For the past several years, I have taken the time during the holiday season to reflect back on the past year by picking my 10 favorite quotes from stories I have written during the year. I often find these quotes help to illuminate some of the major trends of the period and they can be thought provoking as well. Doing this also makes me realize how many smart and inspirational people I get to interview every year. So without further ado, here is my Top 10 List for 2016, in no particular order.
1. At the 2016 PHI Protection Network Conference in Philadelphia early this year, I got to see a great talk by Meredith Phillips, chief information privacy & security officer at Henry Ford Health System in Michigan. Here is a quote from her about data breaches that stayed with me: “What I preach to our executives is that it is not about the data; it is about the people. Behind every line of data and medical record number there is a person. We do what we do because of the person, not the data. That’s what makes us passionate. When you get on the phone with patient whose information has been breached, and hear them cry, or how they feel violated, that is not a piece of data, that is a person.”
2. What would you say if you had to make an “elevator pitch” in just three to five minutes to the President of the United States about what to focus on in terms of the nation’s healthcare system? That was the question put to panelists at a Sept. 26 meeting of the National Academy of Medicine. (I bet they were not picturing a President Trump at the time!) Jonathan Perlin, M.D., chief medical officer of Hospital Corporation of America (HCA), responded: “It’s all about the data. With meaningful use, the president, if you will, has bought the car and now it is time to drive it,” said Perlin, who before joining HCA in 2006 was CEO of the Veterans Health Administration. “The president's opportunity is not to drive on a slow toll road but to realize the vision of a fast superhighway.”
3. I had a chance to interview Geisinger Health System Chief Clinical Informatics Officer Alistair Erskine, M.D., about his perception of the value of the FHIR (Fast Healthcare Interoperability Resources) standard in the realm of interoperability. He compared the concept to a vendor-neutral archive for imaging: “We’d have a vendor-neutral app store for EHRs and portals. A developer, whether they have a relationship with a vendor or not, could develop apps and use FHIR to communicate with the various databases without having to rewrite their software each time. Also, people are saying, ‘I don’t want to have to write my thing in Epic or Cerner. I want to write it in Python, PHP, or Java and use data services to attach it to the big monolithic system of record.’”
4. Another trend we have seen this year is more health systems setting up centers of innovation to encourage entrepreneurship internally and in their communities. Carla Small, director of innovation at Boston Children’s Hospital, told me that innovation is taking place all the time in hospitals, but often there is no vehicle to enable it to happen. “In our case, clinicians are innovative in pediatrics because they are having to do workarounds. Historically the enterprise of an academic medical center is not an agile environment for pushing these things out, so people get frustrated,” she said. “Institutions are starting to see success with startups, as we have. Some of our digital health initiatives have turned out to be revenue generators for the institution. Sitting on know-how and not doing anything with it just doesn’t make sense.”
5. One of my favorite interviews last year was Steven Keating, a Ph.D. candidate in the Massachusetts Institute of Technology (MIT) Media Lab and Mechanical Engineering, who was diagnosed with a baseball-sized brain tumor a few years ago. He was being treated at different hospitals for chemo, proton radiation and surgery, and the hospital EHRs were not speaking to each other. “I would do an MRI at Mount Auburn, another hospital, and if Brigham & Women’s wanted to access it, they sent me in my car with a CD to pick it up and drive back,” he said incredulously. “Even though a lot of these hospitals are using supposedly compliant systems, they are using different installed versions of Epic, so they can’t talk to each other. All these problems I came across are very logistically silly. How come we can use online banking to track all our financial information, but for hospital data, which our lives are depending on, we are still faxing things?”
6. People studying new technology trends in healthcare have mentioned that blockchain, a core component of the digital currency bitcoin, could have an important role to play in healthcare. I spoke to Micah Winkelspecht, founder and CEO of Gem, a Venice, Calif.-based startup developing blockchain application platforms. He said that what we have today is a bunch of disparate data silos. “With the blockchain, you could have a complete, full accurate history of a patient from beginning to end across multiple different systems. This becomes the interoperability model for how EMRs should work.”
7. I saw a great talk this year by Vivian Lee, Ph.D., M.D., M.B.A., senior vice president for health sciences and dean of the School of Medicine of University of Utah and CEO of University of Utah Health Care in Salt Lake City. She described how in 2012, the University of Utah became the first health system to post patient satisfaction ratings and full reviews online. She said this is part of a larger effort to use data and transparency to engage providers and push transformation forward. “We are tapping into the intrinsic motivation of physicians. They are fundamentally driven to outperform, to be the top in their class,” she said. “The best thing is that we created a patient-centered culture motivated by this intrinsic drive. It hasn’t been top down. We have engaged patients, listened to patients. They are our partners in transformation.”
8. At the 2015 Health Datapalooza, the “GetMyHealthData” initiative was launched with the idea that a concerted effort to enlist people to ask for their health data would unlock consumer demand. This year’s Health Datapalooza featured a one-year report back to the conference, and it was ominous. “We thought if we pulled on the rope, it would unravel the knots in the system,” said Christine Bechtel, coordinator of GetMyHealthData. “What we found was that when we pulled, there was an elephant sitting on the other end of the rope.” People got messages that they could have their data if they asked correctly or letters asking why they wanted it. Not a single healthcare organization was able to send data to a health app at a patient’s request. “We saw them being charged high fees that stood in the way of data access,” Bechtel said.
9. In 2015, Bray Patrick-Lake, who is director of stakeholder engagement for the Clinical Trial Transformation Initiative at Duke University and a co-chair of the working group designing the Precision Medicine Initiative at NIH, posted on Twitter a photo of her pile of paper records and disks with the title: “Here’s my worthless longitudinal health record. Patients need interoperable EHRs today.” She was asked at a panel session at this year’s Health Datapalooza if she had one wish granted, what would it be. “Send one person from an EHR vendor to jail for info blocking,” she said.
10. In a moving speech to the Health Datapalooza conference in Washington, D.C., Vice President Joe Biden tied the health data liberation movement to both the cancer moonshot effort he is charged with leading as well as his own son’s battle with cancer. “Today most cancer centers don’t have an easy way or motivation to share data. We have to change this.” He said it was extremely frustrating that his son’s imaging data couldn’t be sent from Walter Reed Hospital in Washington, D.C., to MD Anderson electronically because they were on different systems, and disks had to be sent back and forth. When the administration authorized all the HITECH funding, Biden said, “we didn’t realize five companies would create their own silos. What the heck are we doing?”