A CMIO's Perspective on Health 2.0

As we go about our daily work performing the vital daily tasks that keep our patients healthy, providers functional and our organizations financially afloat, it is often difficult to peek beyond the daily grind.  Unfortunately, if we do this without keeping eye on the future strategies or our organizations, we will ultimately fail them.  We must not be so busy looking at our feet that we don't look at the horizon to guide our long-term path.  It is critical for us to reach outside our walls and see what others are doing and what others view as the future of healthcare and IT within healthcare.  I was able to get such a glimpse over the horizon at Health 2.0 in Santa Clara, California. 

Joe Flower noted in the opening session that most people have difficulty thinking about and envisioning the future any differently than the present.  Reinforcing this thought, the reality is that fee for service continues to dominate the payment landscape.  There are simply too many powerful forces anchoring us in the status quo.  As a result, while we have made significant progress creating an infrastructure, the expected magic of improved quality, efficiency and the quadruple aim have remained tantalizingly beyond our fingertips.  However, the macroeconomic equation simply won't allow this to continue.  Market efficiencies are waiting in the wings to change this equation.  We must do something to change our direction and, as the saying goes, if you don't disrupt the future, the future will disrupt you. Health 2.0 was all about this disruption.

If widespread EHR implementation has laid the foundation of our health information superhighway, SMART on FHIR will provide standardized on and off ramps.  If developers wanted to plug into an enterprise system had to previously rely on a hodgepodge of non-standardized APIs and interfaces.  Now, there are standardized end points that will allow innovators to direct their efforts and creativity on content, not connections. 

No longer will the enterprise vendors have a near monopoly on innovative ways to use and present health data.  These standard APIs are waiting to be used. Just as towns and commerce sprouts up at our highway ramps, we anticipate plug and play apps will sprout up in our health IT ecosystem.  As a result, the creativity of developers will make a currently difficult landscape easier for both providers and patients. 

Data will be at the center of knowledge discovery and decision support.  We previously have had to rely on traditional medical studies with knowledge discovery cycles taking years.  Even when the process yielded valid insights, it was often difficult to validate these external insights to one's own organization.  New data infrastructures will speed this process and allow organizations to use their own data to discover associations and knowledge precisely focused on their particular patient population and workflows. We will essentially be able to industrialize complex, precise knowledge discovery.

Many of the insights borne out of traditional medical studies had to be distilled into simple formulas and abstractions that our puny human brains could consume.  Additionally, operationalizing these insights relied on rule based logic limited by the labor it took for experts to imprint their expert logic into these rules.  As a result, the vast majority of "decision support" content has become noise, lacking precision and reinforcing the notion that our electronic systems are ineffective behemoths unable to nimbly navigate the subtleties and nuances of real health care.  We have been carpet bombing our providers with immense collateral damage.

Big data and its trendier cousin, artificial intelligence, hold the promise to solve this vexing problem.  We will no longer have to distill clinical calculators and alerts to a few handful of data points.  We will be able to use data sets orders of magnitude larger than such rudimentary concepts as drug-drug interactions, MEWS and Sepsis Scores.  Instead of carpet bombing, we will direct precise "smart bomb" decision support to our providers and patients.

Hal Wolf, HIMSS' new CEO emphasized how we need to break outside the walls of the walls of traditional encounter based care.  All this new technology will facilitate the focus of the patient at the center of care delivery.  The concepts of ambulatory, inpatient, home care and skilled nursing will meld into a fuzzy continuum.  Patients who might have been admitted in years past could go home to be monitored at home using new connectivity solutions.  FHIR enabled apps will allow patients to be the vector for all their own data, regardless of how many locations they receive care.  Remote appliances will monitor patients' physical therapy and medication compliance, helping them stay compliant with their care plan.

What this means for providers and patients is that we are on the cusp of what I think will be a real change in how our medical system works.   The pieces are in place.  The question is who will be the first movers and be the most effective in using the new technology?

I remember firing up AOL on my pre-Windows PC's GeoWorks GUI in the 90's.  It felt like the beginning of something different and special,  but I couldn't quite envision that, 20 years later, I would be assembling an essay on a plane from notes I took on a tablet and a pictures I took with a phone at a technology conference that all synced to a "cloud" that my PC accessed via the wifi on the plane.  I have that same sort of feeling now about medicine.  I don't think anyone truly knows how all the pieces will fit together, but medicine will be very different in the future decade and there is no doubt in my mind that information and data will be at the center of the changes.

About the Contributor

Dr. John Lee is the Chief Medical Information Officer at Edward Hospital and Health Services in Naperville, IL and serves as Chair of the HIMSS Physician Committee Chair for FY18.