A Person-Centered Learning Health System - Different Than You Imagine Robert M. Kolodner, MD Chief...
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A Person-Centered Learning Health System - Different Than You Imagine Robert M. Kolodner, MD Chief Health Informatics Officer Open Health Tools, Inc. Friday, 13 May 2011 Indiana Life Sciences Collaboration Conference
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A Person-Centered Learning Health System -
Different Than You Imagine
Robert M. Kolodner, MD
Chief Health Informatics Officer
Open Health Tools, Inc.
Friday, 13 May 2011
Indiana Life Sciences Collaboration Conference
Topics For My Brief Remarks
13 May 2011Person-Centered Learning Health System [Kolodner] 2
I. Disruptive Changes Are Imminent – in Health IT as Well
II. In Summary
Person-Centered Learning Health System [Kolodner] 3
The Name game
Hospital
Medical Center
Healthcare System
Health System
13 May 2011
Did anything change?
Person-Centered Learning Health System [Kolodner] 4
Healthcare Competition
13 May 2011
Person-Centered Learning Health System [Kolodner] 5
Healthcare Competition
13 May 2011
Person-Centered Learning Health System [Kolodner] 6 13 May 2011
Person-Centered Learning Health System [Kolodner] 7
Individual VariationsInnovators Laggards:
13 May 2011
http://en.wikipedia.org/wiki/File:Diffusionofideas.PNG
Indiana
Person-Centered Learning Health System [Kolodner] 8
Notable Quote – William Stead, M.D.*
13 May 2011
“Try, fail. Try, fail. Try, succeed, deploy.”
*Associate Vice Chancellor for Health Affairs & Professor of Medicine and Biomedical Informatics
Vanderbilt University
Person-Centered Learning Health System [Kolodner] 9
Person-Centered Learning Health System
13 May 2011
Person-Centered Learning Health System [Kolodner] 10 13 May 2011
The Roots of Medical Practice
13 May 2011Person-Centered Learning Health System [Kolodner] 11
1. Adapted from Perlin, Dr. Jonathan B, Healthcare 1015 & beyond: Some Thoughts on Planning Ahead, p. 95
Person-Centered Learning Health System [Kolodner] 12
Disease Industrial Complex?
13 May 2011
Person-Centered Learning Health System [Kolodner] 13
Kenneth W. Kizer, MD…
“Do we really mean ‘Veterans First’?”
13 May 2011
14
VHA Values:Framing the Vision . . .
VHA “Domains-of-Value”
Quality Access Community Health
Satisfaction Functional Status Cost-Effectiveness
Provide consistently reliable, accessible, satisfying, high-quality care which maximizes functional status, is cost-effective and fosters healthy communities . .
Challenge: To Demonstrate VALUE
Value = Access + Technical + Functional + Satisfaction + Community Health
Cost
VA Slide from 2001
Person-Centered Learning Health System [Kolodner] 15
“Do you really mean ‘Patient-Centered’?”
13 May 2011
Person-Centered Learning Health System [Kolodner] 16
Person-Centered Learning Health System
13 May 2011
Person-Centered Learning Health System [Kolodner] 17
Institute of Medicine
13 May 2011
Source: CDC Behavioral Risk Factor Surveillance System.
1998
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2006
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2006
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
18
Person-Centered Learning Health System [Kolodner] 19
And recently, IOM began “The Learning Health System Series”
13 May 2011
Person-Centered Learning Health System [Kolodner] 20
…And Being released on May 23
13 May 2011
Transforming Health & Health Care:from Treating
to Preventing to Predicting
13 May 2011Person-Centered Learning Health System [Kolodner] 21
1. Adapted from Perlin, Dr. Jonathan B, Healthcare 1015 & beyond: Some Thoughts on Planning Ahead, p. 95
Person-Centered Learning Health System [Kolodner] 22
Different Than You Imagine
13 May 2011
Person-Centered Learning Health System [Kolodner] 23
Rapid Societal Change
13 May 2011
Person-Centered Learning Health System [Kolodner] 24
Society’s Unsolvable Problem
• A product of the urban infrastructure
• Infrastructure is integral to the goods distribution system
• Exacerbated by the mass transit system• Recently implemented
• Affordable transportation
• Vital for the growth of our urban industries
13 May 2011
Person-Centered Learning Health System [Kolodner] 25
Convene the Experts
• 1st International Urban Planning Conference - 1898• Held in New York City
• Convened to address an Intractable Public Health and Sanitation Problem
• Stymied the Greatest Thinkers of that Time• Scheduled for 10 days
• Delegates ended the meeting after only 3 days!!
None of the delegates could see a solution to the impending crisis!!
Essential urban infrastructure with NO VIABLE ALTERNATIVE!!!
13 May 2011
Person-Centered Learning Health System [Kolodner] 26
The Facts – New York City
Problem had been getting steadily worse for 100 years
HORSES1880’s
• 150,000-175,000 horses; workhorse lifespan ~ 2.5 years• Each ate 1.4 tons of oats & 2.4 tons of hay per year• 3-4 Million pounds of “output” / day• 15,000 horse carcasses removed from streets
1900• Horse-drawn cabs, buses, and trolleys (faster)• >200,000 horses• 200 people killed by horses and horse-drawn vehicles each year
13 May 2011
Person-Centered Learning Health System [Kolodner] 27
The Predictions
New York City – after another 30 years• Horse “output” would reach 3rd floor of apartment
buildings
London – after another 50 years• Buried under 9 feet of horse “output”
13 May 2011
Worldwide Transformation #1 – 1898-1912
Person-Centered Learning Health System [Kolodner] 13 May 201128
Person-Centered Learning Health System [Kolodner] 29
The solutionTO THE POLLUTION
The automobile
13 May 2011
What Was the Medical Technology Adoption Challenge – a Century Ago?
Person-Centered Learning Health System [Kolodner] 31
JAMA – April 21, 1906
13 May 2011
Pp. 1172-3
Pp. 1177
Person-Centered Learning Health System [Kolodner] 32
JAMA – April 21, 1906
13 May 2011
P. 1174
Person-Centered Learning Health System [Kolodner] 33
JAMA – April 21, 1906
13 May 2011
P. 1197
Person-Centered Learning Health System [Kolodner] 34
JAMA – April 21, 1906
13 May 2011
P. 1193
Person-Centered Learning Health System [Kolodner] 35
JAMA – April 6, 1912
13 May 2011
Vol 58 (14)P. 1058
Person-Centered Learning Health System [Kolodner] 36
Why Were There No More JAMA “Auto” Articles After 1912?
…and the “Intractable” Urban Planning Problem?
• New York City status (# of years after the Conference)• 1912 - Automobile outnumbered horses (14 years)
• 1917 - Last horse-drawn streetcar stopped (19 years)
Ford Model “T”production began1 October 1908
13 May 2011
Person-Centered Learning Health System [Kolodner] 37
Unpredictable Nature of Change
13 May 2011
Person-Centered Learning Health System [Kolodner] 38 13 May 2011
IN 1994, What Impact
Did You Think the
World Wide Web
Would Have on You?
Did You Know What the Future Was Going to Look Like?
13 May 201139Person-Centered Learning Health System [Kolodner]
Person-Centered Learning Health System [Kolodner] 40
A Few Off-Target Predictions
That the automobile has practically reached the limit of its development is suggested by the fact that during the past year no improvements of a radical nature have been introduced.
- Scientific American, Jan. 2, 1909.
That is the biggest fool thing we have ever done. The bomb will never go off, and I speak as an expert in explosives.
- Admiral William Leahy. [Advice to President Truman, when asked his opinion of the atomic bomb project.]
There is no reason for any individual to have a computer in their home.
- Kenneth Olsen, president and founder of Digital Equipment Corp., 1977.
13 May 2011
Person-Centered Learning Health System [Kolodner] 41
My Shot• Individuals (persons) pick and choose health care services and providers
– from among a MUCH wider range of choices• MUCH more elf-care, drop-in clinics staffed by nurses & Physician Assts.
• Convenience, responsiveness, and perceived value as PRIMARY drivers
• Embracing “health as it gets easier
• Better care continuity among disparate providers due to HIE
• Health care providers who adapt will increase their market share
• Health care services market shifts from “provider-driven” to “person-driven”
• A few learning health systems disrupt the health care marketplace with full-service, geographically agnostic, 24x7 services.• Emphasis on self-care, facilitated care, and remote care (ANY smart device)
• Provide effective tools to individuals for self-management
• Virtual services predominate by 2025
• “Epidemic of health“ spreads13 May 2011
Person-Centered Learning Health System [Kolodner] 42
Example – Skin Lesions
• Unmet needs – diagnose and easily treat skin lesions
13 May 2011
Person-Centered Learning Health System [Kolodner] 43
Health IT Challenges
• Health/medical information – rapidly increasing, complex, incomplete• Half of what we know is wrong, but we don’t know which
half!
• Learning Health Systems change rapidly• Health IT systems will have to be able to change and
adapt rapidly, reliably, safely
• Sociotechnical problems with UNIQUE “socio”• No other industry has a service-delivery workflow that
requires its most highly trained, most expensive staff to perform the majority of the critical data entry
13 May 2011
3 Health ITDimensions
PopulationHealth
HealthCare
Delivery
PersonalHealth
Person-Centered Learning Health System [Kolodner] 45
Health IT Changes
Application Systems
• Need to converge on common infrastructure to remove wasteful
duplication without decreasing competition• Will increase innovation, competition, rate of change
• Use vendor-neutral open source platforms across competitors
• Expect increased emphasis on Personal Health solutions
Information Exchange Infrastructure
• Neutralize perverse incentives against data sharing
• Start moving data. Standardize as fast as you can AFTER
• HIEs as a shared utility across all users, not as a profit source
13 May 2011
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Key Requirement : A User Interface that Empowers Users
• A common, industrial quality User Interface (UI)
platform that is portable & scalable across multiple
devices and operating systems
• Separate from, and works with, any EHR or suite of modules
• Easy for users to configure themselves [mass self-
customization]
• Safety “guardrails” built into the UI platform
• Usability “driven” both by users and by experts
13 May 2011
Person-Centered Learning Health System [Kolodner] 47
And the Future Health System That We Will Unleash When We Have the Information
Tools We’ve Been Dreaming About?
It’s UNIMAGINABLE!!
13 May 2011
Person-Centered Learning Health System [Kolodner] 48
Notable Quote – W. Edwards Deming
“You don’t have to change; survival is not mandatory.”
13 May 2011
