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The Healthcare Data Conundrum

This week I attended a briefing by one of the senior executives of a private health fund. A fascinating and insightful talk about the changes within the industry and his view of the future of healthcare in Australia, so here are a few things he said that caught my attention.

If you have read my blog before you would know that I’m a firm believer in ‘Data’ being the source of the answers we need to keep our healthcare system going and progressing! He said a few discouraging things about the current situation with regards to data…

  • 30% of claims from institutions are made by paper! Astonishing as according to Wikipedia, (here), in.. “1979: Michael Aldrich demonstrates the first online shopping system”, wow begs the question doesn’t it! It just seems to me in a world where individuals can use facilities like PayPal to set up a personal e-commerce, it would be pervasive in any industry. (For fun there is some suggestion that students in 1971/2 at MIT and Stanford used Arpanet, the precursor of the internet, to arrange the sale of marijuana. I’m sure it was for medicinal use!)
  • “We barely know who the patient is and what was done to them, from the data we are given from some organisations!”. Which led me to believe that even if ICD-10 is being used, it is not being effective in providing adequate depth of data to aid research, etc.

Then there were the statements that I liked very much ….

  • “Giving doctors comparative data is very influential in changing outcomes!” So why wouldn’t someone who has a vocation to help people not want to do the best they can? While talking about impacting people’s behaviour he mentioned the Coles/Medibank deal where people get extra benefits for purchasing fruit and vegetables!
  • “Understanding waste and variation is key!”, an example he gave was that knee Arthroscopy was used 10x more often in Toorak compared to Dandenong in Victoria! I’m sure there is a medical reason rather than their capability to pay!

And there was a great analogy he used when describing the treatment of chronic diseases in a hospital. “It’s like having a single factory floor that is producing both Lego blocks and Saturn 5 rockets!” and while talking about analogous things, he also spoke about countries where they are using virtual training systems to ensure proficiency before practice! Eg: Anaesthetists who have to perform 500 virtual casts before they are let into the OR.

Finally I left a bit frustrated as there is a general recognition of what good that could come from applying modern techniques to datasets. Unfortunately it does not seem like the government is committed, the private health insurance industry has too many restrictions placed on it and the individual institutions don’t seem to be in a position to provide this. Perhaps it is time for a people’s revolution, where we all demand our health data to be available on-line, a crowdsourcing or crowd-demanding sort of approach! What do you think?

Aside

Analyst firm IDC and EMC have released “The Privacy Index”, (here), which surveys our willingness to trade privacy for certain ‘benefits’. They measured a range of indexes shown in the picture above, but what is interesting to me is the … Continue reading

Healthcare in Australia and NZ only has ‘Small Data’ – Really?

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‘Big Data’ is not about BIG nor is it about DATA… but one thing I’m certain of is that these technologies and methodologies will accelerate discoveries, improve patient outcomes and dramatically reduce healthcare costs.  (The one problem is that IT vendors chose the wrong name!)

Before you stop reading, let me convince you of the merits and applicability to healthcare. Consider hip replacements, if a way was found to replace a hip so that it would never have to be redone, both patient outcome and cost would be dramatically improved. (Example from this blog post where the TED talk cites a group of doctors who collaborated, gathered data and found a pattern, which resulted in these outcomes.) Now if you could watch many hip replacements and follow the patients, given a large number of procedures, you would start to detect which ‘techniques’ resulted in the best outcome.  This is the idea of “big data”, to find these patterns automatically using computers and the available data.

What’s changed? Over the last decade technologies that can economically store and reason over disparate data types have been developed. (By different data types think about structured data, the data in a spreadsheet/database that were invented for computers, and natural data called un-structured, such as pictures, X-Rays and ECG waveforms which humans quickly make sense.) The power of these new technologies is that they bring all this information together and provide the analytic tools to find these patterns and correlations and/or create predictive models.

Sounds complicated but if there was a way to capture the data about procedures and the patient outcome overtime, ‘big data’ could find these patterns which result in the best overall outcome. Immediately the cry goes out that the healthcare professionals cannot spend time inputting more data! And they are absolutely right, these systems should aid and assist the practitioner, but let me suggest that a great deal of the data currently exists in the disparate computer systems, within monitors and the various imaging and measuring modalities, as well as on paper. While its up to the IT industry to provide the ways to extract all this information in a secure and controlled way, there are emerging technologies which will take this idea further.

One interesting and perhaps confrontational technology is video analysis. Today video analysis is used to detect ‘suspicious’ behaviour in public places, (Boston example here), helps major stores detect potential shoppers needing assistance and improve workplace practices to reduce accidents. So it is conceivable that a video of a surgical procedure could be analysed and compared with others, to provide input into the improvement cycle! Or similarly a radiologist with a tricky image could be presented with similar x-rays and the diagnoses he peers made.

In summary ‘Big Data’ is about using available data to improve processes, understand trends, find correlations and develop predictive models, while you don’t need huge amounts of data, you do need the vision to make it happen! While Australia and New Zealand lag behind in this area, I wonder if we can learn from what has been done in the rest of the world and leapfrog them?

 

EPIC comes to Australia, an indication of a new era or Déjà vu?

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Royal Children’s Hospital in Melbourne announced their decision to implement Epic a couple of weeks ago, and congratulations to all involved. Now there are end-to-end EMR systems here already, but Epic took the USA market by storm a few years ago, and I believe became a catalyst in changing the offerings in this space.

(Be warned bragging ahead.) EMC in the USA has been very successful in helping Epic’s customers, providing infrastructure and ‘allied’ applications, such as extracting data from and retiring legacy systems and providing solutions for the residual ‘paper’ workflows. I am told that somewhere in the vicinity of 70% of the major Epic installs are run on EMC infrastructure. (End of bragging-sorry).

So to find out what to expect I contacted my colleagues, and as I learnt more I had to keep pinching myself, as I felt like I’d been here before. Then it dawned on me I had!  Except the application wasn’t EMR, it was ERP; and the vendor wasn’t EPIC it was SAP! (Enterprise Resource Planning was the move from siloed applications in the enterprise into an integrated end-to-end system, and SAP became the catalyst and leading vendor in this space.)

I was on a team implementing SAP for an IT service provider organisation, at the time I managed the delivery of services and was this line of business lead on the project. Although this was many years ago I distinctly remember the fist team meeting with the implementation consultants, (a major consultancy). The team lead opened with, “The best thing about SAP is it is an integrated end-to-end system, and you will learn that the worst thing is that it is an integrated end-to-end system!”, and he was right. Huge rewards but a long journey to get there!

Having the technology bent that I have, I got involved in the infrastructure selection. Various vendors pitched their products to us and provided the appropriate configurations and pricing. (As you would imagine, our goal was to transform the way we did business and we were squarely focused on how the organisation, processes, workflows, skills, etc. were going to change and how to effect this change, so the hardware decision was fairly close to the bottom of the priority list. But it is necessary and on the critical path of the project.

Then one of the vendors message to us was along the lines of , “Select us, because we will be transparent, you won’t think about the infrastructure again!” They got the deal, and it worked. They had a depth of expertise, an architecture and design that just delivered the right stuff out of the box, saving us time on the start-up of the project, and just seemed to solve all the issues we had. For example we kept needed new environments for testing or users to get training etc. The SAP experts give us a few days, and the infrastructure guys said, we’ll have that for you in an hour, is that fast enough!!

The ironic and perhaps funny part of my feelings of Déjà vu, are the many parallels between SAP and EPIC.

–          It seems like the vendor decides who their customers are going to be.

–          The organisation must adopt the systems ‘best practices’.

–          The approach ‘divides’ the market into believers and non-believers.

On this last point while in Melbourne when rumors started about this decision a CIO of a similar size healthcare provider was questioning the decision and wondering how the business case stood up, which is the exact same conversation that was had a thousand times about SAP!

In the end if a new product or approach creates innovation that brings benefits that lead to better patient outcomes, it has to be goodness!

 

Change Focus from Cost to Value via Patient Outcomes!

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I’m a TED fan, if you are not aware of TED.com you need to be! To whet your appetite invest under 13 minutes to watch this lecture, here.  Stefan Larsson, (not to be confused with Stieg although, some parallels may exist with the Millennium Series!), describes the reasoning behind the ICHOM initiative, (ichom.org), who according to it’s site:
“The International Consortium for Health Outcomes Measurement (ICHOM) is a non-profit organization founded by three esteemed institutions with the purpose to transform health care systems worldwide by measuring and reporting patient outcomes in a standardized way.”

Here is the simple concept:
slarssen_value

The problem is that we have been measuring the cost and using that as the metric how do you gain a measurement of the ‘outcomes’? That is the role of ICHOM, to measure the outcomes and create the benchmarks as well as find best practices. (If you didn’t watch the lecture he gives examples in hip replacement and prostate surgery.)

The key message is that wherever there has been a focus on improving patient outcomes the costs have dramatically dropped, not too much of a surprise there! I’m guessing that your immediate reaction is, ‘That is all good but who is going to do all this data collection work?’ Interesting is their answer is to use the data that should already exist in patient records as well as involve the patient themselves, reuse and distribution of workloads.

I only have one question, if we have been benchmarking in enterprises for decades, how come this is a new concept in healthcare?  There are numerous benchmarking organisations in various sectors who study a multitude of issues and collect data and publish the benchmarks for these aspect.

I think the answer is simple, in healthcare it’s not that easy!  In commercial organisations there are a relatively small set of quantitative ‘variables’, and in the most they revolve around PROFIT! This may include derivative measurements of cost/efficiency/productivity. However in healthcare the inputs are both numerous and not always quantitative, but today that is no longer a barrier.

Love it or hate it, the ‘Big Data’ revolution taking place has produced technologies and methodologies to compute with ‘subjective’ data! Now measuring patient outcomes and the factors that affect it can be mechanised and thus reasoned over to improve the ‘value’ within our healthcare system.

Now while Australia is participating in ICHOM’s work and I wonder how much impact their results will have on our system as a whole?

Can Technology Transform Healthcare?

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How many times in your life do you have an opportunity to make a real difference? I think I have one of those!  EMC has asked me to look at how we can help transform healthcare with the technologies we create and way our customers innovate with them.

Why do I think it’s such a massive opportunity? Because all the elements are there, an urgent requirement, existing proven solutions and a direction that is compelling.

The Urgent Need
There are many forces driving a structural change, from individual’s demands, to the availability of skills, etc. But let me just paint the dire financial picture. Over the last decade in Australia, the growth in healthcare spending has been about double GDP growth.  If GDP is an indication of the tax base, then more and more of government spending is required for healthcare. Now add in the fact that the majority of health costs occur in the latter stages of life, these costs are going to grow faster in the future as the baby-boomers push the population age up! There is a problem today and the diagnosis is bad, this is an unsustainable situation, something has to change!

Existing proven Solutions
I believe that the answer is in transforming the system using technology, (no surprise to anyone who reads my blog.) Let me outline what I see as the major trends and how technology is vital to these:

–          From Hospital to Home.
My father was a radiologist and he used to say ‘Don’t go to hospital –more people die there than anywhere else!’ Although if you study the statistics, hospitals are becoming more dangerous places as more people contact new diseases and complications due to their stays. The point I want to make is that this method of care is like a mainframe, a time shared resource that you have to go to, but is this the optimal model? In computing terms we are moving to the second generation after this model due to better utilisation, more efficient and lower costs of computing. Surely healthcare infrastructure must transform away from this mainframe model as well?

–          From Consultation for Collaboration
When I grew up we had a family doctor, and he was almost part of the family. He knew my grandfather, (also a doctor), and knew me from the moment I was born until I left the country, I don’t think I saw another doctor! He knew everything about me, not just my medical history, but my lifestyle – (rugby injuries), my neighbourhood, (lived a couple of blocks away). Today, especially as you age, the number of clinicians a person consults with is growing, while there is little to no collaboration between these specialists.

More fascinating, (as I grew up in a radiological darkroom), is that although all x-rays are taken digitally, the patient invariably walks out with a film in their hand! Surely healthcare information must be accessible, shareable, and persistent?

The Future of Healthcare or “From Prognosis to Prevention”

Today healthcare diagnoses and treats, tomorrow we will analyse and avoid! The most promising outcome of technological advancement, as well as the most fascinating, is to truly understand how our bodies truly function and from this knowledge be able to avoid getting sick and to keep us strong all through our lifetime.  I was confused, I thought the practice of medicine was a science, however today for the most part it’s an art. But as we gain an understanding from a genetic and molecular level how the body works, the practice becomes a science, a science of ‘wellness’!

The only issue with this is the magnitude of the data we are dealing with, we are simply drowning in data. The massive amount of research data that is published on a daily basis is way beyond the practitioners capability to ingest and so diagnoses are made that are not based on full knowledge. For the individual, we are creating ever increasing amounts of data from wearable technologies to the tsunami of sensor data. Surely gaining meaningful use from all this data is the key to transforming the quality of the healthcare system?

I invite you to join me on this journey, to share your thoughts and let’s make a difference together!

EMC Strategy Update 2014 – Gateway to the Future.

ViPR signals the future of computing and now I understand this!

First a confession, sometimes it takes me a while to fully understand the impact of some technologies. I remember seeing the first iPod adverts and pondering why anyone would want to carry a hard disk drive around in their pocket!  Likewise when I first encountered ViPR, I thought neat way to manage storage… but it’s not going to change the world?  Like the iPod I have come to understand that this is industry changing. Big statement let me explain.

ViPR has two major components, a controller and data services.  The controller has had a lot of focus, as it was the most built out at release time. Fundamentally it provides virtualised storage and automated management across your whole environment. This gives you visibility into all your storage and a consistent way to manage it; resulting in lower costs and higher reliability. If you were sceptical you would say this is just the next generation of storage virtualisation, and it would be hard to argue that.

Now before highlighting the revolutionary power of the ViPR data services let’s make sure we are on the same page, with respect to the shift in IT technology that is currently underway. Analyst group IDC puts it succinctly as the movement from the 2nd platform to the 3rd platform. (Depicted below)

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This is the movement to an infrastructure that is capable of servicing billions of users, with millions of apps, (driven by social, mobile and big data computing), will look very different to current infrastructures. Enter the Software Defined Datacentre, where we use software to manage and control these elements, (ViPR controller). More importantly, to gain the scale and elasticity required a new hardware construct is required!

One example is illustrated by EMC’s acquisition of ScaleIO.  ScaleIO presents a virtual storage array, that is built from the storage in the servers that participate. Surely this competes directly with EMC’s core storage business today? Yes maybe, but if I need 1000 engines driving a massively parallel workload, I can’t achieve that simply with the hardware resilient architecture of ‘traditional’ storage arrays. While scale out architectures like Isilon scale to the hundreds of nodes, ScaleIO grows to thousands to support the 3rd Platform requirements.

So re-think ViPR in this context, today I am firmly in the 2nd Platform and I implement ViPR to gain control, lower cost and improve availability. Then I get a request to support a 3rd Platform application, let’s say Hadoop. Do I rush out and purchase dozens of servers or how do I plug in the HDFS Data Service into ViPR and support them immediately out of my existing hardware infrastructure?

Here was my ah-ha moment… as I grow my 3rd platform services, I deliver these as data services against existing hardware today and move into specialised or commoditised hardware infrastructures, depending on other factors, but without disruption! Now ViPR becomes a mechanism for me to co-exist in these worlds and move between them as need be. (After all there is still a lot of mainframes/1st Platforms in use today!).

So if I’m right what would you expect to see from EMC? Expect more ‘Data Services’ which will look like virtual versions of the current ‘hardware’ products that exist today!