10 Genius Ideas to Improve Healthcare

Photo courtesy Anna Shaynurova
Photo courtesy Anna Shaynurova

10 Genius Ideas to Improve Healthcare from MIT Sloan’s Bioinnovations Conference

The MIT Sloan School of Management held its 11th annual Bioinnovations Conference at the Boston Marriott Cambridge Hotel on September 20th, featuring influential speakers from the healthcare, life sciences, research, and regulatory sectors. This year’s theme was “Value in Healthcare” and brought an impressive turnout of over 350 attendees.

“Our goal for the conference was to bring together industry leaders across business, science and medicine to discuss some of the most pressing issues in healthcare,” said conference organizer Anita Kalathil. “MIT and Sloan are passionate about how to improve healthcare, whether at the molecular or systems level, and we know that any solutions are going to have to be cross functional. Our goal was to make the MIT Sloan Bioinnovations conference the connecting point for these different groups.”

There were many great takeaways from this conference, but here are 10 of the most noteworthy:

1. Delivering true value in healthcare.

Neel Shah, founder and executive of Costs of Care, was the conference’s opening speaker. “There’s a misperception that considering cost is not aligned with patient interests,” he said. Cost consideration is becoming ever more important in healthcare, as policymakers demand greater accountability and patients demand greater transparency in pricing.

2. Refocusing the future of research & development.

Mark Fishman, President of Novartis Institutes of Biomedical Research, shared in his opening keynote that aging, cancer, brain disease and genetic therapies hold the greatest promise for future research. He also shared his unique approach for R&D, which is to focus less on cost-benefit and more on areas with the greatest patient needs and solid scientific knowledge.

3. Putting Big Data to good use.

There was a lively discussion during the Big Data, Policy, and Personalized Medicine panel, highlighting the need for better ways of collecting, analyzing and interpreting the huge amounts of data that are being generated from various sources, including medical records, diagnostics, genomics, and sensory data from patient devices. The panel members represented a number of impressive companies (TwoXAR, Privacy Analytics and Genospace) that are attempting to do just that.

4. Researching therapies (and prevention).

In his keynote address, Gary Kelloff, Special Advisor to the National Cancer Institute and the National Institute of Health, shared that the present approach in cancer research involves discovering and developing targeted therapies to biomarkers of cancer. While acknowledging the importance this research, Dr. Kelloff also urged participants to invest in researching the prevention of disease.

5. Improving health IT.

In his keynote, John Halamka, CIO at Beth Israel Deaconess, discussed the ongoing challenges in health information technology that need to be addressed: lack of interoperability, providing transparency while also ensuring privacy, harnessing HIT and Big Data to improve quality of care, and facing the ongoing threat of accelerating security incidents.

6. Considering a team approach.

During a panel about medical device development, Ramesh Raskar, Associate Professor at MIT Media Lab & Head of Camera Culture Research Group, shared that he felt the sciences needed to move away from independent research (which can be slow to produce innovations) and toward a culture that allows individuals to work more collaboratively in teams (which can be faster). He also shared a memorable quote: “The innovator may or may not be an entrepreneur,” which again highlighted the advantage of a diverse team approach.

7. Incorporating patient-centered design.

Kristian Olson, Medical Director at the Consortium for Affordable Medical Technology, recommended that “patients be in the room” when designing medical innovations. And Elizabeth Johansen, Director of Product Design and Implementation at Diagnostics for All, shared her techniques for creating user-friendly devices. Particularly helpful was her advice to observe how patients interact with their devices in their own surroundings.

8. Overhauling healthcare delivery.

According to Mikki Nasch, co-founder of The Activity Exchange, “Your zip code is still a better predictor of your health than your genetic code.” Social and environmental factors are huge determinants of health, and the delivery of healthcare in old models doesn’t address this issue. Healthcare needs urgently to transition away from traditional paradigms and into newer models of care, such as ACOs, that better address these social factors.

9. Finding collaboration between payers and pharma.

There was a lively debate during one of the panels about specialty drug pricing. Panel members suggested that payers and pharma need to come together at a systems level to help advance development of treatments and cures. Dr. Winton from Biogen Idec Market Access suggested new payer-pharma models and shared risk plans.

10. Driving innovation with patients at the wheel.

The final keynote of the day was given by Jamie Heywood, Co-Founder and Chairman of PatientsLikeMe, an online platform that allows patients to share information about their medical conditions and treatments and connect with others with similar conditions. Not only does this novel website help patients, but the open platform also allows healthcare and industry professionals to better understand patients’ experiences and conditions and may help to accelerate the development of new treatments. Conference attendee Dimple Mirchandani was impressed with Heywood’s emphasis on continuous learning to better understand diseases and their treatments, and by his inspiring vision for caregivers and patients to use “data for good.”

This article was originally posted on MedTech Boston.

Electronic Health Records: Opportunities

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As discussed in the previous article in this series, the broad adoption of electronic health records (EHRs) has presented healthcare professionals with numerous challenges. It’s not surprising that many of us are left wondering: Will all of this effort to rapidly adopt EHRs even be worth it in the end?

Where We Are Now

To better understand this, it’s helpful to first take a closer look at the current state of the U.S. healthcare system. In 2000, the Institute of Medicine released their landmark report, To Err is Human, which exposed the alarming number of deaths that occur as a result of medical errors in the U.S. This was a big shock to many who assumed that the American healthcare system was the best in the world. To add insult to injury, we also discovered around that same time that healthcare costs were skyrocketing – in fact, they had doubled from 1993 to 2004.

According to the Commonwealth Fund, the United States today has the most expensive healthcare system in the world, spending about $8,500 per capita, or nearly 18% of our GDP, while also consistently ranking dead last in overall performance and quality compared to all other industrialized nations. One can’t help but wonder: What are other countries doing that we’re not? Well, two things in particular stand out when we compare our healthcare system to theirs: 1. A lack of universal healthcare coverage; and 2. A lack of high-functioning, fully-integrated health information systems. It turns out that our international counterparts have surpassed us when it comes to providing high quality, affordable, and accessible healthcare. One of the key elements of their success has been harnessing health IT.

Opportunities to Consider

Considering all of this, it’s no surprise that we have had bipartisan support for the expansion of EHRs from both Presidents Bush and Obama and that we continue to invest in creating a fully interoperable, nationwide network for health information. If EHRs can be harnessed properly, they promise to deliver lowered healthcare costs, improved quality, increased access, and improved population health. Let’s take another look at those challenges presented in the last part of this series. Where are the opportunities in these challenges?

1. Cost

Despite the high costs of implementing new EHR systems, there are also numerous studies that report that high-functioning EHR systems can help to decrease costs in the long run. One study found a 12.9 to 14.7% reduction of duplicative testing with the use of computerized provider order entry (CPOE) and clinical decision support (CDS) in an outpatient setting. Overhead costs may also be decreased through the reduction of chart pulls and from reduced paper, supplies, and storage costs, as well as via decreased transcription costs. Efficiencies can also be gained in billing processes with improved and complete documentation, improvements in the charge and capture process, and through decreases in billing errors. A study from Massachusetts found that paid malpractice claims may also be minimized with use of EHRs vs. paper records (6.1% vs. 10.8% paid claims).

It remains to be seen if EHR-induced savings will be favorable versus the cost expenditures required to operate them. But these studies show that there’s reason to be hopeful.

2. Quality & Communication

Investing in a high-quality EHR system has also been shown, in some studies, to result in higher overall quality, improvements in safety, and decreases in delayed medical decision-making. A study of hospitals in Florida found that those with greater investments in health information technology scored higher in quality measures. A similar study found that those hospitals with greater investments had lower patient complications and lower mortality rates as well. Other research has demonstrated that high-quality EHR systems improved prescribing patterns, too. In these ways, EHRs may support improved outcomes and thereby reduce malpractice and liability risks.

Highly interoperable EHR systems have also been credited with improving the communication and coordination of care between providers, and with decreasing delays in medical decision-making that can result from having to wait for the transfer of medical records. A strong health IT system can also enhance communication between providers and patients and help to foster increased patient engagement through the use of applications such as patient portals and interfaces with radiology, laboratory, and medical devices. Patients may be more apt to become actively involved in managing their health and participating in shared decision-making as a result of having easier access to their health information. 

3. Access 

Another advantage of EHRs is that they can help to provide convenient and timely access to a patient’s health record. We’re still a far way away from a fully transparent nationwide (or global) healthcare network, but these advances are coming. In addition, as the telehealth and mHealth market grows, and as we see better integration of other platforms with EHRs, we will likely see a huge revolution in access to personal health information. This need is especially urgent in light of the dire shortage of primary care physicians. Telehealth capabilities of EHRs may very well be the solution to providing access to medical care for patients in underserved or remote regions.

4. Population Health

As we succeed in integrating systems and improving interoperability, we will have the ability to aggregate huge amounts of health data for entire populations of patients. This “big data” can be used to conduct population health research, which can help identify patterns such as risk factors for diseases. With this, physicians will be better able to recommend preventative measures and evidence-based best practices. This information can also be harnessed to change practice patterns and hopefully, to affect positive healthcare outcomes on a broader scale. EHRs can also help to enhance reporting capabilities, which may help identify potentially dangerous outbreaks or treatment-related risks quickly, so that they can be managed in a more timely and effective manner.

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The Bottom Line

EHRs hold a great deal of promise to truly transform our ailing healthcare system. How well we succeed will depend in large part on how we can overcome and manage key challenges affecting cost, interoperability, safety, and patient-centered care. It remains to be seen if the cost-to-benefit will be ultimately favorable, but these preliminary findings and evidence of international success give us reasons to be hopeful.

This article was originally published on MedTech Boston.

Electronic Health Records: Challenges

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In just a decade, medical documentation has transitioned from mostly paper records to mostly electronic records. According to the Department of Health and Human Services, 78% of office-based physicians and 59% of hospitals use a basic electronic medical record (EMR) or electronic health record system (EHR).

The Beginning

This move came about largely due to a strong governmental push that began in 2004 with the establishment of the Office of the National Coordinator for Health Information Technology (ONC) by then-President Bush. The office was tasked with the goal of supporting the expansion of EHRs and helping to create a nationwide network. Not long after, in February 2009, the American Recovery and Reinvestment Act was passed under President Obama, pushing $19 billion toward the development of health information technology through the HITECH Act. This was further bolstered the following year with the passage of the ACA, which infused even more money into the system, established Meaningful Use measures and began innovative pilot programs to study ways in which high functioning EMR systems could help to improve quality of care and reduce healthcare costs.

Challenges, Galore

These rapid regulatory changes have presented major challenges to office practices and hospitals as they try to adapt to the new requirements while also remaining operationally and financially sound. Despite the huge investments that have been made in new technology, there are conflicting opinions about the value of EHRs and whether or not they will truly help improve quality of care while decreasing costs. A recent study by Medical Economics indicated that 67% of physicians are displeased with their EHR systems. Complaints about EHRs abound, but the most common include the following: high cost, weak functionality and interoperability, safety and liability risks, and interference with physician-patient and physician-to-physician relationships.

1. High Cost

Investing in EHRs can seem ironic when one of our major concerns in healthcare is skyrocketing costs. System-wide implementation of best-of-breed EHR systems, such as Epic, can run in the hundreds of millions of dollars. Beyond the up-front investment, budgets can also be blown by unexpected vendors’ fees, upgrades or ongoing maintenance needs. Unfortunately, it’s not uncommon these days to hear of hospitals going bankrupt as a result of underestimating their technology spending. Organizations must consider not only the hardware and software, but also the costs of implementation, training, support, and the potential loss of productivity during the startup phase. There’s also the concern that as consolidation occurs (with larger vendors buying up smaller ones), organizations may need to purchase entirely new EHR systems as their present systems become obsolete.

2. Functionality & Interoperability

Incredibly, there are over 1,000 electronic medical record platforms out on the market today. There are the big players with recognizable names – Cerner, Epic, Allscripts, NextGen, athenaClinicals – but there are also countless smaller vendors, some of which provide customized EMR systems for specialists. Functionality varies greatly with each system: data entry can be inefficient and time-consuming for certain systems, but not others. Other functionality issues can include slow processing, formats that are not user-friendly, or limited capabilities. Most of these systems are also highly proprietary and may not communicate well with each other. This lack of interoperability presents a barrier to the transparent communication of health information, preventing adequate coordination of care on the small scale and obstructing population health management on a larger scale. The ONC is currently working on an interoperability standards advisory that will hopefully better guide organizations as they try to develop networks with disparate EMR systems.

3. Safety & Liability

As the saying goes: “garbage in, garbage out.” An EHR system is only as good as the information that is put into it. If documentation is poor, unreliable, or unable to be accessed when needed, it poses a threat to quality of care. Additionally, there may be information in the record that should be reviewed but isn’t brought to a provider’s attention, which poses yet another kind of safety risk. We saw this happen at Texas Presbyterian Hospital in Dallas during the Ebola outbreak. Technology can also be at risk for programming errors, glitches, and power failures, paralyzing normal day-to-day functions. And, as we have heard many times in recent days, technology is at risk for data breaches, posing a threat to patient privacy and confidentiality by exposing personal health and financial information. In all of these cases, organizations can become susceptible to significant malpractice and/or liability risks.

4. Professional Relationships

Physicians like Dr. Adrian Gropper, CTO of the non-profit Patient Privacy Rights, are concerned that current systems are interfering with physician-patient and physician-to-physician relationship. Providers often complain that EMRs interfere with clinical care, making interactions more impersonal and less face-to-face, while also degrading clinical documentation. And disparate systems with poor interoperability make it difficult to communicate with other providers as well. Additionally, as organizations adopt legacy systems, referral patterns change, favoring those providers that are network-enabled and putting other, independent providers at risk of being marginalized. There’s also the growing pressure for physicians to meet state and federal health IT mandates. In an environment where there is already a shortage of primary care physicians, there is concern that EMRs will heighten physician dissatisfaction and drive a further shortage of physicians.

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These challenges are formidable, but can they be overcome? Read part 2 of this series tomorrow to learn how EHR systems can create opportunities for improving healthcare delivery.

 This article was originally published at MedTechBoston.

Precision Medicine: Pros & Cons

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23 chromosomes (image from Scientific American)

This past week, President Obama announced a $215 million proposed genetic research plan, called the Precision Medicine Initiative.  According to the plan,  the NIH would receive $130 million towards a project to map the DNA of 1 million people, the National Cancer Institute would receive $70 million to research the genetic causes of cancer, the FDA would receive $10 million to evaluate new diagnostic drugs and devices, and finally, $5 million would be spent on tech infrastructure to analyze and safely store this data.

Not surprisingly, this announcement sparked some online controversy.  If internet pundits are to be believed, this plan is going to prevent you from ever finding a mate, an employer, get health insurance, cause us all to become part of a giant genetic experiment to tailor human beings, and will also put us into crippling debt and line the pockets of Big Pharma.  I’m not even sure I covered it all…The complaints ranged from reasonable to ridiculous.  The most amusing are the conspiracy theorists who are certain that Obama must be plotting a genetic apocalypse.

But, in all seriousness, I have to admit I have concerns as well, despite being mostly optimistic about this news.

Here are some of the exciting positives offered by the precision medicine plan:

  • New diagnoses:  We may finally be able to identify genetic causes of diseases that were previously unknown.
  • Prevention vs. disease management:  Knowing genetic risks ahead of time can help us to focus more on preventing disease rather than reacting after-the-fact, once the disease occurs.
  • Early diagnosis:  We may be able to detect diseases earlier and at a more treatable stage.
  • Protective genes:  Some people have certain genes that protect them against diseases or prevent them from “expressing” their bad genes.  Studying these differences may help us to learn how to protect ourselves against those diseases.
  • Drug development:  Therapies can be developed in a faster and more efficient way by targeting certain genetic problems, rather than using the traditional trial-and-error method.
  • Personalized treatments:  Treatments can be tailored to a patient’s unique genetic aberration and we can avoid giving treatments to patients that we know may cause adverse reactions or that will fail to work.
  • Population health:  We can study genetic patterns in populations of patients to find out causes of diseases, develop treatments, and find ways to prevent disease.
  • Healthcare costs:  There’s a potential to reduce healthcare costs if focus changes to prevention rather than treatment of disease and also if we can streamline drug development.

But, let’s also look at the potential downsides:

  • Data storage:  We already know that gene sequencing of an individual produces MASSIVE amounts of data.  The sequencing of a million people is going to produce unimaginable amounts of data.  How will we store all this big data and analyze it to make any sense of it?
  • Privacy/Security:  Is there anything more personal and vulnerable to cyber-attack than your genetic information?  I wonder if the $5 million allotted to this effort will really be enough.
  • Data relevance:  According to Obama, the data will be collected from 1 million volunteers.  That’s not a random cross-section of people in the US and may not represent the population adequately in order to make population health recommendations.  I’d argue that only certain types of people would sign up and other types won’t.  Would we miss certain disorders? Would we see too much of another disorder in a population of volunteers for this project?
  • Culture:  How do we prevent people from abusing this information and not using it to screen potential partners, deny insurance coverage, denying jobs?  How will this affect culture?  Will we be cultivating a different kind of racism, on a genetic basis?  Are we on the path to a real-life version of the movie Gattaca?
  • Ownership:  Who will claim ownership of this data?  Will it be the government?  I’d argue that this data should be owned by the individuals from whom it comes, but the experience of the genetic sequencing (now genetic ancestry) company 23 & Me is worrisome.  For the time being, the FDA has blocked the company from allowing individuals from having access to their own genetic information.  Will this change as part of the new initiative or not?
  • Drug/device industry:  Genetic research and development of treatments has been very promising and productive in the private sector.  How will government involvement affect research?  Will our governmental agencies work cooperatively with them or competitively?  Again, if the experience of 23 & Me is any indication, this is a real concern.
  • Healthcare Costs:  Yes, there’s potential to decrease costs, but there’s also potential in greatly increasing costs.  It’s no small feat to genetically map a population, analyze the information, store it safely and securely, and develop recommendations and treatments.

Part of me is excited about the potential and I think that it probably does take a huge governmental initiative to tackle and impact population health, but another part of me is concerned about government invading a space that is so personal and private and I wonder if it could slow down progress in developing life-saving therapies in the private sector.

What do you think?  Are you excited or nervous about President Obama’s Precision Medicine Initiative?