Tag Archives: Healthcare

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?

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Data Can Relieve the Healthcare Budget Pressure

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Interesting week in the healthcare space in Australia with the federal budget and then the Royal review’s recommendations for the PCEHR made public. We certainly live in interesting times!

I believe there is an incredible opportunity for us all, as they say in the classics ‘necessity is the mother of invention’. It seems the perfect storm is brewing; aging population, rise of chronic disease, rising costs and budget pressure. The question is how do we set a course through this storm, to ensure the destination is much better than where we have come from? (Poetic even if I say so!)

A couple of words caught my eye in the PCEHR review, ‘meaningful use’. The concept is to achieve a state where the health records are used to improve the health of the community, drive diagnosis accuracy up as well as improving the research and development of new drugs and more effective treatments. This is all about the data! Getting it to a point of completeness and accuracy so it can be used meaningfully!

This may sound familiar as its part of Obama’s plan to change healthcare in the USA. To achieve ‘meaningful use’ and they have defined a 7 stage process to guide their industry along. Similar to the Royal review’s recommendations, Obama has put in place a series of investments as well as ‘consequences’ for not achieving these milestones. When you consider the ‘private’ or corporatized nature of the USA healthcare system, you would assume that it is against their business model to help their ‘customers’ go next-door. So surely there are less vested interests here inhibiting us from creating a national health record system?

Perhaps the idea has not been fully ‘sold’ to the public and the implementation not optimal. Speak to any GP and they will bemoan the integration and the additional workload… which the review recommendations address. So once these issues are sorted out, we begin down a path where the accumulation of data drives every facet of the industry forward and towards a better, faster and cheaper healthcare system!

Marc Andreessen founder of Netscape, a web browser that competed with Microsoft in the early days of the internet is attributed to saying that “Software is eating the world.” He was referring to the dramatic shifts that happened to the music and video industries as they became digital. I think he was wrong, ‘Data is eating the world.’ It’s the use of data to understand that can transform everything we do! The trick here is to not look at digitisation as just a substitute for the old, but as a new way to do things. (For example a CD was more convenient, however on-line music has changed the industry.)

In healthcare there has been a lot of ‘substitution’ but not a great deal of leveraging the potential of eHealth. For example having an electronic patient record is more convenient, however being able to aggregate a large number of histories and understand how treatments are affected by lifestyles which affect long-term health outcomes, has the potential to produce new protocols which deliver better outcomes which will lower costs.

Thinking about the ‘use’ of data once its digital, will lead us to a situation where we are thinking beyond the horseless carriage and to driving efficiency, lowering costs and opening up new ways to revolutionise the way people are kept well.

How IT Buzzwords Impact Healthcare

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Picture from: http://www.healthcarereformmagazine.com/issue-16/feature-issue-16/healthcare-cheaper-better-faster/

Every industry loves their buzz words, and IT does more than most. Today you can’t talk about technology without one of the big four, (Social, Mobile, Big Data or Cloud), being dropped into the conversation. The question is, what has this to do with Healthcare? Well let me discuss this in the next few blog posts, but first context is required.

According to many commentators, such as analyst firm IDC, IT is entering its third epoch. Starting with the birth of IT in the form of the original mainframes, through the current ‘pc’ dominated client server and into the emerging 3rd Platform, typified by the ‘web-scale’ organisations. What I find interesting is that I can see the parallels with healthcare, let me explain.

The first platform was a time shared infrastructure which you would go with a particular job and walk away with a certain outcome. Sound like a hospital?  The issue with this model is that a massive infrastructure investment is required, and it makes use of very high levels of expertise, to use it effectively. That is why today, while there are still many mainframes in use, the ‘jobs’ they tackle are very specific to what it was designed for and where it is the most efficient way to achieve that outcome.

Today, however most computing is performed on the second platform – client server – enabled by the birth of PC’s and networks. This new model enabled new capabilities, such as interactivity, specialisation and a lower cost of production. The ‘work’ was split into different layers and specialist organisations created software solutions which automated processes.  (Think a PACS, RIS, EMR.) This structure is mostly a hub-and-spoke, with specialists performing their specific task and then passing on to the next layer. I would argue much like the delivery of healthcare outside of the hospital today, where a GP refers to a specialist that refers to an ‘ology’ that reports back to the specialist that diagnoses/treats and then reports back to the GP – each performing a task and passing off to the next entity. Now this model is effective at automating a processes but does it inherently improve that process or add to the quality of what is being done?

In my previous blog post I spoke about Big Data and some of what is enabling this… “What’s changed? Over the last decade technologies that can economically store and reason over disparate data types have been developed… (carry on reading here).”  This leads us to the 3rd Platform, if you like consider how the ‘web scale’ organisations do what they do! Such as Amazon predicting books you would like to read, Google giving you the latest information and Facebook changing social connectivity.

What does this mean to healthcare?  You are familiar with the past, computers have helped add up numbers and do accounting, (mainframe), they have automated processes like patient record keeping and image management, (client-server), now technology is help us to predict, understand and tap into the collective. In doing this we get assistance in diagnosis, discovering new protocols and drugs, and predicting likely outcomes. The advantages to healthcare of better planning, decision support and accelerated innovation are dramatic. In essence this is the platform enable healthcare to move into ‘Personalised Wellness’ or ‘Patient Centric Healthcare’. Consider the 3rd Platform as now helping improve thinking, the human process!

Three ‘platforms’ for technology and three ‘platforms’ for healthcare delivery. The IT industry delivers better, faster and cheaper, our challenge now is to use these technologies effectively to deliver better, faster and cheaper healthcare!

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?

 

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:
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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!