As part of the staffing efforts for the new SAS Center for Health Analytics and Insights (CHAI), SAS recently hired Dr. Graham Hughes, MD, as the company’s first Chief Medical Officer (CMO). When I heard the news, I sent a few questions to Graham to learn more about the new role and what it means for SAS customers in the healthcare field. His responses shed light on healthcare trends and explain why the changes in this industry are important to us all, not just to healthcare professionals.
The title Chief Medical Officer is unfamiliar to a lot of people. Can you describe what that position entails at an average company?
Dr. Graham Hughes: Chief Medical Officers are typically clinically and managerially experienced senior physicians who provide medical leadership within healthcare systems, hospitals and group practices. It is also a common role within HMOs and commercial payer organizations. In these organizations, the CMO is typically responsible for providing guidance and leadership to the executive management on issues related to clinical affairs and acts as a bridge between medical staff and administrative aspects of the business. The modern CMO is well respected within their organization based on their depth of experience in clinical practice and clinical affairs as well as in business management.
How does the role differ at SAS?
Graham: Within SAS, the Chief Medical Officer role has responsibility for providing clinical and managerial leadership to the Health & Life Sciences (HLS) business. However, the HLS business delivers software to support care delivery, rather than care delivery itself. The clinical guidance is on behalf of a broader “virtual” community of clinicians (represented by our customers’ clinical needs), and the relationships are being fostered across healthcare organizations rather than within one specific hospital or group practice.
It’s quite common in healthcare related companies, particularly software companies, to employ a Chief Medical Officer (sometimes also referred to as a Chief Medical Informatics Officer) to ensure that there is a consistent internal voice within the organization capable of representing physician and clinician needs.
What trends in business and health care are making this role more important to software companies today?
Graham: Healthcare costs in the United States are at an all-time high and continue to climb year after year. This isn’t a problem unique to the United States; it’s a challenge in almost every healthcare system in the world. To deliver a sustainable healthcare system, we need to tame uncontrolled costs while improving quality of care and overall health of populations.
Physicians and other clinical staff must play a key role in each of these efforts to ensure that the best interests of the patient are kept as the primary focus. Initiatives such as patient centered medical home, value based payments, bundled payments and shared savings models associated with accountable care delivery will require tremendous medical leadership if they are to succeed. Companies that provide products and services to support healthcare organizations that navigate this transformation require deep understanding of the implications to medical staff and overall clinical operations within our customer organizations.
Tell us a little about your background before coming to SAS, and how mathematics has played a role in your career.
Graham: I spent time during my medical training at King’s College in London studying how nerves grow and in particular how nerves in the brain manage to connect from one region to another. I was fortunate enough to work with a professor of neuroscience at the time who also had a background in mathematics as well as biology. He stimulated my early interest in applying mathematical and computer-based models to healthcare.
Having completed my medical training at King’s College Hospital in south London, my interest in applying technology to medicine continued to grow and within 5 or 6 years I had been offered a position at a medical software company to provide medical guidance to their product development. My earliest projects were related to Case Mix Management and Medical Audit systems, software that was inherently focused on providing improved retrospective understanding of existing practice as well as associated costs and care outcomes. I have now spent more than 20 years working full-time designing, developing and implementing advanced clinical software, with the consistent goal of improving life for the physician, the care team and the patient.
Can you give an example of where you have seen analytics offer insight or improvements in the health care field?
Graham: Anytime data is used systematically to help improve decision making in care delivery, analytics is playing a role. An example that comes to mind is from Intermountain Healthcare, where they used data to help improve decision making for induction of labor. Rates of induction of labor have been increasing nationally for both medical and non-medical reasons. There is a good deal of medical literature indicating that the increase in the rates of induction is reflected in increased rates of cesarean deliveries, preterm births and neonatal intensive care admissions.
At Intermountain, thoughtful use of analytics detected patterns in the data that would otherwise have been impossible to detect. Projections were run that modeled the costs savings that could occur should the levels of clinically unnecessary induction were reduced. The data were run by the clinical teams to ensure that they were accurate and the clinicians themselves used the data and the projections to formulate an action plan which has reduced the percentage of elective inductions prior to 39 weeks from 25 percent or so to less than 3 percent. All remaining cases have a good medical justification for early induction.
The outcome is that there are less complications to mother and baby, fewer costly interventions, including far fewer admissions to the neonatal ICU. This is an example of how analytics, combined with understanding of clinical practice can be used to control costs and improve care outcomes.
What untapped opportunities still remain for healthcare analytics?
Graham: We have only begun to scratch the surface of the ways in which analytics can improve health, healthcare delivery and reduce the costs of care. The rapid increase in adoption of electronic medical records and health information exchange technology, when combined with an ever increasing number of advanced digital devices from hospitals through to patient homes, is set to generate an explosive growth in the amount of interpretable healthcare data over the next 3-5 years. Most healthcare organizations are poorly equipped to leverage the insights that can be gained from these vast collections of patient data.
For example, we will be able to use data to better understand how to engage patients as individuals, allowing health systems and payers to design targeted incentives and education programs to improve personal health awareness and health seeking activities. We will need to better understand patterns of care to evaluate best practices, just by looking at the data we already have available. This will help reduce the reliance on prospective clinical trials as the only real way to establish evidence for best practice.
As with other industries, healthcare organizations – particularly those looking to develop accountable systems of care, with increasingly capitated payment models – will need to be able to understand and manage risk, both retrospectively and prospectively in order to set incentives at the right level and to ensure that high quality care at the lowest reasonable cost is rewarded and not penalized. From minute-to-minute care management of the neonate in the ICU, thru to understanding the big picture of our health system, analytics can play a transformational role in creating a more healthy, more prosperous nation.
How do you hope to shape the debate in order to help businesses and individuals realize the benefits of those opportunities?
Graham: In healthcare we have to be bold and humble at the same time. Bold because we need to transform our health system quickly and humble because healthcare is complex and we need to be sure that we understand the implications of our actions because patient care and well-being are at stake. At SAS, we have the same needs – to be bold in developing leading edge solutions to existing and emerging healthcare challenges and to be humble in listening to customers and patients to better understand their true priorities, concerns and needs.
My intent is to provide a clinical channel to our customers to better understand their ever evolving challenges of day-to-day operations and care delivery practices and anticipate their needs. I have confidence that if I can help to represent our customers’ needs consistently to our internal teams, that we have the raw materials and innovative spirit to make a measurable and lasting difference in healthcare.