Can data transparency save the world?

Imagine for-profit organizations sharing data to solve significant health problems. Day-to-day adversaries getting together to create a massive pool of clinical data that can help researchers one day find a cure for the most puzzling diseases.

It’s no longer a dream. With Project Data Sphere, an initiative of the CEO Roundtable on Cancer’s Life Sciences Consortium, researchers from life sciences organizations, hospitals and other institutions can share and analyze cancer research data gleaned from across the industry. The result? An impressive pool of data designed to jump-start cancer research.

Project Data Sphere was a topic during a data transparency discussion at the 2014 SAS Executive Forum. Dr. Kald Abdallah, vice president of immunology for Sanofi US, talked about the project and the need for more ambitious cancer research. While the mortality rate for illnesses like heart disease continue to drop, cancer death rates are climbing.

Part of the reason for this, Abdallah said, is because of the decentralized way that research is conducted. Pharmaceutical companies and research organizations have been doing individual bits of research, but it was difficult to share information.

“Cancer is very complicated, and we’re not finding solutions fast enough,” Abdallah said. “The question is ‘How do we change that paradigm so that we can find solutions – and improve cancer care – faster?’”

The answer came when the CEO Roundtable on Cancer established Project Data Sphere as a way for pharmaceutical and life sciences companies to share their clinical trial data. Once a proprietary asset, this information is being aggregated, and in April, it will be available for researchers across the globe. SAS plays a role in Project Data Sphere, providing data hosting and analytics tools to researchers.

“The only commitment we ask from researchers is that they acknowledge that their findings came from Project Data Sphere,” Abdallah said. That’s not much to ask for, he said, given the scope of the program. Now, researchers in China and India can use the same data as North American researchers, adding a new dimension to cancer research.

Cancer is only one area where increased data transparency is changing lives. Mike Wirth is a special adviser on business and technology reengineering to Virginia’s Secretary of Health. Wirth works with state agencies across Virginia’s local governments to aggregate information to serve under-privileged children.

Part of the Comprehensive Services Act for At-Risk Youth and Families, the program administers a fund that purchases services for at-risk children throughout the state. Their goal, Wirth said, is to ask critical questions and improve the lives of Virginia’s youth.

“We have to know several things,” Wirth said. “Are services available to the children who need them? Are services being provided in accordance with each child’s needs? Are fund being spent wisely? Are programs meeting measurable goals?”

In the past, answering those questions was difficult with 95 counties and 38 independent cities that can have local pools of data about the services provided to children in those areas. To solve the problem, Wirth and his team first took on a pilot project that helped proved the concept to both the general assembly and the localities. From there, they established a baseline of expenditures to understand “typical” expenditures for specific services.

Once they had that baseline and an integrated data set, the next phase was to look for outliers. Through data visualization, Wirth’s team can “see” an individual child and as well as his or her support network. If the child has a darker color, it means they are more at risk. A lighter color means that the data shows that the child is getting necessary support.

“I can start to slide the time [metric] and see kids getting brighter or darker,” Wirth said. “If their symbol gets darker, I can drill in and see what’s happening there. Is it that they are in a bad situation, or is the provider overburdened? It’s a really powerful way to visualize and see the data.”

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The time is now for health care price transparency

The second annual Report Card on State Price Transparency Laws was released earlier this week, and the grades came as a shock to many. Even with the profusion of dialogs and activities that occurred in 2013 around health care price transparency, the US is nowhere near where it needs to be in providing consumers timely, accessible price information. In fact, the 2014 grades are worse; and contrary to last year, not one state earned an “A” grade. Though the lower grades are in part due to the additional evaluation criteria, we still have to ask whether we're headed in the right direction. What changes do we need to make? And most importantly, why do we need to make these changes?

I’ve discussed before on this blog the multiple reasons why health care price transparency is important, but with today’s evolving health care market, the number one reason for change is to aid consumer decision-making. Consumers are playing an increasing role in making decisions around their care and they still have very little means of knowing health care prices. This lack of information contributes to both individual and systemic escalation of health care costs. Further, it’s something consumers are demanding – especially those with high deductible plans and those “shopping” for various health care procedures like an MRI or routine screenings. And the research suggests more than that; consumers want accessible websites that provide these cost comparisons across providers.

So what do states need to do in 2014 to boost their transparency grades?

  1. Legislation. This is a team effort; stakeholders – including consumers, payers and providers - need to come together to advocate for and enact price transparency laws. As Francois DeBrantes of HCI3 stated, “…without legislation, there’s simply no assurance that consumers will have long term access to any pricing information.”
  2. All-payer claims database (APCD). APCDs are the best source of information to provide price information to consumers.  While many states have an APCD or are in the process of developing one, others like New Jersey and Washington have not succeeded in passing legislation for one, despite widespread support. APCDs are no longer a nice-to-have, but a necessity.
  3. Public website. Those states with an all-payer claims database or other repositories of price and quality information, must make the data available to consumers. Further, they’ve got to provide the right and relevant data in an easy to use manner. In other words – just having a public website doesn’t cut it. For example, New Hampshire didn’t get any points for its public website this year because it was disabled and unavailable to consumers for an extended period of time.

Taking these steps towards price transparency will bring us closer to effective consumer-decision making. Although it doesn’t stop at costs, as quality information must also be included to drive the best decisions. Creating price transparency is a significant step that will drive positive change within the US health care system.

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The paparazzi experience

Do you know the look on someone’s face or in their eyes when you just know they’ve had an epiphany or something click and they got it? Many of us refer to that as the light bulb turning on. The past day and half at the SAS Global Forum Executive Conference has been filled with light bulbs flashing on over and over throughout the convention center. It was like the paparazzi was everywhere!

Making decisions without insight

The massive keynote ballroom had six huge blue ring-type structures dangling high on the ceiling giving all pause to wonder and provided uniquely arranged seating options ranging from traditional straight-back rows of chairs  to leather lounge and mod pod chairs to high-top bar-style tables and chairs.

The keynotes by retired General Colin Powell, former CIA and FBI Director Philip Mudd and business advisor Geoffrey Moore were fascinating discussions about the challenges leaders have in making accurate, timely decisions. They gave some great ideas for overcoming those challenges, and cautioned about the critical need for leaders to balance instinct with relevant insight from data from systems of record and analysis from systems of intelligence.

The concepts were complex but energizing. They talked about many ideas, including ways to approach automation of transactional data for national security, leveraging unstructured text and social media banter and better understanding our own businesses and exposures.

Every industry represented discovered new ways to approach existing data and leverage a variety of other data sources to master their own business ecosystem. Among my healthcare colleagues, we began to explore what these new angles of thought now meant to providing quality care, engaging patients in their health decisions, improving the care continuum with physician contact points and detecting symptoms early to avoid a catastrophic health incident.

What were those six big blue rings?

 As the hall emptied, the rings slowly descended unfurling blue curtains - each forming a ringed-room with its own audio and presentation functions. The rooms hosted three sessions of six concurrent presentations that filled the afternoon with stories, examples and lessons in areas such as:

  • Analytic approaches to better understanding your customer.
  • Using unstructured text sources to improve business processes.
  • Creating innovation or idea labs to tighten the ratio between effort and insight.
  • Streamlining detection and prevention of improper payments and fraud.
  • Maximizing the learning curve thru data and analytic visualization.

The light bulbs continued going on for us as we listened. We were asked to approach each session considering eight metrics that matter in using data in our businesses:

  • ROI – Return on investment and return on insight are a must.
  • Data Governance – Is it relative?
  • Productivity – Will this support the analytic life cycle.
  • Timeliness – Will the analytic value be delivered in the time window I need?
  • Accuracy – Are we spending the time to ensure the data is accurate? What is the impact if not?
  • Effectiveness – What is the impact on the pool of staff talent? Is it time to bring on a data scientist?
  • Empowerment – Will this increase be self-sufficienct?
  • Maturity – Where are we in terms of people, process and culture  - beyond technology?

The quote of the day

There is one simple observation that was made during the conference that just sticks with me. Before a packed audience, Bryan Sivak, an entrepreneur and innovator, currently filling the CTO role in the US Department of Health and Human Services, shared how increasing amounts of data are being liberated for use in analytics across a wide variety of public-private partnerships. This liberation has a  direct impact on improving healthcare and lowering costs.  He established an IDEA Lab that focuses on rapidly moving from concept to operationalizing solutions that depend on data and analysis. At the end, someone in audience rose and said, “You are breath of fresh air!” and the audience nodded quickly in affirmation.

Not the most profound quote perhaps but indicative of the value each session brought to all of us in attendance. Indeed fresh air was found in every tent that afternoon.

What does this all mean to the attendees, me included, when we get back to our own desks? Stay tuned for my next post.

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Expand your 'pur'view

Most of us have some presence on professional social network sites such as LinkedIn. For me, the greatest value to those sites is the well-rounded viewpoint and interests I’m exposed to. The broader my exposures, the better equipped I am to contribute to improvements and advancements in healthcare.

Take in the scenery

When I look back at my career in health care, I see that I was totally focused on the tasks at hand. Regrettably, I had little time to explore what was going on in the health care industry in my region, let alone nationally or globally.

My experience was the norm and not the exception. And so when it came time to plan and strategize, too many of the others at the table came with the same experiences, the same challenges, the same environments. We weren’t including perspectives from other industries. So how innovative do you think we were?

Why other industries?

When I finally left health care I didn't go far (even though I  joined the “dark side” - a vendor). I joined a company where I could use my experience in the industry - specializing in applying advanced analytics and leveraging data to improve all health care organizations. With that move, my ability to “take in the healthcare scenery” grew exponentially! Now thru my role with SAS, I can directly contribute to improvements in the health care industry and other industries!

Healthcare is morphing into a far broader body of concerns than the provider and payer. Analytic strategies from a broad range of industries are now important to patient care. For instance:

  • As we focus more on engaging the patient as an individual and a consumer, retail and hospitality analytic strategies are increasingly seen as a knowledge source – especially with personal health devices.
  • As new financing vehicles for care evolve, analytic strategies employed by the financial services industry is increasingly valuable.
  • As new care delivery models evolve – such as accountable care organizations and patient-centered medical homes – mature, analytic coordination strategies from the services industry can be leveraged to tighten gaps in care and improve discharge planning.  

Last fall, I honored to be invited to participate in the Health Innovators 100 Summit. I’m sure the gathering would surprise many. Yes, we represented health providers, payers and the pharmacy sectors, but we also brain stormed with representatives from the retail and banking industries. Innovation was alive and well - there was no “bad idea” except those that went unspoken. 

Learning from each other

Starting Sunday evening March 23, I will attend the SAS Global Forum Executive Conference and mingle with analytic giants from nearly every industry. The conference will be held at the Gaylord National Resort & Convention Center March 23-26.  I will hear keynotes from Gen. Colin Powell (USA Retired), Philip Mudd (former Deputy Director FBI and CIA) and Geoffrey Moore (Business Advisor) while attending analytic thought leadership sessions such as:

  • Bryan Sivak, Chief Technology Officer HHS – Achieving Innovative Health Care Transformation
  • Mark Pitts, SourceHOV – Developing a Strategy & Road Map to Achieve Your Business Objectives
  • Michael Olson, CEO Cloudera – Putting Data at the Center of Business
  • Sterling Price, Director of Customer Analytics WalMart – The Role of Analytics in Customer-Centricity
  • Anthony Volpe, Chief Corporate Analytics Officer, Lenovo –Quantitative Creativity: Addressing Old Problems in Unthinkable New Ways

It is amazing the new concepts and approaches to health care that can be gleaned from organizations that, at first glance, seem to have no connection with the industry!  As I mentioned earlier, when all at the planning table come with the same experiences and environment backgrounds, innovation will be lacking. So I take opportunities like the SAS Global Forum Executive Conference as my chance to “take in the scenery.”

Rick will be posting a few insights from the SAS Global Forum during the conference. Stay tuned!

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The right time for a vaccine

What if scientists could not only identify the right strains for the yearly flu vaccine quickly, but also help marketers know when to advertise the vaccine’s availability?

That was one of the questions posed to college students as part of the SAS Analytics and Data Mining Shootout. The answer from our award-winning Oklahoma State University team provides critical lessons to epidemiologists, supply chain specialists and marketing experts.

What the students showed conclusively is that vaccine development, manufacturing and marketing shouldn’t be conducted in isolation. Predictive modeling that looks at all the variables of the deadly illness, and past efforts to prevent it through vaccination, offers cost-effective lessons in tackling the problem.

I always encourage my data mining students to enter the Shootout. The most recent year’s topic was to address four research problems together:

  • Which virus to include in the flu vaccine.
  • Which promotion program to apply.
  • What amount of vaccine to produce.
  • How best to predict influenza’s impact.

Students were given data sets from four states that included details on the number of people infected by influenza, hospitalizations and deaths – along with details on marketing plans (including costs). I quickly recognized that this wasn’t a pure statistical or epidemiological exercise. It couldn’t be modeled in isolation. Business considerations (like when the vaccine is available) play a key role, so I assembled competition groups that included students with different skill sets.

Dissecting the problem

Industrial engineering major Juan Ma led the effort of a team consisting of data mining students from business school and engineering school at OSU. The team answered each posed question. Using Southern Hemisphere flu statistics and a disease impact model, they chose the most virulent strains currently circulating. To choose the promotion plan, the students used data that showed the percent increase in vaccination (the lift rate) for each of the promotion plans offered. In building the model, they assigned three of their model states the plan that gave the largest notable gains for the smallest cost.  With one state, lift rates improved so little with the cheapest plan that it made more sense to go with the more expensive marketing plan.

“By choosing a model that carefully looks at when to distribute the vaccine and how to market it, you can reduce the impact of these viruses in the coming flu season,’’ Juan says. “When we looked at the literature no one had really tested this type of prevention model.’’

Then the group looked at production costs and delivery schedules and discovered something that real-world flu fighters could learn from: It is ineffective to spend money marketing the vaccine until enough is available to meet demand.

Taking this a step further, once the supply is high, “it made sense to start promotions at the week where there is a drop in the number of inoculations.’’ Juan noted. The group also looked at which model was best at predicting when the flu would hit a given state, allowing the marketers and vaccine distributors the chance to get in front of the outbreak by a few weeks.

The students’ work is theoretical but the judges saw its potential – that analytics can be used to look at the whole problem, rather than public health officials looking at the issue from the more piecemeal that is common today.

Dr. Chakraborty is a Professor of Marketing in the Spears School of Business at Oklahoma State University. He teaches a variety of courses, including data mining and CRM applications, advanced data mining, database marketing, advanced marketing research, marketing analytics and digital business strategy. He has won numerous teaching awards including SAS Distinguished Professor award and has published in many marketing journals. He is the founder of the SAS and OSU Data Mining Certificate program as well as SAS and OSU Business Analytics Certificate program at Oklahoma State University. His student teams from OSU have consistently placed in the top three spots in the Analytics Shootout for the last seven years. Learn more about Dr. Chakraborty on his SAS Bookstore author page.

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Health care’s person-centric passion… balanced with firm resolve

We all understand how the rigors and strains of everyday work can, over time, dull the energy, excitement and passion we once felt for our health care industry, company and professional track. For me, the best prescription to defeat the waves of complacency, cynicism and apathy is to surround myself with health care colleagues, peers and professional-turned-personal friends – all for whom I hold the utmost respect. These people challenge, question and encourage me, and are always eager to allow the dreamer in me to take time to articulate a new vision and then add to it in a collaborative “mind blend” experience. When this happens, we always learn something. Again, HIMSS’ final day-and-a-half didn’t let me down.

The result? This year’s HIMSS theme is top-of-mind for me and so many of my colleagues:  ONWARD! … Innovation, Impact and Outcomes.

The passion for personal health IT at HIMSS

Within the first 10 minutes of Wednesday morning’s “Health IT-It’s Personal” session, I knew the difficult commute was worth it as I was energized for the day with the powerful quote from Leonard Kish: “Patient engagement is the blockbuster drug of the century!” Jane Sarasohn-Kahn, Dr. Daniel Sands and Dr. Peter Hudson (co-founder of the blockbuster personal app iTriage) took off down the runway in a fast-paced discussion of the criticality and successes of personal health IT, tempered with various points-of-view that confront personal health devices and approaches.

As providers and payers have recognized the importance to better engage their patients as consumers, personal health IT is fast-focused on capturing all the data points of consumer interaction to best understand – through advanced analytics – the wants and needs of the patient (both clinically and in market demands). Various personal health devices now fill market categories for monitoring activities like weight tracking, sleep, food, hearing, stress and mood, medications and connectivity with home and car! Still, personal health IT is still emerging. So it’s not a surprise that the topic presents different points of view – such as:

  • This is awesome stuff! Guiding patients and caregivers to be actively involved in their health and experiences is a purpose of the Society of Participatory Medicine, and these tools for monitoring will generate more data (always good) so that one can practically be their own doctor.
  • It’s a big market but will personal health IT/devices deliver the financial payoff it seems it should? Too many of us remember the disease management market that struggled to quantify returns. Who pays for it? Perhaps more important is the challenge of how to cross the chasm from early adoption to mainstream demand. About three-fourths of that session’s attendees were presently wearing some form of fitness/activity monitoring device, yet the majority were also already physically fit. So the question begs itself … how many will find these devices desirable in an attempt to get fit? More on this in my closing remarks…
  • Not so fast my friend! The academics are still challenging the assumption that personal devices improve outcomes or lower health care costs as the data is still anecdotal and the market too young. Of significant concern over the next several years will be how best to share FitBit data, for example, with doctors in a summarized, useful way?
  • How can this help me deliver care? The physician community is still exploring how to merge personal health devices into their care service. Who do I prescribe these for and who pays for them? Is this really going to help my most challenged patients? Who is going to review all this data (more data isn’t always a good thing)?

The conclusion of the group? Huge potential but more work is needed to define value and sustainability. But – now is the time to aggressively use analytics to study, evaluate and predict. The iTriage example fortifies the general “soft” consensus that personal health IT’s time has arrived as the 4 ½ star rated app has responded to the public’s growing demand for more information to make better decisions. Furthermore, returns indicate that patients are 19 times more likely to select an in-network care provider and 40 percent less likely to select an acute-care provider when a non-acute condition exists through the insight empowered by iTriage. It is all about empowerment, leading to behavioral changes, leading to better outcomes!

The passion of Hillary

Will she run? Wednesday’s keynote address by former Secretary of State Hillary Clinton sure sounded like a campaign speech to the packed main hall. Secretary Clinton gave a full hour of prepared comments and Q&A covering her involvement in health care program development and reform, as well as anecdotal observations regarding Vladimir Putin and Russia, the successful elimination of Osama bin Laden, and her various experiences in and with the White House as First Lady, US Senator and US Secretary of State.

Despite orders to the contrary, cameras were snapping and tweets flying out the door as soon as she walked out on stage. But she good-naturedly remarked “I see you all out there tweeting and taking pictures …make sure you get my good side!”

Her compassion and caring for our nation’s health care system and our citizens came through loud and clear as she repeatedly referenced the importance of this national debate. I particularly appreciated her emphasis on the need for cooler heads prevailing if we want to build upon health care’s reform to make sure that what works remains – but we fix and improve that which isn’t effective. The passion of views on health care is important, but that passion must be funneled into constructive discussion – not the destructive purposeful spread of unfounded fear, uncertainty and doubt.

No more kicking the can down the road

While the passion of the final day’s activity pushed the limits of stamina, the resolve to stay-the-course was laid out:

  • Continue with development of new analytic viewpoints to impact outcomes, readmissions, quality and efficiency.
  • Elevate the conversation: The role of health IT is to make health care more effective!
  • Health informatics sits at the crossroads between health care science and computer science. It will only be successful if both disciplines perform better with insight from health informatics units.
  • E.H.R. adoption rates and meaningful-use certifications will change the game.

And… providers, payers and claims’ clearinghouses can look for NO RELIEF from the looming October 1, 2014 compliance deadline for the nationwide conversion to the IDC-10 family of diagnostic and procedural codes. However, some case-by-case exemptions will be made for providers having a tough time meeting their Stage 2 meaningful-use targets. “There are no more delays and the system will go live on Oct. 1,” Marilyn Tavenner, CMS Administrator, said during her keynote address Thursday. “Let's face it guys, we've delayed this several times and it's time to move on.” Health care data analytics can now play in a larger, more robust data capture as the intersections within the data fields of ICD-10, compared to ICD-9, will “explode” in volume and opportunities for new insight.

This is “just” personal

So HIMSS14 is over and we look forward to Chicago HIMSS15. It’s been an interesting week of revelations for me. My career has taken me from government public and personal health regulatory positions, to publicly-traded provider and payer positions, to the past 16 years in analytic software work laser-focused on aligning health care issues and challenges with analytic solutions. I’ve never once considered myself to be anything but working in the health care industry. Yet I don’t think I’ve paid enough attention to health success stories, because as the years progressed, I very easily fell into the American mainstream: a frequent weekend warrior, one who has eaten the wrong foods in the wrong portions, had a drink or two too often and never looked in the mirror as critically as I looked at others. All the ingredients for a disaster.

It seems like there are three tiers of people: the first or younger tier where health means looking attractive to others (all the wrong reasons!) and at the other end, the third or older tier when health is a scary reality that better be addressed before one misses out on seeing their grandchildren grow and thrive. The middle tier is a period of time that only ends when health begins to take a turn of concern – a time of denial.

Thanks to my wife, my daughters and my friends, maybe I’m shifting from the middle to the third tier without a catastrophic health occurrence. At least that’s my objective and I’m monitoring my progress with gadgets and apps. And now, 14 pounds lighter than last Christmas, I know this geek likes the gadgets and apps because I feel more in control of my personal health. And the goals I’ve set for the rest of the year don’t seem as daunting.

In the HIMSS opening keynote, Mark Bertolini, Aetna CEO, said the last of three objectives that he thinks are required to remake the US health care system is to embark on a 20-30 year journey in investing in personal wellness programs and devices. A wellness system that can “sit in the palm of your hand” making it simple, relevant for a young person to adopt for all the right reasons, and to empower. I couldn’t agree more.

Yes, I think the personal health device market is a great thing! Yes, I believe that data and analytics will give greater insight for providers and payers into better engaging patients. Yes, I know that analytics are and will continue helping the health care industry improve care, satisfaction, outcomes and costs … but you might say this is all just a “personal opinion”. You bet it is!

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15,800 steps over 7.46 miles, and I’ve only just begun…. Health care is BIG!

For anyone making their first trip to the HIMSS14 Annual Conference & Exhibition, the first day-and-a-half can be rather dizzying. The number of my trips to HIMSS has reached double digits, and the exponential growth in attendance each year still astounds me. As has been my practice over the years, this morning’s blog takes a briefer approach as I ramp up for the day’s platter full of discussions and educational sessions covering areas such as:

  • Making sure the patient-centric, personal approach continues to be weaved within Health IT.
  • Building analytics to best engage consumers.
  • Final preparations for ICD-10 conversions.
  • FDA’s path forward for open data and next-generation sequencing.
  • Interoperability at the VA.


  • The keynote address by Hillary Clinton.

And yes, my FitBit confirms that (despite the sit-time during educational sessions) – the breadth and scope of the exhibit hall, which optimally should be taken in manageable sections, and the Orange County Convention Center’s enormity – gave me a good 7.46 mile day!

The US health care maze

An illustration of a mouse maze was used in this week’s opening keynote. It represented how the US health system had evolved since the 1940’s with little change except in size and complexity. The number of specialists, offices, hospitals, clinics, labs, out-patient facilities, etc. has made the system harder and harder to navigate and less and less patient-centered. A theme of discussion this week is how information technology, hand-in-hand with models such as accountable care organizations and patient centered medical homes, can begin to make sense of it all for the patient, the plans and providers.

The mainstream technology organizations have coined the phrase “big data.”  The volume, velocity and variety of data points generated within the health care maze are not for the weak-of-heart; but when harnessed with insightful analytics, can contribute to mapping a path through the maze.  So too can the variability (inconsistency in times of data generation) and complexity of data.

Take a walk through another maze

Whether taking in the expansive exhibit hall from an archway observation deck, or walking 15,800 steps the “old fashioned” way, you’d be impressed with the variety and complexity of vendors offering products and services to meet the huge volume of issues and challenges facing health care or to improve daily process or accuracy of measurements.

With each turn down another aisle, I could not help thinking how every product and service generates data in some fashion – yet it seems analytic solutions had evolved into niche-problem solvers.

I prefer to think of analytics as the means to solving ANY PROBLEM, no matter the complexity or degree of importance, dealing with ANY SIZE of “big data” in ANY REACTION TIME.

And there it is…

A line in the sand

I continue to believe that the Triple Aim is 100-percent doable, but we have to change our approach.  Technology now allows us to merge the disciplines of improving care: by improving health experiences and lowering costs into a single analytical mentality that uses the very best of high-performance analytics for the data being considered. The Journal of Advanced Analytics – International Edition, recently published a discussion of the role for big data in addressing the triple aim and it serves as a good mind-set, as well as insight into activity outside of the US.

When I look at the wide range of problems SAS solves for its customers, I know that the only reason we’re able to create solutions that successfully meet the needs of health care is because we attack the problem and don’t get bogged-down into niche technologies with limitations. Despite the volume, velocity, variety, variability and complexity of the data being generated, we focus on what’s needed to enable the health care community to improve what it does, how it does it and when.

Now, will I beat yesterday’s step count?

It wasn’t lost on me that on the shuttle back to the hotel last night I was greeted with a FitBit email congratulating me on a 500-mile badge (granted, I’m new to FitBit so this may pale in comparison to many) – as I know HIMSS contributed to it. I also realize that, for many attending HIMSS, the journey out of the maze toward the Triple Aim must seem far longer than 500 miles. It’s amazing how analytics can shorten that journey!

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Health care’s tides of change … and now what?

The tides are swelling to a boil… the only question is whether they crash upon the shores, only to recede back again into the dark abyss, or leave behind a forever changed landscape?

As the HIMSS14 Annual Conference & Exhibition ramped into full swing yesterday, a dizzying concurrent number of changes are underway across the health care industry. Modernizing the health landscape is big business. According to Research and Markets’ North American Healthcare IT Market report 2013-2017, IT spending is forecasted to grow a compound annual rate of 7.4 percent (from US$21.9 billion in 2012 to $31.3 billion by 2017.)

Little wonder that the theme for HIMSS this year is “ONWARD – Innovation, Impact & Outcomes.” I and my colleagues will be well served to focus on ensuring that the myriad of these investment activities lead to operationalizing innovative changes in care delivery and payment by tightening the ratio between insight & effort.


On face, there are many activities, driven either by the public or private sector, offering promise for positive and permanent changes within health care. Discussions yesterday touched on many of these including:

  • Electronic Medical Records & Meaningful Use (funding via the American Reinvestment & Recovery Act.) Moving to a digitized system can offer improvements in access to critical care information.
  • The shift from ICD-9 to ICD10 will richen the information around diagnosis and exponentially grow the possible intersections for improved insight and understanding.
  • The Affordable Care Act Insurance Market Exchange platforms (both state & federal) for enrollment.  Now the work really begins as the participating plans must now perform – and information around cost and outcomes begins to roll in.
  • All Payer Claims Databases (APCDs) being established by more and more states. Between market exchange data and the consolidated APCD views, new comparative understanding of regional care concerns can be surfaced.
  • Public Private Partnerships. The “P3” approach is further ramping up through programs initiated by HHS-CMS. Collaboration within each P3 can lead to advances in processes and performances. Now the challenge is to share the learning.
  • Data Liberation! Recognizing organizations are capturing vast quantities of data, under the initial leadership of Todd Park, US CTO White House, more and more data is being shared to drive improved opportunities for understanding. www.HealthData.Gov offers the beginning of a library for captured data for research and public/private collaboratives, such as the Health Data Consortium. These are evangelizing the importance of leveraging every data point in an effort to improve health.
  • Establishment of the Defense Health Agency (DHA) to gain efficiencies and eliminate redundancies within the military health system. A centralized Health IT function, led by David Bowen, Director Health Information Technology and CIO-DHA, will offer opportunities for cost efficacy and efficiency as well as a platform for implementing value-based reimbursement and optimized care coordination. Bowen’s enthusiasm, despite the daunting task ahead, impressed me. He has a tremendous team dedicated to ensuring “a medically ready force is a ready medical force” through the work of the DHA.
  • Personal health devices to drive patient engagement and accountability. Patient-centered care can and must become focus for change.


“Hold your horses!” as my grandfather used to say.  Each of these activities either establish a platform, a transactional care delivery information system, a foundation, a database, a warehouse, an organization, etc. Why? How? Now what?

It’s easy to get lost in the tasks and investments directed toward building the “modernized” health system without spending adequate effort addressing what needs to be in place to realize a measurable and impactful return on these investments and efforts.  Failure to do so is in many ways synonymous with simply “crossing your fingers” and hoping the whole thing works.

Let’s be sure there is an analytic vision and commitment in place to take advantage of every available data source (internal and external), in order to gain insight into driving improvements how we provide care, how we pay for care, and how individuals care for themselves and others. Let’s make sure all these investments include attention to morphing summarizations into predictive capabilities, process optimizations, and visualization of analytics in ways management can react to design purposeful change.

There are more and more examples of analytic teams approaching these directives in creative entrepreneur-like ways. I’m looking forward to the SAS Global Forum Executive Conference March 23-26th in Washington DC where leaders across multiple industries gather to share ideas and approaches toward an analytic focus on all their “Big Data” and Data Consolidation & Access projects. Brian Sivak, CTO US-HHS, will share how the US Department of Health and Human Services is using the HHS IDEA Lab to both analytically expand views of a problem and expedite realization of proposed solutions. Find out how public-private partnerships, start-ups and the HHS staff utilize data and analytics to tackle some of the industry’s most complex challenges.

With increasing volumes of data being made available to the health care community amid mandated new approaches to care delivery and payment, there is great risk; for instance, failure to gain new insights into opportunities for health care improvement because of uninspired and too-traditional approaches to problem solving.

Mark Bertolini, CEO Aetna, delivered yesterday’s keynote and his concentration on wasteful spending within the industry and the need to redesign health care’s operational focus was refreshing. His belief is we must always focus attention and insight on the relationship between the consumer and the provider and how access and quality is impacted at every touch point. He emphasized the importance of building a new platform for patient-centeredness. I suspect he too would say, “This stuff is too important, too critical, too personal, to build anything with fingers crossed!”


The tides of change activity are too persistent to believe anything but a forever changed landscape will result. Building the tides of change with an analytic purpose will ensure the landscape is one of improvement in everyone’s health- rather a landscape ruined by forceful undirected tides.

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Let’s stop the duplication … the promise of episodes of care

People who know me know that there’s one thing I hate at work – duplication of efforts. I’m not talking about working on a problem in a coordinated fashion. I’m talking about two or more people doing the same work, to answer the same question. Without coordination, there will be some combination of waste and confusion based on having two sets of results.

Why do we have duplicative diagnostic testing?

In the past several years, the medical community has focused on duplicative diagnostic testing. Why? Because of the negative effect of additional radiation on overall health, combined with these tests’ prevalence and costs.  A study presented at the 2011 American Academy of Orthopedic Surgeons (AAOS) conference showed the top reason for “over-testing” patients is defensive medicine; while peer review, financial incentives, and lack of information-sharing are also contributors.

  • Defensive medicine. Physicians are afraid of being sued because they didn’t order a test. In fact, 19 percent of tests, accounting for more than 35 percent of imaging costs, were done purely for defensive purposes.
  • M&M conferences. Not surprisingly, physicians aren’t motivated to “confess” to their peers because they don’t want to present their mistakes at Morbidity & Mortality conferences. According to the AAOS survey, physicians are actually more likely to order more tests for minor symptoms – if they’ve had a previous negative experience that went through this peer review process.
  • Financial incentives. The current fee-for-service model provides little penalty for duplication of tests, and doesn’t align with medical necessity.
  • Lack of information sharing. When a single physician or group is taking care of an individual’s medical condition, they typically have access to all of your relevant tests and clinical data. But most procedures require a team of providers – including physicians, surgeons, anesthesiologists, therapists, and others – along with batteries of tests for both diagnosis and recovery. More often than not, these providers work under more than one roof, or will at least have different EHR and billing systems. Sharing clinical details across a procedure’s entire episode of care is difficult, at best. In fact, the mere mention of the topic raises the blood pressure of HIPAA Privacy and Security Officers everywhere.

Stopping the duplication…

So how can this change? Unless you’ve been living under a rock for the last few years, you’ve likely heard of the payment reform currently underway for Medicare, and have seen its influence on private plans throughout the US. Basically, the goal is to eventually pay for a procedure like a knee replacement with a single, lump sum payment. This payment would cover all work required to diagnose, treat and complete care for the patient’s medical condition. The individual test, procedure and post-operative work would all be bundled together into a single payment to be shared. The result will be that providers will have to figure out the best way to diagnose and treat patients, including omission of anything unnecessary and costly.

Looking at the episodes of care concept from this duplicative efforts perspective has been like turning on a light for me. In particular, the alignment of financial incentives and information sharing in these models has great promise to reduce duplicative efforts. I can see a future where:

  • Providers are able to focus on standards of care and medical necessity, and can have more confidence when following these standards, rather than being consumed by malpractice and peer review fears.
  • Providers and payers can share the financial risk of caring for the most complex patients, because of a strong financial model that supports care delivery for an entire episode of care.
  • Providers can share relevant information to all providers involved in the entire episode of care, with confidence in the underlying security models and data governance. And a combined standard of care spans the episode and drives sharing of test results.

Levels of understanding and confidence are raised through being able to understand all components, services and complications stemming from all providers involved in a patient’s episode.

Analyzing episodes of care

SAS has built a solution - SAS® Episode Analytics – that can help organizations not just understand the services and components that comprise an episode of care, but also bring light to both potentially avoidable complications and variations in care – even within the care delivery process itself. The insights that can be gained by looking at patient care data from this approach can transform how physicians practice medicine.

I’m excited to be working with such technology at the start of this shift in how we view health care. Schedule a demo session at SAS booth #935 at HIMSS in Orlando, or just stop by the booth to learn more about episode analytics.

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Next steps toward clinical trial data transparency

Industry leaders shift the conversation from “why” to “how”

Imagine that you and a committee of your competitors have been tasked to collaboratively design and build an automobile. You don’t know how it will be used, how many passengers it must transport, or what kind of cargo it will carry. You don’t know what EPA and DOT regulations might exist when your creation rolls off the production line. Got it? Now hit the drawing board and come up with a design that works, wins the public’s trust and forestalls unwanted government involvement.

That’s essentially the assignment set before the life sciences industry in the quest for clinical trial data transparency.

From many of the conversations we’re having, we’re seeing some uncertainty as to what the industry needs to be doing. You need to make clinical trial data available in an easy and inclusive way, but there are many questions still open for debate and consensus.

Finding the questions to ask

What information should be shared, with whom and for what purposes? How much demand is anticipated? How should data access and use be managed? How do you ensure patient privacy without hindering the research value of the data? What should the information delivery and analytics platform look like?

The answers are not challenging from a technical perspective, but for clinical data transparency to succeed, everybody needs to agree on (or concede to) consistent policies and processes – and that’s a work in progress.

“It’s amazing that you have a group of people who all want to do the same thing, but you can’t get them to agree on how to do it,” said a participant at the Clinical Trial Data Transparency Forum we hosted at SAS headquarters in October 2013. Said another: “We go around and around on the same topics and end up with the same unease. Is it just a matter of moving forward with our own individual strategies – or moving forward with a group strategy?”

It’s important for the industry to work together. Sharing and collaboration are critical. That’s why SAS is hosting this multi-part forum. The second installment on February 11 brought together 70 leaders from 28 companies – plus more via webcast.

It’s encouraging to note that conversations are becoming more positive. Conference participants are not talking about whether we should do this; they’re talking about how we can get it right. The recent event focused on the latest news from regulatory fronts, considerations of policy and platform to hammer out, and lessons learned from four pioneers in a joint data-sharing initiative – GlaxoSmithKline, Roche, Sanofi and Boehringer Ingelheim.

Agreed-upon fundamental requirements

From the presentations, Q&A and breakout sessions of the day, we heard agreement on the fundamental requirements of a successful clinical trial data transparency initiative:

  • Public access to a library of available studies, coupled with a consistent, user-friendly and auditable online data request process.
  • An independent review panel process to review research proposals and grant or deny data access based on agreed-upon criteria that may be specific to each sponsor and study type.
  • A scalable, secure computing environment with advanced analytics built in, where researchers can create, run and save their own analyses using multiple tools.
  • Access to patient-level data, de-identified as appropriate for the research at-hand and protected from possible re-identification.
  • Protection of data from uncontrolled distribution or misuse – restricting data sharing across research projects or exports of raw data from the shared computing environment.
  • The ability for multiple researchers to securely collaborate on a project, and for a project to analyze data from multiple sponsors in the same environment.

Inaction is not an option, unless the industry will be content with a framework imposed by others. The better option is to press forward even if the path is unclear.

“Data sharing in a multi-sponsor environment is new, so the more we do it, the more we’ll learn and ease concerns,” said a conference participant. “We need to continue to sell “the why” as we figure out “the how.” Remember, Martin Luther King didn’t have a plan, he had a dream.”

Forum attendees represented: AbbVie, Amgen, Astellas, AstraZeneca, Bayer Pharma AG, Boehringer Ingelheim, Celgene, EIi Lilly & Company, F. Hoffmann-La Roche AG, Forest Laboratories, Gilead Sciences, GlaxoSmithKline, ideaPoint Inc., Janssen R&D, Johnson & Johnson, MedImmune, Merck & Company, Novartis, Novo Nordisk, Otsuka Pharmaceutical, Paarlberg & Associates, Pfizer, Roche, Sanofi, Shire Inc., SAS, Takeda Development Center Americas, UCB Biosciences and ViiV Healthcare. Comments in this article represent a compendium of general discussion at the forum and not the opinion of any particular organization.

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