Well, frankly everything. Healthcare is ripe for unprecedented levels of disruption. Costs are out of control and frankly obscured from the patient even with advances in new technologies costs continue to escalate. Meanwhile the gap between doctor and patient continues to widen as patients seek alternate means to understand and manage their healthcare to where to have their care administered. At the same time, an explosion of data from genomic information to sensor based heath and wellness should allow for a transition from population style medicine to individualized care but changes are slow to take place. Why? In part, because of regulation, embedded process, incentives that don’t align with holistic patient care, cultural barriers, etc.
Recently I was asked to speak at the HIMSS Physicians IT Symposium. I enjoy meeting with CMIO’s who are interested in understanding this shift and how to implement change within their practice, hospital, health systems etc.. There is a confusing array of healthcare IT reform initiatives underway including Meaningful Use, Accountable Care, ICD-10, etc. Several of the discussions focused on the development and challenges associated with digitizing medical records and developing an EMR platform. Clem McDonald who is arguable the grandfather of the modern day EMR discussed the trials and tribulations he went through as he and his team tried to create increasing levels of digitization in a very analog world. At one point he showed a somewhat wacky font his team developed to try and replicate a physician’s script.
Eric Toppol in his book the “Creative Destruction of Medicine” argues that there will be several transformative forces that will shape medicine in the coming years including the digitization of the patient. I think this will issue in a profound shift in how care is delivered including a greater push to early diagnosis and preventative care. It was startling for me to see the number of unneeded procedures, infections that were brought about inside the hospital setting and incurred costs. Anything that can be done to prevent this has to be beneficial. We will see more individuals analyzing not only their activity to understand its affect on health and wellness but also their genetic makeup to understand predisposition to various conditions. This could usher in a wave of preventative care
I believe one of the most transformative forces will be the healthcare consumer especially the next generation of consumer. Patient communities, mobile apps, crowdsourcing and gamification are slowly working their way into healthcare. One of the most profound and possibly disruptive is Patient Communities. The incentive system for physicians is based on numbers not holistic care, so patients have been finding an outlet within these social networks that are geared around health and wellness. When it comes to life changing chronic conditions, patients are increasingly going online for the empathy and support that might be lacking in a clinical environment. In these communities, they are finding people who are going through similar experiences. Value is being delivered in the form of caring and understanding, which leads to greater levels of trust. Greater levels of trust leads to more transparency and sharing of information. Greater sharing leads to better targeting and tighter ties between members with commonality i.e. more data. These communities have matured from sites of caring and empathy to stores of incredibly valuable information for multiple stakeholders in the healthcare community. Cure Together, Organized Wisdom, and “Patients Like Me” are all taking this model and putting their own unique differentiation onto it. Patients Like Me initially focused on ALS but have branched out to other life changing conditions – MS, Cancer, Transplant Patients, etc. I was showing Physicians in our MMM program (Master’s in Medical Management) a patient’s profile in ALS. The patient was charting the effect of Baclofen, a drug used to treat spastic movement disorders. The amount of data disclosed and open is frankly shocking. This patient is tracking a variety of factors including exercise, diet, sleep, and other metrics to help monitor and assess their condition.
With all of the different permeations and variability between patients, this becomes a matching exercise and the more information the greater value patients receive from these communities. Imagine a match.com for patient compatibility. You can contrast this with Electronic Medical Records (EMR), which are being mandated by Meaningful Use legislation. The difficulty is transferring records from paper to digital format, getting them up to date and ensuring data integrity. Generally this information is spread over multiple sites and is incomplete. Physician’s only have what the patient is willing to share or has the wherewithal to share with them. Oftentimes, a patient will not disclose critical pieces of information. In part, since a visit to a clinic can be intimidating and when diagnosed with a chronic condition well that information sometimes takes a backseat to struggling to cope with the news. In contrast, the social sharing of information is vibrant, rich and dynamic which could assist the physician in treatment. I think this partnership between patient, physician and community has a lot of potential to solving the EMR data input dilemma. This represents a huge cultural shift and also a leap of faith in that the value to the patient and society will surmount any of the possible legalities and privacy concerns. Other industries have already started innovating along this path. Healthcare should look to them for an understanding of how they can do the same…