David Blumenthal, MD, MPP, has spent the past decade working from a top-down perspective to fix health care, formerly serving as the national coordinator for health information technology under President Obama and then the chief health information and innovation officer at Partners Health System in Boston.
Now, as president and CEO of the Commonwealth Fund, a non-profit and non-partisan foundation aimed at funding the research necessary to improving health care, Dr. Blumenthal suggests the final solution for health care reform requires us to put the patient in the center of it all.
Empowering patients is a long-standing goal, but now that information is available digitally there is an “opportunity to positively disrupt the health care system,” he asserted.
Information, analytics, and trusted data stewards are the basic requirements of the disruption.
While clinical data from EHRs are “a vibrant new resource,” Dr. Blumenthal noted, financial data, scientific information from medical literature, self-monitoring data, quality data, and more combine to “potentially empower people.” All are variable in nature and change over time but cover virtually every dimension.
Once you have data specific to people, it has to be interpreted, gleaned, organized, and stewarded, Dr. Blumenthal said, and must include references to the existing stock of information. Self-monitoring data continue to amass but “it boggles my mind to figure out how to take patient reports and integrate them with my reports, but we’re definitely on the way.”
Analytics is now at a level and perspective unseen, he noted, but to support “normal people,” it has to be available on mobile devices. Analytics has been seriously neglected up until now, mostly because it’s not where the money is, Dr. Blumenthal continued. Those with three or more chronic conditions are the most important people to empower because they spend 400% more than the average person on health care every year.
Unlike data and analytics, the notion of trusted data stewards is new. They are required, however, to ensure that there is no backdoor allowing for information access by North Korea or organized crime, for example, let alone for the sale of data to other parties for their own private gain.
The question is how to create the trust that will enable and encourage different players to form partnerships. Such concerns are a new element in this environment, but figuring how to create this trust is an inevitable requirement, said Dr. Blumenthal.
We trust the mail system because it is a crime to tamper with US mail, he remarked. While that isn’t enough to establish a trust framework, “we need to give important thought to what is required to create a system of data stewards,” Dr. Blumenthal said, which could be like developing a Siri or Amazon Echo for health.
One of the biggest obstacles is the team-player aspect of health information exchange, at odds with decades of market competition. “We wouldn’t expect Walmart and Amazon to exchange data. It’s not a natural act. It might even raise antitrust concerns. But we expect providers, insurers, vendors, etc., to do so and at their own cost,” he commented.
Technical solutions are nowhere near efficient to address the political, cultural, and other aspects in play. As Blumenthal noted, providers can’t compete for decades and not have issues around collaboration.
There is potential for federally funded research to drive this effort forward, which could be necessary since private work is not at the scale needed, he said. The National Institutes of Health has a legitimate role in supporting collaboration.
Held on Nov. 2 in Boston, the Digital Healthcare Innovation Summit, chaired by Robert Mittendorff, MD, MBA of Norwest Venture Partners, and Bill Geary of Flare Capital, brought together leading innovators, investors, and industry executives to share their valuable insights on the future of healthcare.