A Shot in the Arm - Jason Burke on Health and Life Sciences

We are preparing to enter an incredible time for health information.  In a matter of a few years and barring further political infighting, a tremendous amount of money is being planned to enter our healthcare ecosystem (for a breakdown of the spending, see the Unpacking ARRA article over on the Healthcare Blog).  That's a good thing for both the industry and the economy, and many would argue it is overdue.  But as I look at the commentary in the industry right now, I see a coming replay of the 1990s in pharmaceutical R&D.

For those that did not participate in the glory days of electronic data capture (EDC), here is a brief recap.  For the history of the industry, pharmaceutical research data collection had been done using paper forms.  With the proliferation of personal computing and the subsequent consumerization of technology, everyone wanted to move to collect information electronically, saving time in data entry and quality by including data checks at the time of entry.  The bandwagon got going, check books came out, and industry strategists and pundits all started talking about the huge transformation coming in pharmaceutical development.  But by the year 2000, the first and second generation solutions were largely dead, and the industry had not broadly taken up these technologies.  Why?  Because everyone got so caught up in the financial opportunities and hype that they never stopped to ask two fundamental questions:

• Would this technology help medical practitioners do their day jobs?  Whoops, no, it actually gets in the way because it is designed for pharmaceutical companies, not medical practitioners.  Actually, it was a huge burden on the sites.

• Would this technology improve outcomes?  Whoops, no again, because no medical practitioner is going to use drug company software in the middle of seeing a patient.  They will key it in later, having copied it now on multiple pieces of paper and introducing additional data quality problems.

Is this bolus of health IT investment bringing us to this same scenario in healthcare?  Everyone is going crazy talking about electronic medical records, and the focus seems to be on getting as many EMRs deployed as far and as fast as possible.  I hope our industry leaders are taking a page from history and asking the right questions:

• Would this technology help medical practitioners do their day jobs?  It sounds good in theory.  I can tell you my primary care physician has been using an EMR and other connected electronic data systems, and sees value in it.  I can also tell you I've walked the halls of one of the top pediatric oncology wards in the US, and computers of any kind are the very last thing on the nurses' minds.

• Would this technology improve patient outcomes?  Again, theory sounds good.  My primary care physician loves having more information at his fingertips – reference materials, timely results access, etc.  But those oncology nurses?  They talk about a lot of other issues they see impacting the patient experience and outcomes: nursing coverage, inconsistent procedures, continuous interruptions of treatment-related activities, etc.

Pharmaceutical companies learned three lessons the hard way:

1.  If you bring technology to an inefficient process but don't change the process, you simply make it more expensive, not better.

2.  It is possible for technology to dramatically reduce the time and effort it takes to collect bad data; you can get it in near real time.

3.  The cost challenges were not in the paper; they were (and still are) in finding the right patients, therapeutic candidates, and predictors of safety and efficacy.

So what would make me feel better?  For starters, lets stop talking about systems, and start talking about behaviors.  How can technology be used to drive the right behaviors – better decisions, predictable outcomes, manageable costs?  Sure, EMRs are required, but if you had all that patient data collected in your giant EMR database, exactly what are you going to do with it?  The answer to that question should have a considerable impact on what you might do in implementing your EMRs.

Lets also put interoperability into the right context.  As pharmaceutical firms have learned, you can create great solutions for sharing data, and the information still not be useful.  For example, if data is sitting in an EMR as an unstructured block of free text, your ability to get to better decisions and predictable outcomes will be considerably constrained.  Thankfully, we do have more mature interoperability standards today that can help us along the way.  But interoperability should not just be about pushing data across systems -- it should be about facilitating medical insight across stakeholders.

In the end, we need to make sure our investments really are aligned to the needs of patients.  28,270 is a little less than half of the money spent every second in the US for healthcare.  It's about half the number of people that die of cancer every month in the US.  It's about a third of the number of Americans that die every year of Alzheimers disease.  Same for diabetes.  It is a fraction of the estimated US deaths every year due to medical errors, and about a third of what those deaths cost us every minute.  In the midst of the coming change, let's make sure we are investing in analytical insights and change programs, and not just more data.