Live from HIMSS16: IBM's Judy Murphy on the Changing Healthcare World

At the HIMSS16 conference in Las Vegas, Judy Murphy, R.N., spoke to Healthcare Informatics about the changing healthcare paradigm and what's necessary to move forward successfully in this new world. 

In October 2014, Judy Murphy became chief nursing officer and director, Global Business Services, at IBM Healthcare (the company’s Health Care Global Business Services is based in Washington, D.C., where Murphy is based). Prior to that, she had been chief nursing officer and director of the Office of Clinical Quality and Safety in the Office of the National Coordinator for Health IT (ONC), from June through October 2014; while from December 2011 through June 2014, she had been deputy national coordinator for programs and policy, at ONC. Below are excerpts of the interview with Murphy and HCI Managing Editor Rajiv Leventhal. 

The most interesting thing to me is population health [movement]. What we thought was the golden egg, EHRs [electronic health records], isn't quite what we thought. EHRs are helping us with the current way we provide care, but they are not helping us think about how we can do things better and differently. So I get excited about the idea of getting outside the acute care facilities, really starting to think about the continuum of care, and about managing healthcare throughout, whether you are the healthy or the chronic disease management person. The second part of that is that we are finally starting to say, if we will do population health management, the tool to get it done is patient engagement. Patients will be full partners in their care. We know that success is about how patients can manage themselves, and we enable that.

I think about it a lot, as it's one of the reasons I came here. I have been there for 18 months, and when I first came here, it was less clear to me. I have done EHR implementations for a really long time. The first one was in 1995, and it was 15 hospitals and 120 clinics on Cerner, and then I started doing Epic, and I started  to think about this concept of, what else is there? This is our normal business. You start to think about simple things such as PACS systems, then telehealth, then mobile apps, and how that can change, be it for the provider or patient. My concept is about meaningful use and beyond, and I always said that at ONC.  I wanted to get outside of my personal reality, so I started to look at companies like IBM. Since I have been there, the biggest thing is this acquisition of data and companies that have data. You have 100 million patients with Explorys and 200 million patients with Truven. How can we use that to understand what's going on with disease processes, how can we use that to inform how we will work with our patients and understand the parts of disease process and the way we treat disease processes that we don't know? 

We have this phenomenon in a lot of diseases. We know what we know, from EHRs and structured data. If we want to take it to next level and pick up on things we are not seeing today, and really change the way we deliver care, we have to mine the unstructured  data as well. That's where Watson comes in with the natural language processing component. Maybe the best way to pick up a potential diabetic is some factor that we don't know yet. That's where a cognitive evaluation like Watson product will help us know new things—not just discover the things we currently have. It's about data. I have come to learn that Watson can make correlations that you and I don't know. It looks at a database and creates correlations that normally, which research, is hypothesis based. We test and test, but Watson can help surface things that we aren't thinking about. 

One of the important things is to pull clinical and financial data together. Not everyone has an EHR that is doing the financial part. It's about getting that data together and then uncovering the unstructured data. You have to be pulling that all together to understand your population and understand how you will best intervene with your population. A lot of people think that population health management is getting the data and running the reports. Reports don't change behavior, provider or patient. We are big on the patient-centered medical home; Paul Grundy, M.D., is the Godfather of that, and he is a peer of mine. We have to think about how to engage the patient and change the way we provide care. 

CIOs need to also be worried about this migration away from "I receive healthcare" versus "I am going to shop and buy healthcare." We are beginning to see consumer-like behaviors on the part of our patients. So we need to treat them as such, in a way to make them like it where we could make it easy for them. You merge this concept of "I am a consumer" and "I am getting engaged in my care," and that's the new patient. That can be difficult for CIOs oftentimes, since their customer has been clinical for a long time, and this new concept is about marketing—marketing leaders, clinical leaders and CIOs need to form a team. That might not be easy for everyone. 

The concept of interoperability has been tossed around for a long time. Even before I left ONC a year and a half ago, it was clear this was not just a standards-based problem. It wasn't that we didn't have the standards, but people haven't adopted the standards and haven't created the business case to spend money on doing interoperability. There were non-technical things that were going on. I think this announcement  is exciting because it's saying that we probably won't pass a law that will require people to use standard A. We will use the industry and the organizations that we are already working with to go to the next level for interoperability. 

I think it will stick, because of this joint accountability that is present. Vendors will call each other out. I am doing it, so you will have to do it. We signed up! We are also beginning to see the requirements being asked by the people buying their products. Secretary Burwell continues to say that [a large number] of payment that comes from the government for Medicare and Medicaid will be value-based by 2018, and you have to have interoperability for that. You can't manage a population across a disease entirely for value unless you talk to each other. I think the hook is that that is looming. 

A lot of people are talking about is mobile and the IoT [Internet of Things]. You have this idea that for $200 I can hook an iPhone up to an ultrasound for a pregnant woman and see it on my phone. This will change how we think about and manage our own health. It goes back to the idea that I will be more engaged as a patient with more data. I will be more empowered and be more of a partner in my care.