The Future of MedicalInformatics: Follow the “W tI f    ti    F ll   th “Watsons”                               ” CITIH 20...
The Challenge of Transformation“Science andTechnologyrevolutionize our               Clinical                  Economicliv...
The Difference Between        Revolution and Reform“A reform is a correction of abuses. A revolution i a t       l ti is t...
From Autonomy (Lucas Marsh*)…                                     “To the average human his                               ...
…to Accountability (Clay Marsh*)                          Marsh )“[Personalized medicine is] the process of therapid creat...
The Yellow Brick Road to     InfoMedicine   (Follow the Watsons)                                     5       Health Qualit...
Information to Improve Expert           Decisions“The widespread use [of computers]...in Thehospitals and physicians offic...
“Data for You, Doctor”“Modern communications systems…with their limitlesspotential for storage, retrieval and transmission...
Information to Improve All      Stakeholder Decisions A value-based [health-care] system is grounded in   value-       [he...
Information Experts Share with“Non-E“Non“N -Experts”           t ”“The physician-patient partnership is…an The physician-i...
Stage 1 Meaningful Use“Data f Doctor, P ti t and System”“D t for D t    Patient  dS t    ”                                ...
New Dimensions of Clinical                Information                I f    tiBIOMARKERS                                  ...
Clinical Information “Off the Grid                      Off     Grid”                                          Thomas A. W...
Patient-Patient-Generated Information:Algorithms, AIAlgorithms AI, DNA and “crowdsourcing”                        crowdsou...
Sometimes Shared Information?                                       14         Health Quality Advisors LLC
The Age of InfoMedicineClinical information to improve expert decisions                          p       pClinical and eco...
A New Information EcosystemIndustrial Age            g                                     Information Age                ...
Participatory Medicine“A movement in which networked patients shift Afrom being mere passengers to responsibledrivers of t...
Over-Over-Participatory Medicine                                      18        Health Quality Advisors LLC
“Everyone clear on your role???                 Ingredients: Data availability,                   g                       ...
Personalized, Predictive, Preemptive(Guess Who and What is Missing?)   Source: Cortese, Clin Pharm &Ther 2007             ...
“Measure to Manage”            Patients Face a New ParadigmSource: www.consumer-care.org                                  ...
“Doc, I’ve got back pain        Doc, I ve          pain”Source: Luckmann and Vidal, J Biomed Inf 2010                     ...
New Expectations, New Rules      p         , “Who measures, matters”   Consumer-driven/consumer-   Consumer-driven/consume...
The Impact“What’s sauce for the goose…”• Clinical and financial accountability intertwine• Employers/plans told to put mon...
The Promise and the Peril“As a result of the information revolution, themagic, mystery and power of the p    g , y        ...
As for the future            future,your task is not toforesee,foresee but toenable it.        it.– Antoine de SaintExupery
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Osu informatics citih keynote 4 18-11

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  1. 1. The Future of MedicalInformatics: Follow the “W tI 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 0 Health Quality Advisors LLC
  2. 2. The Challenge of Transformation“Science andTechnologyrevolutionize our Clinical Economiclives, but memory,tradition and mythframe ourfresponse.” Cultural--Arthur--Arthur Schlesinger, Jr. Jr 1 Health Quality Advisors LLC
  3. 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 2 Health Quality Advisors LLC
  4. 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. Thats 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 3 Health Quality Advisors LLC
  5. 5. …to Accountability (Clay Marsh*) Marsh )“[Personalized medicine is] the process of therapid creation of systems and technologies thatdeliver better health outcomes at lower costs andpersonalize care and empower users in asustainable way ” way. *Real-life idealistic director of the Center for Personalized Health Care at The Ohio State University Medical Center 4 Health Quality Advisors LLC
  6. 6. The Yellow Brick Road to InfoMedicine (Follow the Watsons) 5 Health Quality Advisors LLC
  7. 7. Information to Improve Expert Decisions“The widespread use [of computers]...in Thehospitals and physicians offices willinstantaneously give a doctor or a nurse apatients entire medical history, eliminating bothguesswork and bad recollection, and sometimesmaking a diff ki difference b t between lif and d th ” life d death.”--Thomas--Thomas Watson, Jr., Chairman of IBM (1965) 6 Health Quality Advisors LLC
  8. 8. “Data for You, Doctor”“Modern communications systems…with their limitlesspotential for storage, retrieval and transmission, bring withoutour grasp such benefits as a nationwide clearinghouse ofmedical records and case histories, available to everyphysician at the dial of a number or the touch of a button.” –Boisfeuillet Jones, Dept. of HEW, 1962“A doctor considering a patients diagnosis coulduse…technology…to rapidly consider all the related texts,reference materials, prior cases, and latest knowledge injjournals and medical literature….This could help medical pprofessionals confidently determine the most likely diagnosisand treatment options.” – IBM press release on its Watson“Deep Question Answering” computer 2011 Deep Answering computer, 7 Health Quality Advisors LLC
  9. 9. Information to Improve All Stakeholder Decisions A value-based [health-care] system is grounded in value- [health-three simple principles:1. Value for patients2.2 Care organized around conditions and cycles3. 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 8 Health Quality Advisors LLC
  10. 10. Information Experts Share with“Non-E“Non“N -Experts” t ”“The physician-patient partnership is…an The physician-intense collaboration between patient andphysician...[that is] informed by both themedical facts and the physicians 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 9 Health Quality Advisors LLC
  11. 11. Stage 1 Meaningful Use“Data f Doctor, P ti t and System”“D t for D t Patient dS t ” 10 Health Quality Advisors LLC
  12. 12. New Dimensions of Clinical Information I f tiBIOMARKERS 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 11 Health Quality Advisors LLC
  13. 13. Clinical Information “Off the Grid Off Grid” Thomas A. Watson, co- inventor of the telephone 12 Health Quality Advisors LLC
  14. 14. Patient-Patient-Generated Information:Algorithms, AIAlgorithms AI, DNA and “crowdsourcing” crowdsourcing 13 Health Quality Advisors LLC
  15. 15. Sometimes Shared Information? 14 Health Quality Advisors LLC
  16. 16. The Age of InfoMedicineClinical information to improve expert decisions p pClinical and economic information given to otherstakeholders to influence expert decisionsClinical information shared with patientsNew dimensions of clinical informationPatient-Patient-generated information shared withexperts (and not) 15 Health Quality Advisors LLC
  17. 17. A New Information EcosystemIndustrial Age g Information Age gInfo was: Info is:Scarce AbundantExpensive CheapInstitutionally oriented Personally oriented P ll i t dDesigned for Designed forconsumption participationSource: Pew Internet Project 16 Health Quality Advisors LLC
  18. 18. Participatory Medicine“A movement in which networked patients shift Afrom being mere passengers to responsibledrivers of their health, and in which providersencourage and value them as full partners.” –Society for Participatory Medicine“Physicians hold dim view of patients gatheringinformation on their own. Negativeconsequences included more explaining andunneeded interventions.” – FIMDM, 2008 17 Health Quality Advisors LLC
  19. 19. Over-Over-Participatory Medicine 18 Health Quality Advisors LLC
  20. 20. “Everyone clear on your role??? Ingredients: Data availability, g y accessibility, comparability, storability, usability and relevanceSource: Wagner Care Model 19 Health Quality Advisors LLC
  21. 21. Personalized, Predictive, Preemptive(Guess Who and What is Missing?) Source: Cortese, Clin Pharm &Ther 2007 20 Health Quality Advisors LLC
  22. 22. “Measure to Manage” Patients Face a New ParadigmSource: www.consumer-care.org 21 Health Quality Advisors LLC
  23. 23. “Doc, I’ve got back pain Doc, I ve pain”Source: Luckmann and Vidal, J Biomed Inf 2010 22 Health Quality Advisors LLC
  24. 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 Health Quality Advisors LLC
  25. 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 moneyTraditional health system organization collapses “Disruptive innovation” is disruptive Disruptive innovation 24 Health Quality Advisors LLC
  26. 26. The Promise and the Peril“As a result of the information revolution, themagic, mystery and power of the p g , y y p professionmay be somewhat diminished, [but it] willcreate unanticipated opportunities forphysicians to bolster the cognitive and moralpillars of their professional identities.” – DavidBlumenthal,Blumenthal MD (2002)“Technology is so much fun but we can drown inour technology. The fog of information can driveout knowledge.” – Daniel Boorstin 25 Health Quality Advisors LLC
  27. 27. As for the future future,your task is not toforesee,foresee but toenable it. it.– Antoine de SaintExupery

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