what is wrong and then directing our therapeutic treatment of that patient, and then our management of that care takes place in a very episodic fashion. What we’re learning,” he said, “is that we need to understand as much as we can about that patient as early on in life as possible, so that we can understand the systems affected by genomic changes from early on.”
The burden on physicians
Meanwhile, Wachter noted the increasing sentiment among physicians in practice that they are becoming ever more burdened by demands for their involvement in data-driven initiatives, such as value-based purchasing, population health management, patient-centered home vehicles, and accountable care. How can some of the burden be lifted from doctors on a day-to-day basis?
“There’s got to be some interface that makes sense out of it,” Dzau opined. “I think the primary care physician should be a user” of data within the context of improving the physician’s practice, he said, “but should not have to be responsible for integrating that information.”
Related to that point, Williams also noted that a tremendous amount of customization of data processes will perforce have to take place at healthcare organizations nationwide. “We were at a Blue Cross plan two weeks ago in the middle of the country,” he noted, “and they told us they had their own protocols,” he said, referring to HealthMine’s capability to use the data on health plan members/patients that the company collects for healthcare organizations. “And they wanted to configure the data to their own treatment protocols and to a system that their doctors already log into from across their state. So we want to make this work for them, and because of the differences between all the providers, Blues plans, and other health insurers, we work with, we’re going to configure things in a way that works for them.”
How will specialist physicians fit into the emerging landscape around data use? Wachter, speaking to Niederhuber, said, “Your field of oncology may be the field where big data is the most advanced genomics is the most advanced, and it might be argued that we don’t need the doctor at a certain point, or we need the doctor even more. What are your thoughts?”
Niederhuber responded by saying that “I certainly see the doctor as part of a team, first of all. We have the experts in imaging, and the experts who can look not only at the tumor, but different spots in the tumor, the peripheral part of the tumor, the host parts of the tumor, etc.; science is advancing. But it will be a high-level team that helps make the important therapeutic decisions.” Increasingly,
