CITIH keynote presentation.

1. The Future of Medical
Informatics: Follow the “W t
I f ti F ll th “Watsons”
”
CITIH 2011 National Summit OSU Medical Center
Columbus, OH April 18, 2011
Presented by:
y
Michael L. Millenson
The Mervin Shalowitz, MD Visiting Scholar
Kellogg School of Management &
President, Health Quality Advisors, LLC
mm@healthqualityadvisors.com
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2. The Challenge of Transformation
“Science and
Technology
revolutionize our Clinical Economic
lives, but memory,
tradition and myth
frame our
f
response.”
Cultural
--Arthur
--Arthur Schlesinger, Jr.
Jr
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3. The Difference Between
Revolution and Reform
“A reform is a correction of abuses.
A revolution i a t
l ti is transfer of power.”
f f ”
--Edward
--Edward George Earle Bulwer-Lytton
g Bulwer- y
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4. From Autonomy (Lucas Marsh*)…
“To the average human his
body is
b d i a great and sacred
t d d
mystery. And the man who
knows the riddle of that
mystery is a god. That's
what we are – gods. And
the thing that holds us
together as a group is our
realization of this.”
– Not As a Stranger (1954)
*Idealistic hero of best-selling novel and movie, being spoken to
by a cynical colleague
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5. …to Accountability (Clay Marsh*)
Marsh )
“[Personalized medicine is] the process of the
rapid creation of systems and technologies that
deliver better health outcomes at lower costs and
personalize care and empower users in a
sustainable way ”
way.
*Real-life idealistic director of the Center for Personalized
Health Care at The Ohio State University Medical Center
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6. The Yellow Brick Road to
InfoMedicine
(Follow the Watsons)
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7. Information to Improve Expert
Decisions
“The widespread use [of computers]...in
The
hospitals and physicians' offices will
instantaneously give a doctor or a nurse a
patient's entire medical history, eliminating both
guesswork and bad recollection, and sometimes
making a diff
ki difference b t
between lif and d th ”
life d death.”
--Thomas
--Thomas Watson, Jr., Chairman of IBM (1965)
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8. “Data for You, Doctor”
“Modern communications systems…with their limitless
potential for storage, retrieval and transmission, bring without
our grasp such benefits as a nationwide clearinghouse of
medical records and case histories, available to every
physician at the dial of a number or the touch of a button.” –
Boisfeuillet Jones, Dept. of HEW, 1962
“A doctor considering a patient's diagnosis could
use…technology…to rapidly consider all the related texts,
reference materials, prior cases, and latest knowledge in
j
journals and medical literature….This could help medical
p
professionals confidently determine the most likely diagnosis
and treatment options.” – IBM press release on its Watson
“Deep Question Answering” computer 2011
Deep Answering computer,
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9. Information to Improve All
Stakeholder Decisions
A value-based [health-care] system is grounded in
value- [health-
three simple principles:
1. Value for patients
2.
2 Care organized around conditions and cycles
3. Results measured
Michael Porter & Elizabeth Olmsted Teisberg Harvard
Teisberg,
Business School, Redefining Health Care (2007)
“In God we trust. All others bring data.”
--W.
--W. Edwards Deming, c. 1951
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10. Information Experts Share with
“Non-E
“Non
“N -Experts”
t ”
“The physician-patient partnership is…an
The physician-
intense collaboration between patient and
physician...[that is] informed by both the
medical facts and the physician's experience.”
--Timothy Quill
--Timothy Quill, MD and Howard Brody MD
Brody,
Annals of Internal Medicine
Dr. (John) Watson reads the news to
Sherlock Holmes in The Five Orange Pips
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11. Stage 1 Meaningful Use
“Data f Doctor, P ti t and System”
“D t for D t Patient dS t ”
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12. New Dimensions of Clinical
Information
I f ti
BIOMARKERS
J
Diagnosis
• Presence of disease or
identifying at-risk patients
at-
Staging of disease (severity)
Prognosis of disease (metastases)
Stratification of patients
• Responders/non-responders
Responders/non-
Monitoring/predicting toxicity
Monitoring therapeutic effect or
pharmacodynamic effect
James Watson c. 1957
Watson, c
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13. Clinical Information “Off the Grid
Off Grid”
Thomas A. Watson, co-
inventor of the telephone
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14. Patient-
Patient-Generated Information:
Algorithms, AI
Algorithms AI, DNA and “crowdsourcing”
crowdsourcing
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15. Sometimes Shared Information?
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16. The Age of InfoMedicine
Clinical information to improve expert decisions
p p
Clinical and economic information given to other
stakeholders to influence expert decisions
Clinical information shared with patients
New dimensions of clinical information
Patient-
Patient-generated information shared with
experts (and not)
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17. A New Information Ecosystem
Industrial Age
g Information Age
g
Info was: Info is:
Scarce Abundant
Expensive Cheap
Institutionally oriented Personally oriented
P ll i t d
Designed for Designed for
consumption participation
Source: Pew Internet Project
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18. Participatory Medicine
“A movement in which networked patients shift
A
from being mere passengers to responsible
drivers of their health, and in which providers
encourage and value them as full partners.” –
Society for Participatory Medicine
“Physicians hold dim view of patients gathering
information on their own. Negative
consequences included more explaining and
unneeded interventions.” – FIMDM, 2008
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19. Over-
Over-Participatory Medicine
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20. “Everyone clear on your role???
Ingredients: Data availability,
g y
accessibility, comparability,
storability, usability and relevance
Source: Wagner Care Model
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21. Personalized, Predictive, Preemptive
(Guess Who and What is Missing?)
Source: Cortese, Clin Pharm &Ther 2007
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22. “Measure to Manage”
Patients Face a New Paradigm
Source: www.consumer-care.org
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23. “Doc, I’ve got back pain
Doc, I ve pain”
Source: Luckmann and Vidal, J Biomed Inf 2010
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24. New Expectations, New Rules
p ,
“Who measures, matters”
Consumer-driven/consumer-
Consumer-driven/consumer-centric quality
measures
Peer assessment
Payer-
Payer-driven measures
Regulators, accreditors, lawyers, entrepreneurs
“Power shifts”
Physician-
Physician-patient partnering: “new
new
professionalism”
Hospital-
Hospital-physician partnering: “a capital idea”
Analytics l
A l ti elevated and valued
t d d l d
Teamwork trumps individualism 23
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25. The Impact
“What’s sauce for the goose…”
• Clinical and financial accountability intertwine
• Employers/plans told to put money where mouth is
• Consumer autonomy encounters consumer
accountability
“Why can’t we all be friends?”
• Arguments about measures as granularity increases
• Arguments about roles
• Arg ments abo t mone
Arguments about money
Traditional health system organization collapses
“Disruptive innovation” is disruptive
Disruptive innovation
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26. The Promise and the Peril
“As a result of the information revolution, the
magic, mystery and power of the p
g , y y p profession
may be somewhat diminished, [but it] will
create unanticipated opportunities for
physicians to bolster the cognitive and moral
pillars of their professional identities.” – David
Blumenthal,
Blumenthal MD (2002)
“Technology is so much fun but we can drown in
our technology. The fog of information can drive
out knowledge.” – Daniel Boorstin
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27. As for the future
future,
your task is not to
foresee,
foresee but to
enable it.
it.
– Antoine de Saint
Exupery