One CIO’s View of the Path to Precision Medicine | David Raths | Healthcare Blogs Skip to content Skip to navigation

One CIO’s View of the Path to Precision Medicine

May 10, 2018
| Reprints
Beth Israel CIO John Halamka describes the powerful combination of patient-generated data, genomics and ‘exposome’

In a wide-ranging May 9 discussion with Health Catalyst Senior Vice President Eric Just, John Halamka, M.D., M.S., CIO at Beth Israel Deaconess Medical Center in Boston, delivered some strong opinions about the future of precision medicine and gave some concrete examples of transitions already under way at Beth Israel.

For instance, Halamka spoke about how his organization is taking advantage of the Internet of Things and mobile devices to help create and track patient care plans. He discussed a blockchain pilot project Harvard is doing with M.I.T., and he noted that the move to precision medicine is proceeding at different paces in different regions of the country just as the shift to value-based care is.

Halamka started by drawing a distinction between personalized medicine and precision medicine, two terms that often get conflated. (In fact, they often seem to be used interchangeably.) If you have a 50-year-old female patient with diabetes, personalized care would be following treatment guidelines and protocols that have shown to be effective for other 50-year-old females with diabetes. It is really more of a population health approach.

Precision medicine goes beyond that to take into account genomics, diet, immunizations and the environment — which Halamka referred to as the “exposome.” That term has been defined as the measure of all the exposures of an individual in a lifetime and how those exposures relate to health. Halamka said he foresees a continuum will develop between the population health personalization approach and precision medicine, which takes into account much more individual detail, including genomics. He used some examples from his own experience and that of his family to make the case that general guidelines about how patients respond to certain drugs, for instance, are much less valuable than a much more targeted approach aided by genomic insights.

In an example of how a patient’s own experience can be used to fine-tune care, Beth Israel has created a mobile app called BIDMC@Home to help patients manage their health from home, as directed by their physicians.

Halamka noted that it highlights several industry trends at once: patient-generated data, mobile apps and IoT devices, and new reimbursement methods. The app allows clinicians to create care plans that remind patients what they should be doing that day. “Patients help us close the loop by entering whether they took their medications and whether they are sticking to a low-sodium diet,” he said.  Beth Israel can pair that with IoT data the patient might agree to share, such as data from a digital scale or blood pressure or pulse oxometer readings. There are spirometers that plug into iPhones, he added. With the care plan and compliance combined, you can start to see the effect. “The idea is that we can gather and show you insights into your behavior and whether it is leading to better health or not,” he said. “We believe it is going to be very cost-effective to do as cost models change to value-based purchasing.” Using telehealth and putting digital scales in the homes of chronic heart failure patients is the wave of the future as new reimbursement methods take hold, he said.

Another tech trend Beth Israel is taking advantage of to help solve real-world problems is machine learning. The hospital found that 25 percent of patients were not showing up for specialist appointments. By using machine learning to predict which patients those are, it can intervene. Perhaps they lack transportation, and the hospital can arrange for an Uber pickup. In another example, it used machine learning to analyze operating room schedules and surgeon’s usage of time blocks.  “We found that just by changing the schedule of 15 surgeons, we could free up 30 percent of operating room capacity,” he said.

Halamka is interested in the potential of blockchain in healthcare, while clearly stating that it is early days. Speaking about a blockchain pilot project between Harvard and MIT, he said they are starting to work on the possibility of advanced consent management using a public ledger. You would state your consent preferences and applications could derive your consent preferences from the ledger.

Beth Israel recently announced that Halamka is leading the newly launched Health Technology Exploration Center (HTEC) to explore new and emerging technologies such as the Internet of Things, machine learning and blockchain. By fostering relationships with partners around the globe via telemedicine, BIDMC hopes the center will improve healthcare quality, advance new treatment options, and shape the delivery of patient care.

In the Q&A section of the webinar, Halamka was asked what a reasonable time frame might be for precision medicine to begin driving value: He responed by noting that different regions of the country are proceeding at different paces. “We are starting to get to elements of it on the East Coast. Why? Because our financial livelihood depends on it,” he said.  In other areas of the country, such as the Midwest, there is not the same level of data aggregation and curation. In a few areas, precision medicine may have an impact in the next year or two, he said, while in others it may be between five to 10 years from now. “Early pilots will tell us what works and what doesn’t,” he added.

Halamka noted that he was involved in a lot of the Meaningful Use regulatory work at ONC, and added that he thinks this is “not an era for more regulation.” Rather, he sees it as a time for experimentation and pilots of new tools and techniques. “I believe the next few years belong to the innovators and the private sector. I hope we don’t have more regulation in the near term.”

The Health IT Summits gather 250+ healthcare leaders in cities across the U.S. to present important new insights, collaborate on ideas, and to have a little fun - Find a Summit Near You!


/blogs/david-raths/innovation/one-cio-s-view-path-precision-medicine
/news-item/innovation/report-massachusetts-general-hospital-targeting-various-blockchain-use-cases

Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
| Reprints

Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

More From Healthcare Informatics

/news-item/innovation/medicaid-transformation-project-expands-24-health-systems

Medicaid Transformation Project Expands to 24 Health Systems

December 6, 2018
by Heather Landi, Associate Editor
| Reprints

Seven new health systems have joined the Medicaid Transformation Project, a national effort to transform healthcare and related social needs for the nearly 75 million Americans who rely on Medicaid.

In total, the project now includes 24 health systems that comprise 342 hospitals, more than 65,000 beds, in 25 states with over $121 billion in combined annual revenue.

The Medicaid Transformation Project, which was announced August 28, was formed with the vision that healthcare organizations can work collaboratively to enable better health and outcomes for vulnerable populations, while also reducing costs, through the adoption of digitally-enabled care models. The project is led by AVIA, a network of healthcare organizations committed to digital transformation, and Andy Slavitt, former Acting Administrator of the Centers for Medicare & Medicaid Services (CMS).

The project initially began with 17 health systems, with five health systems anchoring the work—Advocate Aurora Health in Chicago and Wisconsin; Baylor Scott & White Health in Dallas; Dignity Health in San Francisco; Geisinger in Danville, Pa.; and Providence St. Joseph Health in Renton, Wash.

The project worked with health systems to target four critical challenges over the next two years to better meet the needs of vulnerable, low-income populations: behavioral health, women and infant care, substance use disorder, and coordinating community care to reduce avoidable emergency department (ED) visits.

The seven new health systems joining the Medicaid Transformation Project span distinct geographic and socioeconomic markets: BayCare Health System in Clearwater, Fla.; Boston Medical Center in Boston; Cedars-Sinai in Los Angeles; Carilion Clinic in Roanoke, Va.; Children’s Hospital Colorado in Aurora, CO; Jefferson Health in Philadelphia; and University Hospitals, in Cleveland.

According to Medicaid Transformation Project leaders, underpinning this action is an acknowledgement of the current health disparities seen in communities across the country. A leading indicator of such disparity is life expectancy, which is highly correlated with ZIP code, income, and race because care delivery varies greatly based on those factors. Insufficient healthcare access, patient engagement, and social determinants create variations in life expectancy that can be as great as 16 years between communities that are just a mile or two apart. The Medicaid Transformation Project’s commitment is to close the gap in care and outcomes in communities in need through a renewed focus on innovation and investment, leaders say.

“The current healthcare delivery system needs to be disrupted to dismantle health inequities. At Jefferson Health, we believe that collaboration and creativity will drive this necessary transformation,” Stephen Klasko, president and CEO of Jefferson Health, said in a statement. “We’re joining the Medicaid Transformation Project to learn from others across the country and to find the best innovations that improve care and outcomes for the most vulnerable among us.”

The 24 participating health systems have decided to initially focus on transforming the role of the emergency department, and leaders recently convened in Chicago to discuss how to better position EDs for sustainability and care coordination.

To do this, project participants are seeking to improve linkages from the ED to other critical parts of the delivery system, namely primary care, behavioral health, specialty care, and social services and supports. The underlying goals are reducing unnecessary ED visits, reducing avoidable ED visits, and improving patient disposition and sustainable transitions at the moment of discharge, project leaders say.

“By bringing together the nation’s leading health systems, we have a unique opportunity to improve the health of underserved populations in a way that hasn’t been done before. We’re committed to sustainable, durable solutions that improve care and outcomes for people. We must consider the best existing and new ideas and invest in the right ones,” Andy Slavitt, Medicaid Transformation Project Chair, says.

At the Action Forum, Medicaid Transformation Project participants discussed care models that had shown success—but had been previously limited by barriers in labor, cost, or technology. They viewed 10 on-site demonstrations of scalable solutions and engaged directly with company founders to explore relevant care models, ranging from community health worker (CHW) programs to virtual triage. They gathered insights from one other and from leading Medicaid experts, including Molly Coye, M.D., former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, and Vikki Wachino, former Director of the Center for Medicaid and CHIP Services.

“The collaborative model of the Medicaid Transformation Project is providing us with a new and necessary lens to view a long-standing challenge, which is improving access and coordination to community care,” Thomas M. Priselac, president and CEO of Cedars-Sinai, said in a statement. “Our team is excited to share what we’ve learned working with our community partners, and to scale new digital solutions that lower long-standing barriers to care.”

The health systems in the Medicaid Transformation Project will next select scalable solutions to extend care models and begin early implementation. “These 24 health systems have put a stake in the ground around transforming the function of the Emergency Department in communities with heightened vulnerability. By acting locally and collaborating nationally, we can create a force-multiplier effect that will inspire ripples across the country. We’re honored to help lead this work,” AVIA President Linda Finkel said in a statement.

The Medicaid Transformation Project will launch its next body of work on behavioral health in January 2019.

Related Insights For: Innovation

/article/innovation/uvm-health-network-advancing-integrated-health-system-s-initiatives-through-data

At UVM Health Network, Advancing an Integrated Health System’s Initiatives through Data Governance Strategies

December 5, 2018
by Mark Hagland, Editor-in-Chief
| Reprints
At the Burlington, Vermont-based UVM Health Network, Leah Fullem is helping to lead data governance processes intended to speed the advancement of key IT strategies

The Burlington, Vermont-based University of Vermont (UVM) Health Network was created in October 2011, when what was then known as Fletcher Allen Health (now the University of Vermont Health) in Burlington, Vermont, and Central Vermont Medical Center in Berlin, Vermont, signed an affiliation agreement. Six hospitals—the University of Vermont Medical Center, Alice Hyde Medical Center, Central Vermont Medical Center, Champlain Valley Physicians Hospital, Elizabethtown Community Hospital, and Porter Medical Center—and the UVM Health Network Home Health & Hospice (formerly the Visiting Nurse Association of Chittenden and Grand Isle Counties) make up the network. As the organization’s website notes, “Working together to better serve our communities makes us stronger, focused on collaboration instead of competition. As a team, The University of Vermont Health Network improves the lives of our patients by delivering outstanding care cost-effectively, as close to patients’ homes as possible,” it adds. “The University of Vermont Health Network cares for communities on both sides of Lake Champlain, from the Adirondacks to the Green Mountains and beyond.”

Bringing together those diverse hospital facilities and healthcare services has necessitated formal data governance processes. And, in that context, Leah Fullem, vice president of enterprise information management & analytics at the UVM Health Network, reached out for consulting support to Stephanie Crabb, co-founder and principal in the Tampa, Florida-based Immersive consulting firm. Recently, Fullem and Crabb spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the journey around data governance at UVM Health Network. Below are excerpts from that interview.

Can you share with me the origins of your initiative to create a formal data governance structure at UVM Health Network?

Leah Fullem: A couple of things made this time the right time to pursue this work. The UVM Health Network—we came together several years ago, anchored by UVM Medical Center, and affiliated with community and critical access hospitals in Vermont and in northern New York. And we had some network structures in place. And a few years ago, we decided to implement a common cost accounting and financial services solution; and now we’re in the initial phases of a rollout of Epic system-wide. The medical center has been on Epic for several years now on inpatient and ambulatory; and revenue cycle components will be included in November 2019. So we’re looking at implementing common tool sets across the network, with common workflow and documentation standards.


Leah Fullem

We’re trying to improve the way in which we capture information, so that we can better work together as a network. That’s why it’s a good time to initiate enterprise-wide data governance. But we still have multiple different areas in which data are consumed, produced, and analyzed, with a lot of different ways of doing that. So we contracted with Immersive about a year ago, and then did a scan, looking at our data resources, tools, data governance and standards we had in place, and gave us a nice set of recommendations and a roadmap.

What were the biggest gaps you found?

Our story is not uncommon; we found that we had multiple areas where we were duplicating effort; analysts in the finance area and quality area, or multiple different areas, were writing different queries with different parameters, across the same subject areas, for reports. And they were using different metrics to calculate from. So we had data silos, which meant that data analyst teams being directed by different supervisors, weren’t able to partner with each other. So there were a lot of knowledge gaps; we had a huge amount of analyst talent, but we weren’t able to leverage the talent we have. We have SQL servers, many other forms of storage, of data; and the Epic rollout will include an enterprise-wide data platform that we’ll implement over the course of the next year, and that will allow us to make sure we’re on common platforms with common platforms.

Stephanie Crabb: One unusual thing about UVM is that UVM has had incredible executive support and sponsorship around data for a long time. Dr. John Brumstead, the current CEO, was the network CMO and chief quality officer; so he’s an individual who’s always been very bullish and visionary around the use of data and information.  And he himself had taken the first pass at implementing data governance when he was the CMO. So it’s really important—we talk a lot about executive sponsorship in data governance, and about whether it’s really there, whether it’s real. And one success factor at UVM was the fact that Dr. Brumstead was a stalwart supporter and leader. And he put forth from the very first meeting that failure was not an option. So he really set the tone, and was open to creative ideas, and was focused on putting ideas into action. That’s how Leah’s position was created.


Stephanie Crabb

What have been the biggest lessons learned so far in all of this?

Fullem: I’m still early on in my involvement in all this; I’ve been in this position six weeks so far, but much work has already been done. We’ve set up a network-wide data governance council with broad representation across business functions and institutions; created a network-wide data governance policy; we’ve begun a project on provider dictionaries/better data management processes; and we’ve been focusing on data governance, stewardship, and moving forward with a new structure. When Dr. Brumstead first started talking about instituting data governance, there was no locus of authority for participating in data governance or collaboration efforts; now, that’s here.

And in the first six weeks of my job, I’ve been going around speaking with as many people as possible in Vermont and northern New York. And we’re talking about the way people access data, and what tools analysts might be using. So I had expected some pushback, but overwhelmingly, people across this network have been enthusiastic and supportive of this, which was surprising. The commonality is someone saying, “I had something that I thought was easy, but it wasn’t, and no one could get back to me in a timely way, and I had to wait six months, and by then, it wasn’t relevant to me.” And we’re moving heavily into population health and care management, so there’s a great deal of interest.

The biggest lesson we’re learning in process is that this is a cultural change more than anything. Yes, data is involved. I report up to the chief population health and quality officer. This is a cultural change. We will improve access to data, improve the quality and accessibility of data and information, to allow us to make better decisions on behalf of our patients and people. We have people who still only trust the data given to them by their analysts, or data they’ve extracted themselves. And yet there are conflicting numbers all over the place. So creating trust, to open people up to changing the way people receive or experience data, through new ways of looking at the information, involves a huge change effort.t So above all, I need change agents.

Crabb: Lessons learned from our point of view through the work—to augment the change piece—have been several. One thing that UVM has done very well is that they didn’t just do an assessment and roll forward with a roadmap; they were really honest about their strategic, tactical, and cultural readiness. And I applaud Leah up and down, because she has a really tough job, it’s an ambitious agenda. But in the first year of their preparation, they’ve been really attentive, have set the right objectives, have taken the best of what they’ve learned and are trying to apply that very tactically. Second, they’ve focused on the people and organizational structure piece. One of our recommendations to them was, don’t through a bunch of tools at this; if you don’t have the people and processes and organizational structure that make sense, it won’t help. Creating Leah’s position as a network organizational position, that was a huge demonstration of good faith and commitment. Not only did they say they wanted Leah, they agreed to a leadership team of eight or nine positions in her office that she’s currently fulfilling, positions in data management that are needed.

So, the lesson is, not just giving lip service to it, but putting skin in the game and following through. And this 25-person-plus data governance council that started meeting in February of this year, was incredibly important. It was incredibly well constructed, with critical business functions. That team has rallied from day one, and has gotten an incredible amount of work done in five short meetings. And the charter they created for themselves, and coupled with creating a good operating environment to carry out the mission, are two very important things, and indications of the seriousness with which they’ve taken this.

What would your advice be to CIOs and CMIOs who will be facing similar data and IT governance situations and challenges?

Fullem: This is common advice, but we need to make sure that we’re meeting the needs of our clinicians, our finance departments, our operational leaders, since data is the key to making good decisions. All of this has to be done in a way that we make technology available to our users in ways that are easy to use and access, with the right information security principles, to move forward as a business.

Crabb: That our data land information leaders are important partners to our CIOs and CMIOs. This initiative originated out of IT, was led by Dr. Doug Gentile, our CIO. But the goals far exceeded the boundaries where IT is drawn in that organization today. And it wasn’t a tug of war of any kind; it was a natural extension of work that was incubated in IT. It’s been a healthy, symbiotic relationship that was first incubated in IT, and allowed to fly, understanding that data as an asset deserves its own center of excellence, just as IT is a center of excellence.

 


See more on Innovation

betebet sohbet hattı betebet bahis siteleringsbahis