In 1961, President Kennedy announced an ambitious goal: putting an American on the moon by the end of the decade. On July 20, 1969, months before the deadline, Neil Armstrong walked where no human had before.
Here’s the question: If we can accomplish an unprecedented goal like that in just eight years, why, after decades of effort, is healthcare IT such a mess? Why is it that we can sequence a human genome for less than $1,000, and yet doctors’ offices and hospitals operate with faxes and pagers?
This perplexing question was the subject of a discussion I participated in at this year's South by Southwest in Austin, Texas, along with fellow panelists Karen DeSalvo, national coordinator for health IT in the Obama administration; Charles Huang, CEO of Lynchpin and a healthcare investor; and Brian Baum, our moderator and CEO of vitaTrackr. Together, we analyzed what has bogged down healthcare IT systems and what can be done to bring healthcare’s moon mission to a successful conclusion.
The vast possibilities
To state that healthcare IT is vital is stating the obvious. It can make healthcare more convenient for providers, more efficient for payers, and more affordable, personalized, preventative and error-free for patients. It can enable the coordination of care that’s essential if we’re to get out of our current high-cost, uneven-quality hole.
But the possibilities go even further. As providers achieve the next level of IT use—integrating data from multiple providers, payer claims systems, pharmacies, labs, telehealth, and retail clinics (and eventually remote monitoring and multisource behavioral and lifestyle data)—they can accomplish astonishing things. Wearable sensors and smart algorithms will avert acute COPD attacks and emergency room visits. Diagnoses will be automatically compared against millions of similar cases to provide more error-free treatment plans. Genomic data can power more personalized treatments.
Most importantly, technology could provide the key to the next great step forward in healthcare: helping people to make better choices and change unhealthy behaviors.
Steps like these could help save us up to the 50 percent of the $3 trillion national healthcare bill that is viewed as waste and give us a healthier population to boot.
So why is the integration of healthcare taking so long? Is it really that much harder than putting a man on the moon?
A colleague jokes that NASA was so much more efficient because it operated on a single-payer system. That’s not wrong. Some projects are so large and complex that they require central guidance and financing to succeed. But there are deeper issues as well.
Chief among them:
Misaligned incentives. It’s still far from clear how doctors and hospitals (the traditional health data stakeholders) will benefit from integrated data—or how they’ll pay for it.
This is a partly a matter of healthcare’s notoriously misaligned financial incentives. Doctors make more money from managing the sick than from managing the well; hospitals profit from filling their beds, pharma companies profit from high priced drugs, and insurance companies try to lower costs by rationing network access and care and by raising deductibles. As a result, the system fails to provide rewards for breakthrough behavior. The current march toward fee-for-value reimbursement should provide a push in the right direction—if it survives the current political climate.
EMR complexity, EMR fatigue. The developers of healthcare IT systems have reason to like the current system as well. Proprietary platforms such as Epic and Cerner are big business. Thanks to the Federal HITECH Act, the vast majority of medical records are now digitized. Could EMR systems be reworked to talk to each other across providers and integrate new forms of data, including remote monitoring?
Of course, but it’s not easy. Existing EMRs are complex (and frustratingly clunky). If it’s hard to adapt functionality to the needs of multiple specialties (and it is), it’s going to be exponentially harder to turn the raw feeds from potentially dozens of new sources into a reliable, actionable contribution to care. Besides, the most recent round of EMR implementations have drained hospitals of millions and even billions of dollars and left personnel exhausted.
Provider feet dragging. If hospitals and health systems are hesitant to upgrade, doctors are mostly resistant. Physicians are currently inundated with reams of data on biomarkers, test results, physician notes, medication lists, and patient questions and self-diagnoses that dwarf what they had decades ago. Much of it is redundant, inaccurate, or otherwise useless. The magic-wand wish of some doctors is an intelligent, trusted algorithm that sorts through the noise and makes it easy to detect the signals that matter to better manage their populations (and frenetic schedules). As for the new frontier— multisource health and lifestyle data from wearable sensors and digital lifestyle management programs to change behaviors—many doctors say they’ll be willing to entertain the idea when they see large-scale longitudinal clinical studies that prove it works. Absent all that, it’s unlikely physicians will start clamoring for more data and integrated platforms.
It’s hard to blame traditional players for not aggressively pursuing more integrated health data. A new level of integration of data would be an immensely costly and resource-intensive effort, and the benefits may not outweigh the costs. And data sharing is a two-way street, with all the dangers that entails, given the intensely personal nature of health data, and the concerns around data ownership, security, authentication, and litigation.
Here’s one hopeful sign: Outside of healthcare, Uber, Trivago, StitchFix, Amazon, Netflix, and Pandora are disrupting major parts of the economy, dismantling long-established business models by focusing on addressing consumer hassles and creating smarter platforms, rather than making better products or services. They are winning by capturing greater customer share of attention and having sharper algorithms, rather than because of their human capital or physical assets.
On the surface, healthcare may appear to be moving in the opposite direction with attempts at mega mergers and asset consolidation plays. And yet, if the arc of other industries (and the expectations bar they are resetting for consumers) is any indication, a consumer-centric business model for data sharing may be over the horizon. The first step for those players is mapping out the consumers’ (many) hassles in healthcare and constructing their business models to address that. When a similar business in healthcare produces breakthrough results for consumers, we may see a wave of disruption that remakes healthcare as it has remade so many other industries.
To read more of Oliver Wyman’s digital ideas and points of view, visit our Digital Bytes library.